Posted on: Wed 08-04-2015

Complement of the New Year. After my last outing - Rape of Medical Laboratory Science the Bane of Adequate Health Care Delivery in Nigeria, there were some violent reactions. The reactions were quite expected but some of them were misplaced. We are here to say the truth, and as it is said, it is only the truth that can set us free. It is not about being parochial or selfish. What are the truths? (a) Is our health care services the best or upto our desired expectation? (b) Is our medical laboratory services among the best in the world? The answers are no I suppose. Is inadequate diagnosis contributory to medical tourism in Nigeria? The answer is yes, I suppose too. So further question is do we need to develop our medical laboratory services adequately? You are entitled to your opinion, but if the answer is yes, then the medical Laboratory scientists should be encouraged to practice optimally and to continually improve their skill. Likewise, all other professionals. Every group should limit their practice within their areas of training and competence. The government, its agencies or individuals should not employ quacks.

          This takes me to the present topic on Universal Health Coverage. Universal Health Coverage, put in its simplest form, is making health services available and affordable to all or majority of the citizenry. This has been the yearning and expectation of Nigerians. Before now, there had been slogans like Health for all by the year 2000, etc. The targeted years have come and gone without any tangible mark made. With the National Health Act on board, there has been euphoria that the universal health coverage is here with us. Is this true? Let’s look at some of the factors that may impact on it.

1.    Non-compliant attitude of Nigerians leaders.

       Nigerian leaders or rulers are selective in their compliance to laws and rules. They chose which laws to obey and when to obey them. The National Health Acts is only a law like many other laws in the health sector. A law is useless if it is not obeyed or is selectively obeyed or applied. We have not realized our health goals partly because we refused to obey or implement our laws and policies. Remembers also that, the national health act did not abrogate other extant laws. So for it to be effective, it has to be implemented alongside other laws. Therefore until we begin to observe the rules of law comprehensively, we will be far from achieving our target. Again there was jubilation that the Act made adequate provision for fund. This may be true, but there had been an opinion that funding has not been the major set back in providing “health for all”. Allegation of embezzlement and misappropriation of fund had been common place in the health sector as it is in other sectors of Nigerian economy. And until issues of corruption is addressed, universal health coverage remains a mirage.

 

2.       Constant Agitation in the Health Sector.

There is constant industrial turmoil in the Nigerian health sector. The various union take turns to embark on industrial strike. Doctors go today, other health workers the next day. And the government worsens the situation by their non-charlancy or selective and lopsided attention/action.

I hoped that government would have used the opportunity of the doctors’ strike during Ebola outbreak to confront the hydra-headed monster of labour unrest in the health sector but it never happened. Unfortunately, JOHESU have taken their turn and the government seemed uninterested. The fained ignorance of the detail of the agitation by Mr President and the subsequent promise to address the issues at stake is a matter of postponing the dooms day. A situation where government enters into agreement now, only to renege on it the next day is the height of insincerity. It is either that she lacks the idea of what to do or the political will. It is still not late. Government should take dispassionate position and address the issues raised by various stakeholders in the health sector. A single salary structure as it was before 1985 is the solution. Otherwise the “health for all” will remain a mirage.

 

3.       National Health Insurance Scheme

NHIS is supposed to be a major driver of universal coverage. But after many years of establishment, it is yet to cover a good proportion of Nigerian population. As well, most of the complex and costly to manage ailments are yet to be covered. Also the payments to providers are not in tune with the current economic reality, hence some providers sabotage the scheme. Therefore the scheme needs a review. Also more information and enlightenment is needed.

4.       Concurrent Public and Private Employment by Public Sector Health Workers.

                   This is a situation where a public sector healthworker owns and manages a private health institution. This practice is a norm in Nigeria and is not restricted to the health sector. Originally public sectors workers were not permitted to engaged in “private practice”. But at a point when the ratio of practitioners to the population was found to be inadequate, professionals were given a waiver to run part time private practice. The reality today is that the practice has been taken too far. Healthcare professionals in government employment now own and manage health institutions that compete effectively with the government hospitals. In many situations, they run down the public hospitals for the private ones to thrive. Like the Bible says, you cannot serve God and mammon at the same time. Put another way, one cannot effectively serve the public and self simultaneously. Naturally, self comes first to the detriment of the public service. That is principally why services even in our tertiary health institutions are below expectation.

                   Presently, the nation has enough health workers to effectively render service, but the distribution is lopsided. So, all we need is effective redistribution of the manpower. Someone who has dual employment first has denied another person employment. This is warranted in this era of high unemployment. Secondly he is in an unhealthy competition with the government institution that he is working for, and other private institutions. Thirdly he is robbing government because he is paid more than he puts in. Therefore, I think the policy that permitted private practice is obsolete and counter productive and as such should be repealed. Dual employment should therefore be made unlawful. Health workers presently in government service should be given the option to close down their private institutions and remain in government or resign. So if this kind of racketeering is dismantled, health care services will be further extended to the citizens. And importantly unemployment will be further reduced.

5.                 Exorbitant Cost of Health Care Delivery

It is most unfortunate that quality health care services in public and private institutions in Nigeria are high and beyond the reach of the average Nigerians.  This impedes access to health care. By my assessment the cost is determined by many unfathomable factors beyond the actual cost of services rendered. Otherwise why should the cost of “save and normal delivery” be high? Again, why should the cost of management of a common disease like malaria be high when no malaria drug is more than one thousand Naira (N1000.00). The high cost of health services is the major reason people engage in self medication.

                   The way out; I believe a healthy competition in the sector between private/private, or private/public will do the magic. For this recommendation to be effective there are preconditions that must be met. First the dual employment of public sector healthworkers should cease. Secondly health care professionals should restrict themselves to their areas of training and license. E.g, 1. A hospital should have an equipped laboratory and a medical lab scientist in its employment before it can make claims of “lab services available”. Otherwise it should work with independent labs. 2. A hospital without a pharmacist should not dispense drugs but only prescribe for the patients to procure from a registered pharmacy. If these measures are adopted among others, the competition will be healthy and services will be affordable. Above all the culture of mutual respect will be in place.

 

6.       The Working Schedules of Consultants

                   I have been pondering over the working schedule of consultants in our health institutions and how it affects universal health coverage. The two days only work schedule for consultants, I see as grossly inadequate for adequate coverage. I need to be better educated on why policy makers put such policy in place.

                   In my opinion, the work schedule for consultants should be as regular as that of any other clinician. Alternatively, consultant services should be on part time, only to be paid for the days work is done.

7.       Environmental Health.

                   Our environment substantially contributes to the state of our health. Dirty environment breeds diseases while clean environment fosters good health. Diseases like malaria, typhoid, etc are endemic because our environment is filthy. Look along our streets and drainages to appreciate how dirty our cities are. Preventive medicine is anchored on environmental management. As such we cannot achieve adequate preventive health without a healthy and clean environment.

                   It is said that “prevention is better than cure”. And because we have over emphasized curative medicine, we have been unable to achieve “health for all” by whatever year. And we will be unable to achieve universal coverage if we continue on the same lane. We must eschew egocentrism and engage all stakeholders. Environmental health officers and Community health officers have essential role to play in our health care delivery. It is by effective and adequate engagement of all relevant professionals that we can achieve the targeted universal coverage.

8.       Leadership in the Health sector.

                   Leadership is key in all human endeavours. The level of performance in any sector is dependent on the leadership. Inspite of all effort and fund expended in the health sector, we are still far away from achieveing the health related MDGs. Some people complain of inadequate funds. That may be correct, as there may not be a state of adequate funding. A number of issues compete for fund. The important question is, whether our achievement is commensurate with the fund available.

                   Yearly there are budgetry funding as well as that from donor partners. How well have we applied these funds? Have we been able to sustain what we already have in place? Some people have been in leadership and if the state of our health sectors is inadequate, they should be called to answer. But my take is that leadership should be based on merit and not on any primodal consideration.

          Conclusion:                                               

          All Nigerians have expressed desire to have optimum health care delivery, but we are yet to attain it. It is attainable, if we work at it. But with the attitude of business as usual, it is far from us. We need to adopt the attitude of mutual respect among health professionals and not superiority complex, sincerity and non-partisanship by government and its officials and respect for the rule of law - by respecting and obeying all existing laws and policies of government and obeying court ruling/orders,. These are preconditions for achievement of Universal Health Coverage in Nigeria. 

 

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