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Sunday, September 22, 2013

Reviving Healthcare

Professor Amos Gadzama is the  immediate past  President,  Medical and Dental Consultants’ Association of Nigeria (MDCAN) and a consultant chemical pathologist at the University of Maiduguri. In this interview by Sade Oguntola, he explains challenges before a virile health system and how to ensure health becomes the right of all Nigerians among other issues. Excerpts:
Medical tourism is an issue in Nigeria and how can it be stopped?
Before now, the health care system worked as a system where the primary health care did the work and did it properly; the secondary healthcare took over from where the primary health care stopped to advance care to the next level. Then the tertiary health care concluded whatever was left. But with the disjointed nature of the health system, this had contributed to the problem of medical tourism.
Ensuring appropriate links between the tiers of the health care level was part of the reason for the 2103 Biennial Delegates meeting and Scientific Conference of the  Medical and Dental Consultants’ Association of Nigeria (MDCAN). It was a meeting to see how we can revive the primary healthcare and secondary health care levels as well as improve on the tertiary health care.
The problems of the secondary and primary health care levels are very simple and known to almost everyone. This had to do with attitude. In those climes that we compare ourselves, is their attitude to work like it is here? This is not so. Our attitude to work has to change.
Also, the issue of funding is equally important. If you tell somebody that you have given a certain amount of money for a job, do you ensure that this money is spent for that job? Do you come back to check if the right thing was done with the right amount? We are committed to ensuring efficient and effective healthcare. People in other professions talk about whistle blowers, why can’t we in the medical profession blow whistle on health centres to ensure that the right things are done and at the right time?
If you remember, we held our meeting in Asaba and all medical doctors agreed that we would stop things like industrial strike that does not allow us to achieve good health care services, which is our goal. But if others in the health sector use strike as a means of intimidating the government and the government falls for that intimidation, then we have no option than to use the method available, which is acceptable to ensure that the health care delivery system moves to the next level.
 MDCAN as an association intends to ensure that the trend of medical tourism does not move away from Nigeria. The train of medical tourism is constantly in motion.
It is a train that nobody, not even the superpowers can be able to stop. It is a trend that if you are determined, if there are adequate plans, and doing the needful, its direction moves towards Nigeria instead of moving out to other countries such as India, Dubai, Germany and so on.

A big challenge currently  on is that new doctors find it difficult getting a place for their one-year housemanship training. What is the way out?
The way forward is to be realistic about the issue. Having a human resource development plan is very important. How many people do we need to be trained? How many people do we need to render services, research and so on? Vacancies would now be created based on such data. A situation where there is no feedback to the varsities that train medical students from the employers of their product does not help. So we have to ensure that there is a feedback from the market on how many doctors they need and the feedback is what the universities will use to create vacant admission and training.

Does it mean we are producing too many doctors that we do not need, considering Nigeria’s population?
We need to use principles that people that got it right used. It is not, however, that Nigeria is producing too many medical doctors for its population. But the fact remains that the number of nurses, doctors and other health professionals that we need must be calculated rather than just spending energy on training.
On the issue of house officers, these are new doctors under training, we must be able to know how many spaces are required and the number to train to meet our domestic consumption.  But a situation where such calculations are not done, where there are no feedback mechanism to the university where they are being produced and the primary and secondary health care facilities are not functional, this pool of house officers will continue to increase.
Of course, this is one of the issues why the primary and secondary health care levels should be made functional to ensure that the health care delivery in Nigeria is optimised. Also, the health budget has to take into consideration what we need.

The National Health Bill when passed will be central to Nigerians accessing good health and as well as ensure a reduction in out-of pocket spending, what  is your take on this bill?
The National Health Bill is a framework that every other issue in the health sector is supposed to build on  and what is holding it back is that certain things must be put in place before the bill could be passed. The National Assembly  is working  on this already to ensure that Nigerians get the health care they deserve through this bill. But they should, however, be encouraged to ensure that the bill is in like manner to that which operates in other climates so that we can attain health care delivery that is globally acceptable.
On the National Health Insurance Scheme (NHIS), the position of MDCAN is that the scheme should be universal in every sense. If you are a Nigerian, there is a basic minimum package which is meant for you. We are looking forward in the shortest period to see that every Nigerian gets at least this minimum package from the scheme. But in doing this, the sources of the funding has to be that a particular percentage, maybe two per cent of the consolidated revenue fund should be given to the National Health Insurance. Also, it should not be a Federal Government’s project, but rather a project at all state and local governments should become part of in terms of funding. A specific percentage of what comes into the state and local governments should be put into the provision of health care.
 There should be a synergy among on the tiers of governance  in terms of health care. A situation where we are talking about eradication of polio in one place and the other do not take it as a disease that should be given attention to is not right. Of course, the disease that is eradicated in one region will find its way to other regions and as such we will never get out of that problem.
So, we should find a way whereby the consolidated revenue account can be assessed for health care so that basic minimum health care package should be given to Nigerians because health is wealth.

But is health really a right in Nigeria?
It is a global saying that it is our right. You have a right to live and you cannot live if you are not healthy. So you can now see that health is our right.

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