Privatization is a partial or complete transfer of ownership from government to private individualts, largely for economic reasons. However,it may come with improvement in efficiency and service delivery due to dearth of unnecessary government and political intervention. The opponents of privatisation though base their argument against this on the fact that the idea of privatization is capitalistic and would lead to unemploymemt, inequalities as well as widen the gap between the rich and the poor.

 

Health care delivery is among the concurrent list just like Education, Agriculture and Roads. Constitutionally its duty bound for all tiers of government to provide quality health care to its teeming populations. The Federal Government of Nigeria controls almost all the tertiary hospitals and referal centers in Nigeria and of course is the major employer of specialists in healthcare. For example the number of doctors in University College Hospital Ibanda is about five times the number of those under the employment of the Oyo state government. Furthermore, the number of consultants in UCH is also more than the number of all consultants under employment of all the south-western states put together.

 

This scenario is replicated in virtually all the geopolitical zones in the country and allows each and every Nigerian full access to healthcare specialist in different areas of medicine.

 

In the United Kingdom, health care is delivered via National Health System which is funded by the UK government through taxation from personal income tax,company incom tax and VAT. It ensures free access to quality care to all UK residents irrespective of your sex, race, social status, sexual orientation or religious belief. In Nigeria, we have NHIS but its limited to federal government employee only.

 

In United state of America, they have the medicare and medicaid while Germany, France and even south Africa, the biggest expenditure on health is shouldered by the government. These are countries with more sophisticated healthcare system equiped with latest gadget yet their government didnot privatize the whole system. At least,the system allows a common man to access quality care at no or little fee.

 

The question then is: why then would Nigeria want to be different?

 

In Nigeria, apart from the patients refered from secondary centers on account of difficult-to-manage-cases who have to sell properties before coming to the hospital, only the elite afford most of such services. Majority of poor patients die in the general hospitals, primary care centers and at home. The major barrier to patronising such bigger centers is finance. If not for the NHIS, many civil servants most likely would not be able to afford the tertiary health services in Nigeria. Therefore,there is wisdom in subsidy in the health sector.

 

If this happens then what would be the fate of internship/housemanship, CMEs and some hospital-based courses like Nursing, Midwifery, Health Information Management and many more under the privatization programme. Should the house officers, pharmacist interns, medical laboratory scientist and radiagraphers interns be paid? Or would they in turn be asked to pay for practical experience or they are going to be considered as clinical attachee with no financial obligation. What will be the fate of residency training and the resident doctors?

 

Another question that kept swirling around in my mind was "which salary structure is going to be adopted for the staff under the provitization regime" Is it CONHESS with skipping, is it CONMESS with relativity and skipping or a different salary structure. Can the system afford the huge salary of all the health workers including administrative staff or would the staff strengths be reduced like what happened in the aftermath of the NITEL and PHCN privatization exercise.

 

How much are patients going to be charged to raise money to pay salaries and make profit as well.

 

Another area that is still not clear to me is issue of consultants working in teaching hospitals who are primarily university emloyees. If the teaching hospitals are privatised, how are they going to be paid? Will they still be generating income for a private individuals and at the end of the month receive peanut as salary or would it be negotiable? Will their primary employers (Universities) agree to release their emplyees to be permanently stationed at a private centers and yet their salaries and promotion come from them. In the current arrangement, graduates of residency training can pursue a career in academics and rise to become a professor while working as an honourary consultant in a teaching hospital.

 

I can not forget to ask myself about the fate of medical students undertaking clinicals postings in the teaching hospitals.Teaching hospitals are primarily established to train undergraduate medical students to meet the manpower need of the nation. Ahmadu Bello University Teaching Hospital(ABUTH), Lagos University Teaching Hospital(LUTH), University College Hospital and University Of Nigeria Teaching Hospital are primarily built to train the medical students from their respective Universities as implied in the hospitals name. 

 

For goddness sake, how can you make your landlord a tenant overnight?

 

I dont know why nigerians are obssessed with privatization. It seems to politicians, the solution to every problem in Nigeria is privatization. Previously there was the botched attempt to sell universities in the name of privatization. We lost NITEL and Nigerian Airways all in the name of privatization and we have nothing to show for it. I am of the opinion that the private investors can go ahead and build their own hospitals as big as the teaching hospitals, staff and equip them and see if patients will not come. They shall do it in away it will accomodate both the have and the have not. This will increase patients turnover. They should learn from Dangote who took a risk to invest billions of naira to established Obajina cement factory without going into private-public paternership.

 

For me the solution to Nigeria healthcare delivery is the total overhauling of  primary and the seconadry levels of care. The general hospitals are grossly understaffed and mostly managed by scarcely experienced personnels. There are few  general hospitals that have a stationed consultant and sadly these are the centers with more patients in attendance. The major reasons are poor renumeration, dilapidated structure and unwholesome condition of service. Some have no electricity or adequate water supply. These hospitals are under the care of state governments and therefore government at state levels have to ensure renovation,staffing and equiping such general hospitals.The federal government need to expand the scope of the NHIS to include non-civil servants and state governments need to also key into the NHIS programme to increase access to quality healthcare.

 

By Abdullahi Sadiq Mohammed

Mando Kaduna.

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