The issue of cost of medications and healthcare expenditure is germane in Nigeria. President of the Nigerian Medical Association (NMA), Professor Mike Ogrima in this interview with Sade Oguntola x-rays the challenges people with chronic illnesses face in the current economic crises.
There are concerns that high cost of drugs may lead to medical emergencies in Nigeria, do you agree with this?
I quite agree with you, but it is not only with drugs. Existing in Nigeria is an emergency because the cost of living is quite high for an average Nigerian. We are not manufacturing anything in Nigeria to support our forex. Most drugs are imported. So finding forex to support its importation is the crux of the matter. The whole economy is not stable; so it will affect every aspect of our lives. Drug is just one of those things.
If the cost of drugs is really on the high side, what does it portend Nigeria?
When costs of medicines are high, many patients would not be able to afford them and as such level of adherence to medication use will be low. Of course, when compliance to medication use is poor, their disease would get worse.
Aftermath of this is increased mortality and morbidity level. That is what we are having now. It is an evidence of the poor economy on the citizenry. The diseases that were rare before are coming up. This includes non communicable diseases like diabetes whose incidence is increasing because of stress.
Cases of hypertension are also on the rise. I am sure if you conduct a study in a community now, the number of persons with hypertension would be far higher than it was suggested by a past study that indicated that at least a third of Nigerians have hypertension.
Any impact on hospital attendance, be it government or private hospitals?
The private hospitals are in business and so need to make profit. But even in government owned hospitals, where treatment is said to be subsidised, impart of high cost of drugs would still be felt because of out-of-stock drug syndrome. As such, patients would still end up going to purchase most of their drugs outside the hospital.
Health financing is topical given Nigeria’s current economy. As NMA president, how best can it be tackled?
The way out is National Health Insurance. Although some people say they do not want to join, for different reasons, but it works. All we need to do is to build on its existing achievement; extend its scope and make sure that it is compulsory for every person in Nigeria, irrespective of their profession and where they reside.
In addition, we should have social welfare scheme inbuilt within the national health insurance scheme because there are certain age groups that must benefit who should not even pay. This includes the very poor, old and young; they are the vulnerable age groups.
How satisfied are you with the state of medical training in Nigeria?
I am quite happy with the products from the system; they are very good based on the rating of their global practice. Our products are excelling outside the country.
We have been keeping the country’s health indexes at its current level. For instance, if we do not have specialists in different medical fields trained in the country, we would have been worse than this. I am satisfied.
But then there are issues with training of resident doctors and new doctors on housemanship, which some attributed to inadequate facilities to train, non payments of salaries and allowances.
Already, the government is looking into housemanship training for new doctors. In restructuring the process of training resident doctors, we advocate centralising their admission and training.
Also, we can coordinate the training of new doctors on housemanship as well as improve the capacity to absorb more. We have places where they can be trained; the only thing is that government does not have enough funds to pay.
Fund is the main issue. Availability of equipment and facilities to train boil down to proper budgeting and planning to ensure they could be imported. This can therefore build up the capacity of the existing structure for training the different cadres of doctors.
Would you agree that the medical profession is an endangered species considering that places for their employment and training are reducing by the day?
This is the reality of the day because the economy of the day is not as buoyant as before. But even in that context, every occupation is endangered. Government cannot employ, so everybody should go into entrepreneurship.
As a doctor, you cannot say that you are endangered because you can engage yourself; you should not wait for government to engage everybody.
As the new NMA president, one issue that Nigerians are bordered about is incessant strike in the health sector. What is your take on this?
I will be the last person to call my doctors out on strike.
But some resident doctors are on strike now?
The resident doctors are the younger ones in the profession and of course you expect that in a family, where you have a lot of children, you have different behaviours by them. That does not mean that you will not own responsibilities of those children, we are guiding them, we are giving them good mentorship and we are also calling on the government to be sincere. When government reach any agreement with any group, it must be sincere to implement such agreements.
As NMA, we would carry everybody in the health sector along. We should be seen to work as a team. The patient is the number one in the health sector, not the various professions.
Is this possible?
It is very possible. Every profession in the health sector need to go back to the ethics of their profession. We have deviated a long time ago from the implementation of the ethics guiding the various professions. We should go back to the basics; mutual respect for each other and being sensitive to the plight of others.
Medical tourism is a big issue in Nigeria, what is the way out of this practice?
Medical tourism is a big problem; but improving the scope and capacity of NHIS will provide funds for facilities likewise asking doctors or medical professionals to form cooperative to float a mega hospital that is known for an ailment is a way out.
The other way out is to make sure that we advertise the various services hospitals in Nigeria can provide. A lot of Nigerians are ignorant of the scope of services that we are providing in Nigeria. Of course the elites have their own share of the blame since they are the ones that control the fund.
The elites want to partake in the extracode in accompanying patients, which is corruption in the medical tourism. So if we can tackle all these, we are going to reverse medical tourism and there will be inflow of people seeking for medical attention from Nigeria.
But advertisement is against the rules of the profession…
Individual doctors cannot advertise, but there is no law against advertisements of institutions or services a hospital can offer. The Indians do a lot of this. This is how they get our citizens to patronise them. So we should also advertise our own services.