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Tuesday, October 7, 2014

Nigeria at 54 (Healthcare and How it Should Be)


WHILE one appreciates the fact that since Nigeria got independence in 1960 from her colonial Godfathers there have been noticeable improvements in some pre-independence health indices (particularly with respect to health infrastructure, availability of Health Human Resource and training institutions for medical doctors/dentists and Allied Health Professionals), one is constrained to state that these developments notwithstanding, Nigeria is still sadly contending with most of the basic problems identified during the pre-colonial and immediate post-colonial periods.
Truly, aside from recent successes in the containment of the Ebola Virus Disease as well as publicized improvements in some health indices like Infant and Maternal Mortality Rates, Nigeria's health care system is still largely deficient with Government at all levels yet to decisively address most of the basic challenges confronting the health sector, such as:
Poor and decadent state of health infrastructure, and equipment; The Federal Government's promise in 2013 to institute a Health and Hospital Development Intervention Fund (HHDIF) as well as establish six regional world class hospitals have remained mere rhetorics.
At 54, Nigeria's health care system is still being undermined by the poor political commitment to health and the health care needs of Nigerians, by Nigeria's top political and public office holders.
The health sector is also still blighted by poor budgeting for health at Federal, State and Local Government levels. This has not been helped by the absence of constitutional justiciable health rights for Nigerians and the frequent recourse to foreign medical care by Nigeria's top political and public office holders, a situation that has led to the burgeoning phenomenon of outbound Medical Tourism with the attendant huge capital flight of over $800million to other countries.
At 54, Nigeria is yet to enact a National Health Act while Universal Health Coverage in Nigeria is still hovering around a miserable seven per cent coverage, far lower than rates seen in other less endowed countries like Rwanda, Tanzania and Ghana.
At 54, Nigeria is yet to witness massive investments in health research, particularly Public Health Research and other areas of operational research. The Ebola pandemic and the glaring absence of proactive research efforts (by African countries, including Nigeria) to develop a preventive vaccine or a drug cure for Ebola Virus Disease since its first outbreak in 1976, is a clear testimony of the poor priority for health research. The rential and reactionary states of most African economies is also manifested in the health sector, with an almost perennial wait on the developed countries of the world to develop solutions for largely African problems.
At 54, there remain huge deficits in health human resource. Professionalism, best practices, job description, job roles and team play under the universal leadership and co-ordination of the medical doctor/dentist (Clinical Team Leader) seem to have taken a flight from Nigeria's public hospitals, with attendant negative consequences on Inter-Professional Relationships and effective service delivery. This is further complicated by the unwieldy and unproductive number of Health Regulatory Councils and Boards in the health sector with some having conflicting professional regulatory laws/Acts which have led to some of the worst inter-professional crises/conflicts in Nigeria's health sector;
Similarly, poor capacity building of the available health human resource, uncompetitive wages, unsatisfactory working conditions, as well as inequitable distribution of the health workforce have affected the smooth, effective and efficient delivering of healthcare services at all levels.
At 54, Nigeria's health sector is still replete with failed agreements occasioned by Government's non-observance and implementation of agreements freely entered into with her employees and Associations in the health sector. This, in most cases, has led to series of avoidable strike actions in Nigeria's health sector.
At 54, Nigeria's health sector is still heavily challenged by the Poor state of security in the country, including the security and safety of healthcare workers particularly in their workplaces; Worsening mass poverty in Nigeria with attendant negative impact on the utilization of healthcare services on account of poor financial access; Increasing incidence of unethical practices and quackery in the health sector with lots of quacks impersonating medical doctors/dentists and causing untold harm to innocent Nigerians;
At 54, Nigeria still has weak and poorly integrated Primary and Secondary levels of care and a weak referral system, all of which largely contribute to the suffocation of the nation's existing tertiary health institutions with large crowds of patients, burn out of the few available medical doctors/dentists and other health professionals, and ultimate decline in productivity and efficient health service delivery.
After 54 years of independence, Nigeria still has a largely chaotic drug procurement and distribution system. There is reckless and indiscriminate advertisement of unproven and uncertified herbal and medicinal products on the electronic and print media; Prescription laws are hardly enforced with virtually every Nigerian and indeed health care worker indulging in illegal prescribing of prescription-only drugs, contrary to the provisions of the extant laws which categorically state that only Medical doctors/Dentists and Veterinary doctors have the right to prescribe medicines. The non-enforcement of Nigeria's prescription/drug laws have resulted in some untoward consequences, including unfortunate deaths of some innocent citizens.
Of course, the Poor development of some health-related infrastructure such as power and energy, roads/transportation system, potable water, housing and security, have also tended to blight the expected progress of Nigeria's health sector.
While the challenges befuddling Nigeria's health sector at 54 may seem daunting, I remain optimistic that Nigeria's health sector can still be positively repositioned if the following are given serious consideration and implementation:
1) Sincere and improved commitment by Nigeria's political and public office holders (at all levels) to good governance, participatory and committed political leadership (the type that was recently displayed in the containment of Ebola Virus Disease imported into Nigeria by late Patrick Sawyer);
2) Institution of constitutional provisions that guarantee Nigerians justiciable health rights;
3) Enactment of a National Health Act through the expected Presidential assent to the National Health Bill passed by the National Assembly;
4) Improved Universal Health Coverage backed by Community Health Insurance Schemes and the enactment of a National Health Insurance Commission Act (the bill of which has been passed by the National Assembly).
It is my expectation that the well celebrated Presidential declaration at the March 10, 2014 Presidential Summit on Universal Health Coverage held in the State House, Abuja, will not go the way of other declarations such as the 2001 Abuja declaration of African Heads of State on a 15% minimum budgetary allocation to the health sector.
5) Insulation of the health sector from the vagaries and bureaucracies of the civil service through the creation of a separate Commission for the health sector;
6) Urgent development of a manual by the Federal Ministry of Health containing the detailed job descriptions and expectations of the various health professionals and workers in the heath sector (particularly Nigeria's public hospitals), coupled with the altruistic and constructive disposition of all health professionals with a quick return to professionalism and best practices;
7) Improved sectoral allocation to health by all tiers of government laced with effective performance monitoring and evaluation;
8) Improvement in other health related infrastructure;
9) Imposition of stiffer penalties for quacks and impostors.
10) Enforcement of all existing legislations, including all Prescription and Drug laws in Nigeria.
*Dr. Osahon Enabulele is the Vice President (WAR), Commonwealth Medical Association;Immediate Past President, Nigerian Medical Association.

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