By Professor Friday E. Okonofua
A National Hospital is so-called because it portrays the health images of a country. It is and should be a mirror through which the health care delivery system of any country is seen.
The name should not be given just for fancy, but rather it should be justified in its pre-eminence in the country, its ability to do what other hospitals are unable to do, and its ability to deliver composite health services that address the health care needs in the entire country.
Thus, such a hospital will be the ultimate referral hospital that can handle complex medical conditions that cannot be managed at the lower cadres of the health care delivery system. Although it is difficult to envisage a hospital that will effectively manage all health conditions known to human-kind, a national hospital should have dedicated expertise to handle in some of the most daunting health challenges in the country or communities where the hospital operates, such that those conditions can be substantively managed and treated in the hospital.
This will obviate the need to refer diseases that are prevalent in the country to other parts of the world where a National Hospital exists for treatment.
Throughout the developed world and increasingly in the developing world, there are hospitals that function as National Hospitals. Although for ethical and professional reasons, it is not usual practice to designate hospitals as essentially used by certain categories of persons, it is certain that many countries make specific efforts to provide high level support, facilities and resources to designated hospitals that would ensure that their highly valued populations, especially those in government and policymaking that are essential to their strategic development, receive treatment within the country rather than outside.
There are security implications when high ranking officials of priority countries are allowed to leave their countries to receive medical treatment outside their domains. Such countries not only lose their prestige and strategic importance, they actually allow others to see their weakness and vulnerabilities, which could relegate their ratings in economic and political spheres of influence.
Furthermore, healthcare is now a major source of economic revival for many countries, with countries such as India accumulating massive economic growth and development as a result of their investment in health tourism. When a country sends its most valued personnel to other countries for medical treatment, such a country cannot be relied on to receive high-profile clients in exchange from other countries. Indeed, nobody including internal and external stakeholders would trust the healthcare delivery system of that country. The result would be a huge external migration of financial resources for health from such a country to other countries, without a concomitant effort to gain positive external economic inflow to balance the scale in terms of economic growth.
Such is the situation with Nigeria today, that unless we make specific efforts to identify and develop specific hospitals where we can concentrate high quality personnel and facilities, we will continue to lose a lot in terms of our economic recovery efforts. The National Hospital has the potential to stand as the epicenter of Nigeria’s health care delivery, which could be transformed into a monumental edifice that will stem the propensity for well positioned officials to seek medical treatment outside the country.
Many of our citizens often talk about the need for Nigeria to reduce medical tourism outside the country. But, unfortunately, no one, to the best of my knowledge, has taken specific steps to develop an institution to the highest professional standards that will prevent external migration of persons and, indeed, stimulate migration of people seeking health care from other countries.
Primary versus tertiary healthcare
Some people have used the argument that Nigeria should focus on primary health care rather than tertiary health care in efforts to achieve universal health coverage and ensure equity and social equilibrium in the provision of health, as a reason for not potentiating high level tertiary health care. While it is true that primary health care is critical as a principal component in Nigeria’s current experience of the burden of disease, it is equally important that secondary and tertiary health care cannot be ignored. The emerging epidemiological transition in disease occurrence suggests that Nigeria is now a harbinger of diseases of poverty as well as those diseases of affluence that occur in the developed world. Therefore, it is important that the country takes critical measures to ensure the practice of universal health coverage that includes the provision of healthcare for citizens with all forms of diseases.
Indeed, as I am also an adherent of primary health care myself, I would encourage the country to prioritize its practice. But unless we also consolidate the delivery of secondary and tertiary health care, it would mean that those who emerge from the throes of primary health care will be constrained to incomplete health care which would reduce the access to health care for vulnerable citizens.
To the chagrin of the current national health recovery efforts is the stark realization that even the primary health care that every talks about is not well delivered in the country. No doubt there are policies on primary health care at all levels of government in the country, but the extent to which the policies are implemented has been less than coordinated or effective. I believe that the argument on prioritization of primary health care over tertiary health care provision is an argument that is laced with heterodoxy, and is an excuse not to do anything for health care.
Unless all components and divisions of the health care system are consolidated with each given their individual legitimacy and pre-eminence with mapping of specific pathways of development, it is unlikely that this country will enjoy the full benefits of health care delivery that citizens so badly deserve.
It is relevant to ask how the National Hospital has fared in its 20 years of existence. No doubt the hospital has grown in leaps and bounds to become one of the largest and most solicited hospitals in Nigeria. The National Hospital remains the only federal tertiary hospital in Abuja, making it a prime institution that requires the attention of all stakeholders.
Specifically, from its humble beginning with only 250 beds, the hospital now has 404 beds, making it one of the largest tertiary medical institutions in the country. The hospital also now has the full complements of units that enable it to function as a comprehensive hospital that meets the needs of various all categories of clients.
The hospital is organized around four Directorates – Clinical Services, Administration, Finance and Accounts, and Maintenance, each with adequate staff and services that complement each other. The Directorate of Clinical Services has 20 Clinical Departments and 1,600 medical and other related personnel. Clearly, the hospital must be one of the most highly staffed hospitals in the country.
The hospital is administered based on the committee system. The National Hospital has nine Revolving Fund Committees that enable it provide sustainable services in areas such as drug use, laboratory services, radiology, dental services, in-vitro fertilization, labour and delivery services, theatre use, general consumables and services related to trauma. In a country where hospitals are characterized by lack of drugs and consumables, the use of the revolving fund system by the hospital is commendable.
With the new focus on quality delivery of clinical services both nationally and internationally, it is heart-warming that the hospital has various committees that monitor its services and regularly train staff in the use of modern methods of provision of health care. Some of such committees hosted by the hospital include the Quality Assurance Committee, the Research and Ethics Committee, Infection Control Committee and Training and Continuing Education Committee. Such committees enable the hospital to obtain information and feedback on its services.
- T o be continued
- Okonofua, Vice-Chancellor, University of Medical Sciences, Ondo delivered this paper at the 20th anniversary of the National Hospital, Abuja.