•Greater commitment required from FG — Dr Osahon Enabulele

•Presidency must initiate comprehensive reforms — Pharm Olumide Akintayo

By Chioma Obinna

After 63 years of independence, Nigeria is still grappling with basic health services challenges such as out-of-pocket payment, non-functional PHCs, and poor health budgets among others.

Certainly, Nigeria’s healthcare is not where it should be at 63. What exactly should the President Bola Tinubu administration do to revive and reposition the health sector? In this interview, the President of the World Medical Association, WMA, Dr Osahon Enabulele, and former president of the Pharmaceutical Society of Nigeria, PSN, Pharm Olumide Akintayo examine the fortunes of the nation’s health sector at 63, while procuring a way forward.   Excerpts:

Presidency should show greater commitment, lead by example — President, World Medical Association, WMA, Dr Osahon Enabulele

As Nigeria marks its 63rd Independence Anniversary, the President of the World Medical Association, WMA, Dr Osahon Enabulele has traced the country’s backwardness in healthcare to poor political commitment and unsatisfactory coverage level of the National Health Insurance Scheme.

Enabulele in a chat said some less endowed countries, including Rwanda, have since gone past these challenges with over 90 per cent Universal Health Coverage, UHC, and a health budget that surpasses the minimum agreed in the 2001 Abuja declaration.

 “It is sad that most Nigerians still make out-of-pocket payments for health care services because of poor political commitment and the unsatisfactory coverage level of the National Health Insurance Scheme.

“At 63, Nigeria’s health care system should be at a level where Nigerians, irrespective of their geographical location, can have ready access to quality and affordable healthcare services driven by an adequate number of well-motivated, skilled, safe and secured health workforce.

“At 63, Nigeria’s healthcare system ought to be a destination point for medical tourists rather than what we still see in terms of unceasing medical tourism and migration of medical doctors and other healthcare professionals to other climes.

“At 63, Nigeria’s healthcare system ought to be able to guarantee safe and decent working conditions for physicians and other health professionals who are daily toiling to keep the hapless citizens of Nigeria alive.

“At 63, Nigeria ought not to be experiencing the unceasing kidnapping of physicians and other health care professionals in the course of exercising their sacred responsibilities. I am not so sure if I would want to go through this yearly sermon because governments in and out do not seem to adhere to progressive recommendations.

My experience as a delegate to the 2014 National Conference reinforces my conviction. How many of the laudable recommendations we made have seen the light of the day? So, a lot depends on the political commitment and sincerity of the leaders of the day. “I would say that what the Tinubu government should be doing is dusting up all previous progressive recommendations for improving Nigeria’s healthcare system.”

Continuing, he said the Government should show greater political commitment to health and lead by example.

Osahon said one way the government can lead by example was to implement Section 46 of the National Health Act which seeks to restrict the use of tax payer’s resources to fund unnecessary foreign medical travel without the approval of a medical board. The WMA President added that the Government should improve funding for health to a minimum of the prescribed 15 per cent of the National budget.

“Importantly, the Government needs to move at a faster pace to significantly improve universal access to healthcare in Nigeria with guaranteed financial risk protection schemes.

“The Government should ensure Nigeria’s health personnel have safe, decent and enabling working conditions. The Government should put in place competitive wages for physicians and other health professionals as part of measures to retain them in their fatherland.”

Presidency must initiate comprehensive sector reforms, change appointment tactics — Pharm Olumide Akintayo, former PSN President

In his own response, former president of the Pharmaceutical Society of Nigeria, PSN, Pharm Olumide Akintayo said the Tinubu administration to embrace community pharmacy-based while making the health Ministries, Departments and Agencies, MDAs, accountable.

“Today, the global trend is to embrace community pharmacy-based value pharmacy-based gives the patient a substantial say in the totality of his care plan. In budgetary terms, the Federal government needs to make MDAs in health which are rated the most corrupt by ICPC very accountable.

“The Physician CEOs have oftentimes adopted this very way of life. In terms of new levels, President Tinubu must go into the history books as the first Nigerian leader who will wholeheartedly implement the Basic National Healthcare Provision Fund which is the equivalent of 1 per cent of the Consolidated Revenue Consolidated.

“If Tinubu manages this well through appropriate appointments in the health sector then we will witness new beginnings in NHIA, PHC, and the supply chain of essential drugs and vaccines.

Akintayo said the quest for Universal Health Coverage remains a ruse because the tool to drive it is not working in our clime.

“In 2023 both the Federal and State Governments desire successful social health insurance programmes by enlisting only physicians and hospitals to cater for health services which of course will always be the situation.

“In a similar spirit, we don’t run a broad spectrum PHC system. For our PHC philosophy to thrive we must rejig it holistically by tapping into the potential of Community-based health professions by focusing on their high cross-mobility or is its proximity to the grassroots which makes them the preferred option for healthcare in the roots which accounts for over 80 per cent of our population.

Akintayo argued that the global trend is to embrace community pharmacy based value pharmacy-based gives the patient a substantial say in the totality of his care plan.

“Permit me to say here that Mr President needs at the minimum, an Honorary Adviser on Pharmaceuticals and Drug Distribution reforms to harness the immense potential of that unique sector of the health sector.   I observed that the President’s delegation, at least those invited to the investment drive to India a few weeks ago was dominated to the extent of 45 per cent by Pharma manufacturers and players.

“In this era of hi-tech, our healthcare should be technologically driven with an emphasis on the management of human and material resources by seasoned administrators and managers of cognate experience.”

He recalled that the Nigerian health system once attracted the Royal family which sought care provisioning at UCH, Ibadan, at that time rated as one of the top five facilities in the entire Commonwealth and that hospital governors led the healthcare system, freeing health professionals from routine administrative tasks.

This allowed them to focus on their areas of competence, leading to positive outcomes and a potential reverse of negative health indices.“Unfortunately,  some of our CEOs are professionals who have lost focus and ruined the Drug Revolving Fund schemes apart from other acts of monumental corruption. That is why the issue of privileges and benefit packages is a major part of this entropy we contend with in the health sector.

“Moving forward, the Tinubu Presidency must change tactics with regard to the spirit of appointments in the health sector for gainful output. There is no doubt that we need comprehensive reforms in healthcare to keep pace with the rest of the organised world in Nigeria.

“The horizon is tough with unprecedented hardships but sometimes I reckon today’s bitter pills may give way to soothing balms that can ameliorate our tomorrow if people in high places show a lot more convincing disciplinary propensities.”

Akintayo noted that President Tinubu appointed two physicians to the FMOH and also added a Physician-Special Adviser on Health, a move that he described as typical of previous administrations. He remarked that the health sector appears unprofitable under current circumstances and that with seven more physicians in the Federal Executive Council, it would be difficult to make decisions.

Akintayo commended the current Health Minister, Prof Ali Pate for starting well by initiating consultations with major stakeholders and expressed optimism that his global exposure would bring some relief in the days ahead.