Declare state of emergency in health sector —NMA
President, Nigerian Medical Association (NMA) Dr Adebayo Faduyile, in this interview with Sade Oguntola, X-rays the challenges in the health sector and why improving health of Nigerians should be prioritized by state governors.
A bill to amend the National Health Act to regulate international medical trip by public officials and revitalise the health sector, thus checkmating medical tourism was not passed by the National Assembly. What is the implication of this?
Well, the issue of health and where an individual seeks health care is personal. And it is left to an individual based on affordability and availability. As a public servant who helps to regulate and see that the health institutions work optimally, what is expected is that they also should be able to seek health where they prefer it.
It is really unfortunate that the Nigerian public officers and politicians do not still believe in giving the best to the health sector whereas Nigeria agreed with the Abuja declaration of 2001 that at least 15 per cent will be budgeted for health every year.
The executive or legislature has never deemed it fit at any given time since 2001 to give more than five per cent. This year, what is budgeted for health is about 3.9 per cent.
If they have made our health institutions and facilities functional, why should they want to go abroad? But it now becomes something that is used to show their class by saying they are seeking medical care outside the country.
Certainly, the bill if, passed would have ensured a more conducive operating environment to attract the best medical brains in the diaspora back into Nigeria to add to the value of health institutions in Nigeria.
But when the necessary types of equipment are not available, health institutions are not appropriately funded and there are only archaic health institutions, certainly, you cannot. Ordinary oxygen that you need to give some people in emergency care, many hospitals do not have. And these are things that lead to mortality. Those are the things that we want the government to show interest in and put more funds into it.
The rejection of the bill is very unfair to Nigerians; the rejection shows their insensitivity to making sure that what may be the common interest of every Nigerian is preserved by the government.
They have shown that they are not having the interest of Nigerians at heart since they have the wherewithal to go abroad to go and seek health. They take it as their fundamental human right, but others, if they want, can die since they will not put funds into health.
If the area you are supervising is not good for you, then why are are you doing it? That is the malady that we have found ourselves in this country.
Do we have the expertise in Nigeria to take care of almost all medical conditions public officers go out to treat?
Even when they seek bail on health grounds to travel abroad for treatment, the major causes of illness they have are hypertension and diabetes. Are these things that they cannot take care of in Nigeria? Nigeria has many highly specialised people that care for these conditions; it is just that they are just interested in staying.
But can their fundamental human right as legislators take precedence over that of other Nigerians to good health?
Well, it depends on their consciences. If I had been elected to lead my people, I should be making possible sacrifices for those I am leading. Notwithstanding the proceeds of the office that our leaders will enjoy, they should be seen to be fair and to get to satisfy the needs of the led before they think of themselves. But the opposite is the case now.
Can you say that Nigeria is healthy based on the facilities we have in our hospitals?
Our health system is in shambles and it is because we have largely not been able to take care of the little things that cause deaths among us. Nigeria is the highest contributor to maternal and infant mortalities in the world. Our average life expectancy is also low.
One thing that this says is that many Nigerians are not healthy. Things that should not cause death are things that kill in this country. I will not be able to scientifically and unequivocally say whether Nigerians are healthy or unhealthy, but our statistics show that our health indices are one of the worst in the world.
How will do you describe Nigeria’s health service?
Our health service is top heavy but bottom thin. But the place where we should put our greatest resources because it has the greatest number of clients to access healthcare services is the primary healthcare centres. Our PHCs are ill-equipped, we do not have the personnel. It is in a total comatose state.
Also, secondary healthcare centres are poorly staffed. They are not given the necessary attention and are largely not ready to take care of the people that need services. This has put pressure on tertiary healthcare centres that are supposed to see fewer and most complicated cases that will need highly specialised people to treat.
At these top heavy tertiary healthcare centres, there is a lot of backlogs and long waiting hours. And this has led to a lot of mishap in our health system. So, I will describe the health system in Nigeria as largely chaotic; there is no proper pattern on how we can get the best on our health.
Labour Minister, Dr Chris Ngige, said Nigeria has sufficient doctors and so they can migrate abroad. Does this also applies to other members of the health sector required to ensure optimal health for Nigerians?
First, this assertion by the minister of labour is not correct. He is ill-informed and it is unfortunate. We have debunked that severally. Nigeria in the urban area has a ratio of one doctor to 10,000 people in the urban area, whereas the World Health Organisation (WHO) has said that for access to optimal, highly efficient and effective health, it should be a doctor-patient ratio of one to 600. Nigeria is lacking in this.
In rural areas, it can get as high as one doctor to a population of 20,000 or 30,000, depending on the state of the federation. For example, in Zamfara State, the total number of doctors that the state employed is less than 50. Many of these doctors are in urban areas or big rural areas. So, you can see that Nigeria is lacking in the required number of doctors.
It is not only doctors that are in short supply; all other health workers including nurses and pharmacists, are not appropriately and adequately employed in our health institutions. Nurses are also going to drives and it is really sad.
Come May 29, what will you want the federal government to prioritise in health?
We need to change our attitude to health management. The real trouble, the chaotic health system, requires that governors take care of primary health care centres because they are largely at the level of local governments. Governors employ at the secondary healthcare centres, the general hospitals, and the failure we are having is largely at these two levels.
We are also failing at the level of the teaching hospitals, the pressure on the federal teaching hospitals are so much that they are actually doing things that are at the level of the primary health care centres and secondary healthcare centres.
So, we need to talk to the governors to put a premium on the health of its citizens. Many of them will not employ; they do not believe in taking care of health because it is largely an intangible thing. For you to have health in place, you need to employ a lot of medical personnel.
So, for the next four years, we need the federal and the state governments to show strong political will in improving the health of Nigerians.
The Federal Government made a plan to have PHC in each ward of the federation, that is good, but they cannot employ health workers required to man these centres because it is not within their purview. That is the dilemma. We need them to declare a state of emergency in health.
Declare state of emergency in health!
Do you not think that health is in a comatose state? We need to declare a state of emergency; we need to pump in more funds and look deeper into rescuing the health of Nigerians. The health sector is sick.
The private institutions are one of the largest that will take care of people in this country, but the government has seen the private as their competitors, which is largely unfortunate.
We have told the government to allow them to have access and to allow them to have some interest-free import concessions on some of the medical equipment. All these things the government are not interested in.
We mooted the idea of a health bank akin to the Bank of Industry or Bank of Agriculture where our people can get financial support to set up standard multi-specialist institutions. The government has shown a mixed interest. These are areas that we want the government to look into, otherwise it will not show that we are ready to improve our health statistics.
If you look at the health statistics of Ghana, a country that is close to Nigeria or even South Africa, you will understand the gravity of the situation that we are.
Anybody who has cancer in Nigeria is almost going to die because there is no policy that the government has put in place to address patients who have cancer. Meanwhile, in some countries, they receive highly subsidised care.
In Nigeria, even cancer centres are not functional because they do not have cancer treatment machines. Drugs for cancer treatment are out of reach of the ordinary people; even people who are in the middle class cannot afford those drugs. But what are they doing? They are looking the other way. So, we have a lot of problems.