Professor Kenneth Ozoilo is former president of the Medical and Dental Consultants’ Association of Nigeria (MDCAN). In this interview by SADE OGUNTOLA, he assesses the state of Nigeria’s accident and emergency departments, among other issues, just as he says that funding without an overhaul of the health system cannot ensure equitable health care services for Nigerians.
H OW will you describe Nigeria’s health system and its hospitals?
A lot has been said about Nigeria’s health system, especially as one that is very weak. This is totally true. There are different components of the health system. We need to be mindful of the little successes that it has achieved. This is to the credit of the highly trained and efficient personnel in the health team operating it. But we have a deficit in infrastructure. A lot still depends on the personal commitment and dedication of individuals. I yearn for a system that doesn’t have to depend so much on individual commitments but one that is backed up with equipment and infrastructure. Yes, the health system is weak and we have a lot to do in terms of refining our processes.
Are Nigerian hospitals still mere consultation rooms?
You have to look at it in context. There are more activities than just consultations in hospitals. There are fantastic people doing fantastic things all over the country. There are pockets of successes all over the country based on individual commitments and efforts. But certainly, a lot of institutional efforts need to go in terms of administration, organisation, and management of the health system, plus adequate funding.
Will there be an end to the mass exodus of doctors and the Nigerian health sector crisis?
Of course, there will be an end. It may go either way. Theoretically, a point could come when everybody leaves. But we don’t want to get to that point. We like to see a situation where things improve in the country so that the drive to leave will stop or reduce. To achieve this, the government has to do a lot and not just in the health sector. Factors driving people out of the health sector include the economy, insecurity, and so on.
Doctors have become targets of kidnapping because it is believed that they are paid much. People are even killed randomly, even while traveling. To the extent that doctors are part of society, they are also vulnerable to those attacks. There is a lot to do to stop the brain drain.
What is the role of the private sector in putting an end to the happenings in the health sector?
The public health sector has been affected by the inefficiencies of the public service. A certain amount of private sector efficiency needs to be brought into the public sector. The sector needs to be re-organised to be run like a business. Government runs health care like a social welfare service, but it is not funding it accordingly. Models of the private sector need to be computed into the public sector to achieve results.
For instance, in the public health sector, there are more non-medical workers than medical workers. But the reverse is the case in the private sector; they don’t overload the support structure. They cut excess spending and individuals work for the length of time they are paid for.
Like in the private sector, government needs to give incentive to productivity. This will get more people to sit up and really do what they’re supposed to do. The current system by the government encourages people to put in the minimum.
Moreover, the government needs to incentivise investment in health care. If somebody wants to set up health facilities in Nigeria, it should be encouraged. In fact, the Nigeria Medical Association (NMA) has advocated that soft loans be given to people to invest in health care. Hospitals, like those people rush to in India, can be set up in Nigeria by business-minded people. I don’t like this idea of overdependence on public health systems because they have a lot of their inefficiencies. If you look at the private health sector, it is more efficient.
Recently, the Saudi Arabian government came to recruit doctors from Nigeria. What is your take on this?
That event is very unfortunate; it’s even sad that nobody is saying anything about it. The government has a responsibility to take a position at least to acknowledge and recognise that there is a problem and that something is forcing our health professionals out of the country. This is so because the recruitment was done openly. It is an indictment on the government because there is something it is not doing right. Those governments are benefiting from our failures. It is an affront on the government.
It should be a cause for concern for the average Nigerian. I’m worried about the Nigerian workers because they don’t see it as a crisis. The doctors that are supposed to treat you under your so-called national health insurance are moving abroad. The labour congress will hit the streets to resist an increase in the pump price of fuel. But something more catastrophic is happening; the health workers, including doctors, are emptying in droves and everybody thinks this is a problem for the doctors. It is rather a problem to the wider Nigerian society. Everybody should raise their voice to try to see what we can do about it.
As a professor of trauma and general surgery at the University of Jos, are road traffic accidents and emergencies on the rise?
Road accidents have increased significantly in recent times. Based on our research in Jos, road traffic crash was about 65 per cent of all causes of injuries about 10 years ago. But our review about four years ago indicated that it has gone up to about 75 per cent. Although injuries from violence like kidnapping, banditry, and the herdsmen clashes are increasing, it is far below that from road crashes in Nigeria.
But my greatest worry about road traffic crashes is our response when they occur. Nigeria does not have effective pre-hospital and ambulance services. Provision of pre-hospital care in the early minutes to hours after the incident can reduce mortality from an incident. Although the rate of accidents is high in developed countries which adopted this proven strategy, the actual mortality from it is less because of a very short response time.
And again, this is not about just buying ambulances and distributing them, you need a system in place that works in a synergistic manner so that all emergencies, not just accidents, can be helped. These are areas where the country needs to devote its resources. And it comes down to disaster preparedness.
How will you rate the accident and emergency units of hospitals in Nigeria?
The accident and emergency units, especially in public institutions, have a lot of room for improvement. We can only boost manpower but the majority is below average in terms of infrastructure. On paper, there is a policy that patients should not pay for emergency care. But then, in reality, we do not have a provision for this because nothing is free, someone has to pay for it.
We need to be very deliberate about how our health sector is funded, including emergency services. Right now, governments barely manage to pay salaries. There isn’t enough to buy equipment. You come to some accidents and emergency units and there is no oxygen or intravenous fluid. It makes nonsense of the emergency response. But this is something that would have been taken care of if the relevant laws like the basic health services provision fund and the emergency medical services fund under the National Health Acts are implemented.
YOU SHOULD NOT MISS THESE HEADLINES FROM NIGERIAN TRIBUNE
We Have Not Had Water Supply In Months ― Abeokuta Residents
In spite of the huge investment in the water sector by the government and international organisations, water scarcity has grown to become a perennial nightmare for residents of Abeokuta, the Ogun State capital. This report x-rays the lives and experiences of residents in getting clean, potable and affordable water amidst the surge of COVID-19 cases in the state.
and then