Posted on: Tue 11-08-2015

For over two decades, the nation’s Health sector has been embroiled in one turmoil or the other. From the dwindling Public funds which have left the sector bereft of the required investment to make it up to date with the level of scientific and technological development in the global healthcare delivery. The over- stretching of infrastructures at the various centers, and now assuming a menace level is the interdisciplinary crisis which has consistently brought the sector to its knees lately.  All these and more have contributed to the problems of massive brain-drain in the sector, poor service delivery and consequently promotion of quackery. Successive Governments have attempted to solve this myriad of problems and much as they tried the problem will simply not go! The foregoing therefore is the basis for the comparison with the Gordian knot legend. It was reported then, that Alexander the Great chose to slash the cord when he did not have the patience of painstakingly removing the strands that make up the intricate knot in order to expose the loose ends and achieve the status of a king!

The health sector especially as seen in the last two years has proven to be such an intricate knot with regards to the labor relations among the various professional groups therein, so serious has it been that the time when Public health facilities were fully operational with the full complement of all the professional groups was barely 50% in the two years. It was a case of one group coming up with a set of  demands in a dispute, these are resolved, the resolution is then used as the basis of yet another dispute by  the next  group and the cycle continues… leading to a paralysis of the sector during the period of dispute. The same squabbles were responsible for the tortuous journey of the National Health bill in the National Assembly for about three sessions before it was almost hurriedly signed into law in the twilight of the last administration, leaving the implementation in the current limbo which no one knows when it is going to be resolved.

It is smarting from this observation of the sector, that the alleged existence of a proposed Document containing the health agenda and restructuring plans of the present Government   triggers a Red flag reaction. It may appear to be in the realm of speculation yet, but with the benefit of hindsight, such allegations are not totally unfounded as there is no smoke without fire according to the generally held notion in Nigeria. While waiting for the unveiling of the Government’s   policy thrust in the sector, it should be impressed on everyone that there is no shying away from the fact that a more robust Private participation may be unavoidable in the sector and to that extent the idea is most welcomed. However, the manner of entry into the system is critical and this should be well thought out before flinging the doors opened for such participation. For instance, from the experience of the previous exercises in other sectors, the Private players have not shown superiority in their service delivery as against their state run predecessors, with the exception of perhaps the Telecommunication sector. While the nation can afford to go through the learning curve in other sectors, coping as it were with the attendant hitches experienced. The health sector cannot be subjected to such vagaries; this is due to the dire consequence that may result from the slightest infraction both in terms of the losses (including that of lives) and capacity for social upheavals! Therefore the current structures should be retooled in such a way that they will become less acrimonious, while the Private players should be given the right incentives to build their own structures, independent of those already existing from the public purse. This arrangement should be allowed to subsist until such a time when they(private players) will be strong enough  not only to stand on their own, but would have creditably discharge themselves as being capable of handling the system solely, by this time the Government can then divest itself completely from  playing in the sector. The reason for this transition is to position these players first  for the already existing market of Nigerian medical tourists to other countries, this will serve to conserve  the much needed FOREX for other developmental purposes while the Tourists spend less for the same services, then other high end clients can also make use of these services, thus guaranteeing the return on the Private investment, they can then take up more middle level clients, thus increasing access to care by a large segment of the society while  at the same time build the indigenous capacity of the Nigerian Professionals.

The coming of these players also presupposes that there is a regulatory framework to ensure value for the money spent to access care and the investors are protected from unfair competition occasioned by the present state of regulatory activities. As a matter of fact, I do not see any reputable foreign investor in the Health sector come in with funds with the parlous state of regulation in the system and this should serve as a guide in the selection of the so called investors, in order not to bring some inexperienced players who just see the whole venture as an avenue to increase their business portfolio without the cognate experience. An example of the attitude of the foreign investors to regulation is in the Pharmaceutical sector, where between the mid 80s and early 90s when there was distortion to the regulatory framework, most of the Multinationals in the sector left the Country in one fell -swoop!

It should be clear by now, that, while the country needs the inflow of fresh investment into the sector, utmost care ought to be taken in order not to create more problems than what it is aimed to resolve which the Alexandrian option may cause. The government ought to remember that the health sector is not just another sector of the economy that can be allowed to falter then stand afterwards, but instead, it is one that the entire essence of governance, (which is to see to the welfare of the citizenry) revolves round. And as such any private player being brought must be like the proverbial god, who his worshippers insist should either improve on their current status in life, or otherwise leave them as they are, without further depreciation. This must guide in the selection of the path to be taken in revamping our already   decrepit health sector to the extent that only those with the capacity and capability to add value to the sector are invited for private participation.

Femi Awotunde

[email protected]

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