Notorious for disruptive strikes, an ill-motivated workforce and meagrely funded, the prolonged crisis bedevilling Nigeria’s health care sector shows no sign of waning. The crisis was aggravated recently when the umbrella body of medical doctors sounded the alarm about the “impending disaster and collapse of the public health sector” in a newspaper advertorial. As expected, the Nigerian Medical Association based its warning on the diminishing role that sees medical doctors playing second fiddle to other health professionals in the treatment rooms. The public is the whipping boy in this worrisome internecine feud. The Federal Government should step in to put a stop to the wrangling.
Apart from redundant equipment and a poor working environment, the NMA is aggrieved that other allied health practitioners, including pharmacists, laboratory technologists and nurses have usurped its traditional functions in the sector. “The NMA is highly appalled by the state of affairs in the healthcare delivery system,” it lamented. Also, the NMA sees as dangerous a trend in which everybody in the health care system is allowed unfettered access to patients. Truly, this is confusing. It can neither help the patient nor the health care system.
To reinforce the complexity, the NMA alluded to a case of a consultant plastic surgeon, who was prevented from reviewing the wound of a patient he operated on by a top nurse. This is absurd. The rules governing the practice of medicine are clear, and every Nigerian ought to feel concerned. The Minister of Health, Isaac Adewole, has his work cut out for him. He should reiterate the duties of each group of health care practitioners.
Also at issue in the face-off that has paralysed the public health system is the report of the Yayale Ahmed-led Presidential Committee of Experts on Professional Relationships in the Public Health Sector, which was submitted to the government in January 2015. While the NMA argues for the implementation of the report, which establishes a Chief Medical Adviser to the President, the Pharmaceutical Society of Nigeria, the Joint Health Workers Union and the nurses council are stridently opposed to it. Their major grouse is that the document gives medical doctors control of 15 professional regulatory councils and 55 health institutions.
But reaching an agreement on this document is a critical factor in resolving this crisis. Adewole should subject the report to a critical review, but all the parties should come to the table with an open mind to chart a way forward. The NMA should have a spirit of give-and-take on some positions, including who mans the ministry of health, which often causes acrimony between it and the other professional health bodies. Taking the United Kingdom as an example, the current health secretary, Jeremy Hunt, studied Politics, Philosophy and Economics at Oxford. He was deployed there from the culture ministry. There is no animosity that he is not a medical doctor. Likewise in Australia, Sussan Ley, the health minister, studied Economics.
As it is, it is the ordinary Nigerian that is bearing the brunt of the bad blood and ineffectual public health system. The crisis is exacerbated by the poor state of our hospitals. Nigeria, with a population of 170 million, has only 40,000 registered doctors. Out of this, 19,000 have left the country to practise overseas. Among those at home, 70 per cent practise in the urban areas, where only 30 per cent of the populace live. Thus, the whole system puts the average citizen at a gross disadvantage. In contrast, Cuba, with just a GDP of $77.15 billion (2013, World Bank), has 58.2 per capita doctors for 10,000 people. The United States has 49.0 per cent, Canada 29.9 per cent, Norway 42.3 per cent and Greece 61.4 per cent.
Other health indices are equally pathetic as the government finds it difficult to fund public health. A former official of the resident doctors association at the University of Ilorin Teaching Hospital said that doctors had been carrying out surgery using lamps, torch and cell-phone light because of epileptic power supply at the institution. This is dangerous to the health of patients, but there are plenty of other anomalies.
Our dereliction brings rich dividends to other countries with efficient health systems. The Nigerian Sovereign Wealth Investment Authority said that 30,000 Nigerians seeking medical attention overseas expended $1 billion to treat themselves in 2014, with 47 per cent of the sum going to India. Sixty per cent of the outflow is spent on cardiology, orthopaedic, renal dialysis cases and cancer, the NSWIA said.
With the Federal Government allocating N257.3 billion (or 4.23 per cent) of the N6.06 trillion budget to health in 2016, the situation might remain pretty grim. But elsewhere, the United Kingdom voted $437.5 billion for health (2011-2012), while the Netherlands, Belgium, France, Germany, Denmark and Austria commit 10.0 per cent of their GDP to funding public health, according to data compiled by Eurostat from the Organisation for Economic Cooperative and Development and the World Health Organisation. In the UK, medical treatment is free under the National Health Scheme, which is funded by tax.
So, how do we stem the crisis? The health minister should unveil government’s agenda for the sector, especially about the inter-professional relationships among the groups, provision of modern equipment, capacity development and training of personnel. Funding is important. Adewole has to devise innovative ways to capture more Nigerians in the National Health Insurance Scheme, as experts argue that the shared benefits offered by health insurance get more citizens joining the system.
