IN a document prepared by the Federal Ministry of Health in November 2014 entitled “Recommendations for a National Policy on Incentivising Healthcare Investments,” the Federal Government put in place plans to ‘sell’ public health institutions.  Among the institutions slated for sale to private investors are the teaching hospitals across the country, including apex public health institutions like the University College Hospital (UCH) Ibadan, Lagos University Teaching Hospital (LUTH), the University of Nigeria Teaching Hospital (UNTH) Enugu, and Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, among others. It is believed that the privatisation of these institutions would bring in additional private capital that will lead to better funding and ensure better quality healthcare at the lowest cost and thus improve benefits to all stakeholders in the sector, among other benefits.

 

Naturally the proposal has attracted heated but mixed reactions.  Health workers under the aegis of Joint Health Sector Unions (JOHESU)/Assembly of Healthcare Professional Associations (AHPA) have opposed the move. They have argued that the proposal is driven largely by entrepreneurs in the healthcare sector who are inclined to taking over the hospitals in conjunction with International Finance Corporations (IFC). They argued further that privatisation would have adverse consequences on consumers of health services, as it would make such services unavailable to majority of Nigerians. The health workers warned that foreign company domination which would come on the heels of privatisation would prevent Nigeria from building capacity through Nigerian health providers.

 

It is important to appreciate the dilemma that has forced the Federal Government to seek new ways to improve the quality of healthcare in the country after several decades of the dominance of public provisioning in the health sector. A review of the annual budget in relation to the healthcare delivery leaves much to be desired. Poor quality healthcare services and insufficient financial risk protection are prevalent. There are serious infrastructural challenges, while competent and highly skilled Nigerian doctors continue to seek greener pastures in foreign countries.

 

Private healthcare providers face difficulties in accessing growth capital; the cost of doing business remains high and there is a general lack of market information. The fragmented nature of the sector makes it difficult to diffuse business/financial knowledge amongst health care delivery business owners and the regulatory environment is restrictive.

 

Undoubtedly, the proposed policy amounts to a major shift in health policy, from healthcare as a social programme of the government to a healthcare as an industry focused on service delivery and quality of care, centred on robust participation of the private sector. But this policy does not address the problems itemised above.

 

 

We identify with the President Muhammadu Buhari administration in its commitment to improving healthcare delivery. A healthy population is a wealthy population. A major reform of the health sector is essential to improve life expectancy and quality of life of Nigerians.  We sympathise with the government on the enormity of the challenges it faces in reforming the health sector. We, however, caution the government against privatisation and against the partial or complete transfer of ownership of the hospitals, especially the Teaching Hospitals, from government to private individuals whether local or foreign.

 

There are several reasons the wholesale or partial privatisation will not augur well for the health sector.  First, Nigeria faces enormous challenges in the sectors that have been privatised. To say that privatisation has been successful without qualification in any sector of the economy is to tell a huge lie. Secondly, healthcare delivery is in the concurrent list just like Education, Agriculture and Roads. Governments all over the world are duty-bound to provide quality healthcare for their citizens. The Nigerian constitution requires that all governments in Nigeria provide health services to Nigerians at all levels. Thus, the government by privatising would not only be abdicating its constitutional responsibilities, it will be selling the hospitals to a private sector that has not demonstrated outstanding and substantial experience in providing tertiary services. This is not the direction the government should go.  It will also not be in consonance with best practices worldwide.

 

Nigeria has only recently introduced the National Health Insurance Scheme (NHIS).  The reach is still very limited, mostly to Federal Government employees. Many civil servants and workers in private companies are still unable to afford the tertiary health services in Nigeria. The ordinary citizens still depend on traditional medicine and are often victims of quack doctors because of lack of funds.

 

Privatising the teaching hospitals will come with its own challenges.  This is particularly critical for government support of medical research and the arrangements for internship/housemanship, medical residency and hospital-based courses like Nursing, Midwifery, Health Information Management and many more. Teaching hospitals are essentially established to train undergraduate medical students and as research centres to produce knowledge. They are not profit making organisations and should not be made so through privatisation.

 

By Nigerian Tribune