Pursuant to our promise to go through as many portions of the recently signed national health bill as possible (Kindly refer to the first volume of this commentary HERE:– we will go through some more pressing sections; clerk its dictates, biopsy the motives of its sponsors and review the histopathological result with a view to internalizing how it affects our day to day existence and practice as medical practitioners.

Part1 (Nos 2-10) summarily deals with the establishment and functions of the National Tertiary Health Institutions Standards Committee, National council on Health as well as its technical committee and other related parastatals and offices. I just hope that:

Part 1, No 11 statutorily creates the Basic Healthcare Provision Fund which will be a Federal Government Annual Grant of not less than one percent of its Consolidated Revenue Fund as well as funds from international donor sources and unspecified 'other' sources.

 

Many people in the know have cried out repeatedly that WHO and the World Bank recommend a minimum budgetary allocation of 15% for the health sector, but I'm afraid their voices have been mistaken for auditory hallucinations or worse still, the irritating buzz of tinnitus. A few words on any online search bar will reveal how far behind we are in this respect compared to the countries the people who signed this policy into law run to on health tourism. Well, as my Yoruba 'goons' would say, "Oro o pariwo"...

 

One commendable thing that section does while it elucidates how the money will be disbursed is that it also specifies situations in which money will not be disbursed to underperforming local governments, for example. I sincerely hope these measures will be properly adhered to. While all eyes are usually on the executive as our prime suspects once issues of corruption are raised, you will be surprised how much goes down (all puns however farfetched, strongly intended) – at the state and local government levels. While it is simply naïve to assume we can bring these things down to ground zero, let us at least try to hold people accountable for all their actions and punish all those found guilty by capable courts.

 

Part II, no 17 subsection 2 says something I fear we need to remind ourselves as health practitioners and administrators. It goes thus:

'If a health establishment is not capable of providing the necessary treatment or care, the Health establishment in question shall refer the user concerned to an appropriate health

Establishment which is capable of providing the necessary treatment or care (in such manner or such terms as may be prescribed by regulation'

 

It is high time we stop this condemnable habit of holding on to patients longer than necessary especially in the private health sector. As an intern, I lost count of times I was on call while in my medicine rotation that we had no new admissions till late in the night. It always stunned us while clerking these patients to learn that virtually all of them were on admission in some private hospital which allegedly assures them that all was under control till late in the night when it turns out that...well...nothing was really under control. The BP suddenly starts rising like the dollar to naira ratio; the blood sugar refuses to settle down gentlemanly like our petrol prices. Suddenly the lucid interval wears off and the head injured patient that seemed miraculously unharmed begins to deteriorate like a very steep dive from a gargantuan waterfall. Suddenly someone somewhere sees a need to refer.

By the time such critically ill patient gets to places where appropriate specialist care can be rendered, it is most often too little too late.

 

'The best doctor is the one who knows his limits'

Well I have put it out there...I hope this helps someone somewhere. Only then will I die satisfied that I did not stifle the truth when its entreating frail arms beckoned me to speak.

No 18 of this same bill goes on to encourage public private partnerships. I strongly believe this is long overdue. In my little years of practice I have worked at both ends and marveled at how a little coordinated partnership between the neighborhood private hospital and the established general hospital would go a long way in creating a win-win situation for everyone. It reminds me of our popular primary school meal song of how 'some have food and cannot eat, while some can eat but have no food'

Some institutions are literally burdened by a highly trained specialist workforce but lack the enabling environment or equipment while some that have the latter lack the workforce or the-wait for it- patients!

 

We will stop here for now. Kindly drop comments and clarifications below as we take a break from these mental rants, and yes, kindly do share so every party involved will know that someone, somewhere is watching.

 

Ciao!

Dr Adebola Oluwaseyi