By Ifeanyi Okowa
Let me begin by welcoming all of you to this year’s Annual General Meeting of the National Association of Resident Doctors.
Coming against the backdrop of the COVID-19 pandemic, it is my considered view that this meeting offers us a good opportunity to review the ongoing national efforts to combat the epidemic as well as assess our readiness to respond appropriately to future public health emergencies.
I believe we can turn this crisis into an opportunity to bolster our health infrastructure, expand capacity and upgrade manpower in the health sector in such a way that our healthcare system will be better poised to deal with future outbreaks.
There are two major takeaways for me from the COVID-19 pandemic as it relates to Nigeria. The first is the necessity of having in place a national policy document on responding and managing unforeseen public health crisis. The absence of such a framework, as well as the novel nature of the coronavirus, posed a major drawback in articulating a coordinated response at the initial stage of the pandemic in the country.
Testing was a huge problem because of the shortage of human resources, testing kits, laboratories, and case definition for testing that prioritizes symptomatic cases and their contacts. The whole country only attained a daily testing capacity of 2,500 samples late in July, which is a far cry from what it should be for a country our size.
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Testing was not only extremely low; it took days before the results could be known. Confronted with a fast-spreading disease like COVID-19, the delay meant the virus could spread unchecked as it hindered early contact tracing.
Here in Delta, samples had to be taken to the Irrua Specialist Teaching Hospital in Edo State, which served the entire South-South geo-political region of the country. The wait was excruciating and exerted immense physical/mental toll on critical health personnel who had to be making frequent trips to Irrua in Edo State.
Subsequently, we were able to enter an arrangement with Irrua Specialist Teaching Hospital in partnership with Pan African Network for Disease Outbreak Research and Rapid Response (PANDORA) to establish a molecular mobile laboratory in Delta. Since then we have conducted 0ver 9,000 tests in the State while confirmed cases are 1,799 as of Friday, September 18.
More importantly, as result of the improved testing and transmission of results, we have been able to achieve 99% contact tracing. Commendably also, there has been corresponding increase in testing at the national level as more laboratories were opened and some private hospitals were licensed to conduct tests in Lagos, the epicentre of the pandemic.
My second takeaway is that post COVID-19, there is a compelling need to adopt and implement a viable and sustainable healthcare financing programme for all States in the country. Each State is primarily responsible for the financing and implementation of its healthcare system.
A healthcare financing programme that is focused on up-scaling primary health care services, enhancement of human-resource-for-health capacity, deployment of a technology-enhanced healthcare services delivery process and improved access to measurable quality healthcare services outcome for all, is imperative.
With an abysmal 0.5 per cent of its GDP in public health spending, Nigeria has one of the lowest public healthcare financing globally. This figure is lower than the regional average (2.4 per cent) but, even more importantly, it is below the expected average for countries in the same income group.
Consequently, our public health institutions are reeling under the pressure of underfunding, inadequate manpower, shortage of equipment and population explosion.
A viable and sustainable healthcare financing programme ensures adequate preventive and baseline curative healthcare service for all. Considering the current fiscal constraints, a review of the Second National Health Strategic Development Plan is necessary to enhance practicality of its operationalization for better health outcomes.
We need a sustainable framework that provides the financial modelling and enabling opportunity for adequate human capacity, infrastructure, commodities and financial resources management, while ensuring that all healthcare facilities can provide round the clock services with capacity to respond quickly to routine healthcare services as well as public health emergencies/outbreaks.
Here in Delta, we established four well-equipped case treatment and management centres for COVID-19 patients at the Center for Communicable Diseases and Research at the Federal Medical Centre, Asaba Specialist Hospital, Delta State University Teaching Hospital, Oghara, and Central Hospital Warri.
The Government also set up 11 holding facilities across the State at General Hospital, Okwe; General Hospital, OgwashiUku; Central Hospital, Ughelli; Central Hospital, Warri; General Hospital, Bomadi; Central Hospital, Sapele; Central Hospital, Kwale; General Hospital, Ekpan; Central Hospital, Oleh; General Hospital, Agbor; and Eku Baptist Hospital.
Although 34 States and the Federal Capital Territory have passed the law for the implementation of Universal Health Coverage, it is fair to say that capital inadequacy is at the core of the low level of implementation across board. As a long-time advocate for Universal Health Coverage, it is my submission that we redouble our efforts and pursue this scheme with renewed vigour.
A situation where less than 5% of the 191 million (World Bank 2017) Nigerians are currently covered under the National Health Insurance Scheme is unacceptable.
The implication of this is that over 180 million persons have little or no protection from the financial hardship resulting from healthcare service.
In Delta State, we developed a strategic implementation plan focused on clear deliverables that are in line with the provisions of the Basic Healthcare Provision Fund component of the National Health Act. Similarly, the Guidelines of the National Health Insurance Scheme were aligned to the prevailing peculiarities of the Delta State healthcare service system.
As the frontrunner in the implementation of this scheme, I am proud to inform this gathering that Delta State Government has accredited 405 health facilities comprising 268 Primary Health Care Centers, 66 Secondary Health care Facilities, 65 Private Health Care Facilities, 1 Federal Medical Center, 3 Abuja Health Care Facilities and 2 Lagos Health Care Facilities to operate the scheme. Total number of enrollees is currently 788,740. We can be proud of the progress we have made even though there is still much work to be done.
It is also imperative that our healthcare service interventions be “patient-centred.” Outcomes, not inputs, are the true measure of quality healthcare. As the Keynote Speaker at the National Health Summit, which held in Abuja in November last year, I posed the following questions:
“When it comes to Patient-Centred Care in Nigeria, many questions are begging for answers. Are we prepared as a nation and as healthcare providers to embrace this transformational approach to healthcare delivery? Is the human resource available and adequate for this system of care? How accessible and affordable is healthcare to our growing population, most of who fall below the poverty line?
What is the percentage of Nigerians still paying out-of-pocket for healthcare? Is the healthcare provider warm or welcoming? Do the health staff inspire trust and confidence in the ability of the health establishments to deliver quality healthcare leading to patient’s satisfaction?”
Bottom line is, we must start to consciously measure outcomes as part of our healthcare delivery process because that is surest way to revamp a floundering healthcare system. It ensures that our resources, which are scarce and finite, are judiciously deployed for the benefit of the patient.
I am glad to announce that this administration has agreed to fund 80% of the training requirements enshrined in the Residency Training Act (2017) as agreed with NARD and DELSUTH. It is my earnest expectation that you will reciprocate this gesture with renewed vigour and commitment to your duties.
In concluding this address, I salute our medical doctors and healthcare providers for their courage, commitment, and determination to combat the COVID-19 pandemic. Nigeria has survived this and previous public health emergencies/outbreaks due to the sacrifice, dedication, ingenuity, and resourcefulness of our healthcare providers.
Regrettably, many of them got infected during this pandemic while some, sadly, paid the supreme price.
Okowa, a medical doctor, is the Governor of Delta State. This article is adapted from his speech at the Annual General Meeting of the National Association of Resident Doctors, at Delta State University Teaching Hospital, Oghara, Delta State.