By Dickson Omobola

President of the National Postgraduate Medical College of Nigeria, Professor Akinsanya Osibogun, has warned that the sin theory of disease is a challenge to the delivery of modern healthcare services in Nigeria.

Osibogun, who regretted that the commercialisation of faith has led religious leaders to deny sick patients the treatment that could help them, said if not nipped in the bud, it poses serious health implications for patients.

Speaking at the Medical Guild Lagos 2023 Scientific Conference, themed: ‘Optimising Health Services for Nigerians in the 21ST Century,’ he, however, said advancing the health of Nigerians would require intersectoral collaboration between private organisations and government.

He explained that government bureaucracy and inefficiencies make quality delivery of services difficult, adding that the future of quality delivery of services is largely in private provision and government regulation of services.

He said: “Without belittling the role of faith in our well-being, I dare say that the commercialization of faith has led many quack pastors to deny many sick patients the treatment that could have helped them. The sin theory of disease poses a great challenge to the delivery of modern healthcare services.

“We should note that the use of incantations, counter-spells, bloodletting, trephining, scarifications etc are continuing practices in many communities even in Nigeria with serious implications including loss of critical appropriate intervention time, introduction of agents of sepsis and outright haemorrhaging and death. From all accounts it would appear that the earliest medicine men were sorcerers, magicians and spiritualists with some of their descendants persisting till today.”

On the challenges of health care delivery in Nigeria, he said: “A main challenge to the delivery of quality health services in Nigeria remains the level of financing and the inefficient use of resources. Total Health expenditure per capita in Nigeria is a meager of $97 compared to roughly $4,000 in Europe and $8,500 in the United States. General analysis of global data shows that the more a country spends on health per capita, the better the health outcomes.

“Our fund pooling mechanisms are currently weak and inadequate. Up to 70% of our current total Health Expenditure is from Out of Pocket. In general, from global data, the more prominent OOP is in a countrys health financing mechanism, the poorer the health outcome. Third, even with our low level of health expenditure, we are inefficient spenders with our health outcomes being worse than those of a country like Senegal spending less than half of what we are spending.”

On advancing the health of Nigerians in the 21st Century, he said: “From our national experience, government bureaucracy and inefficiencies make quality delivery of services often difficult. The future of quality delivery of services is largely in private provision and government regulation of services.

“Financing availability will require investments in health infrastructure, equipment, pharmaceutics and consumables as well the pre-service and in-service development of human capital. Availability addresses the Supply side of the problem.

“To address the demand side of the problem and ensure that citizens have access to needed health services, then we must look for fair financing mechanisms, particularly those that protect citizens against catastrophic expenditure for health. Catastrophic expenditure for health sends individuals, families and communities into spiraling poverty.

“If we are ever going to lift our people out of poverty, we must address their health and access to health services. A mechanism that can help in achieving this must be fair in fund pooling and health risk sharing. Either a general tax mechanism or a dedicated tax mechanism in the form of mandatory health insurance can be a fair fund pooling mechanism.

“Whichever of the two pooling mechanisms is adopted, our next concern will be the quality delivery of health services. In my opinion, the best fund disbursement mechanism to promote quality delivery of healthy services will be a pay-for-performance mechanism in which providers are paid on the basis of both quantity and quality of services provided.

Advancing the health of Nigerians in the 21st Century will require intersectoral collaboration addressing the social determinants of health in addition to ensuring a resilient and sustainable health system which itself must be designed to make health care available, accessible, of high quality and relevant to the health needs of Nigerians. If we fail to address the issues of availability, accessibility, quality and relevance, then we will fail in advancing the health of Nigerians. However, we can not afford to fail if we want history to judge us fairly.”