In health, education, Nigeria has slipped backwards —Falase, Ex UI VC

In this interview with SADE OGUNTOLA, former vice chancellor, University of Ibadan, Professor Ayodele Falase, speaks on an array of issues affecting the nation including problems in the education and health sectors. Excerpts:

 

YEARS back, hospitals like UCH were ranked high in the health care sector. In fact, people come in from different parts of the world to access care. Now, what we have is patients being flown abroad for care. Hospitals had now turned to mere consulting rooms. What really went wrong?

Well, you cannot have a better healthcare than what your country is. What I am trying to say is that we have had the best facilities in the past. But with the political changes, everything has run down.

There is no doubt about that but we have gained in many areas. We have trained many specialists in Nigeria and they are working in this country and serving the people. But most of the things that we have done in the past, we have allowed to slip. We have slipped backwards and now unable to maintain the facilities that we have in the past.

But when people talk about medical tourism, let us be clear. Medical tourism is not because of diagnosis. Take cardiology specialty, my field, for example, we have the different machines that may be required here in Nigeria. We have all the facilities, but patients cannot or do not want to pay for it. That is the crux of the matter.

In the private sector, all these facilities and specialists are in place. However, everybody tend to fixate on the public sector. But the problem is that people cannot afford it or they do not want to pay for it. That is the matter.

Since the private sector is now taking over gradually, these equipments are available in private sector but people may not be able to afford treatment in the private sector.

Thirdly, we have an inbuilt attitude in our mind that anything that comes from a black person or black doctor is inferior to what comes from a white doctor.

As such most people will rather prefer white doctor to treat them than a black doctor even if the black doctor is even more knowledgeable than the white. So, it is a matter of attitude.

But we have been there before. Nigeria has attained several things before; we had the one of the best teaching hospital in the commonwealth and so on.

There is no doubt that we have allowed things to slip; lack of water, lack of electricity and so on have impacted negatively on our practices. And I think a major part of the problem is because we have allowed these things to go into abeyance.

Before, when I was in the university, we had constant power and water. Then in the University of Ibadan, as a student, we never even thought of power outage.

But when we started centralising things by building the Kanji dam, we then cancelled all local power stations and then we were now having power shortage.

What we ought to have done was to improve on the local facilities. Ibadan power supply was from Eleyele. Power was generated in Ijora power station and it was steady. Ijora power station is still there. Eleyele dam is still there but they have all gone into oblivion.

What we needed to do was to improve on it as the city is growing, but we just cancelled everything, and start to depend on Kanji dam. We are now transmitting power for the country. So there are things that we have not done.

This is where it is linked with our political development because the military believes in centralising things- command and control. But we have allowed everything to slip.

So those are some of our problems; there are fundamental things. They are all linked to agitation for decentralisation which is regionalism. You see when you overcentralised things, you are building inefficiency.

So those things that we had achieved before, like the universities that we had built to world class such as Universities of Ife, Lagos, Ibadan and Ahmadu Bello, we have allowed to slip. Now, we are slipping and slipping further, all because we have centralised things and put them under a “command and control”.

 

Does that account for the disparity in medical care when Nigeria is compared with countries like India that had their independence about the same time as Nigeria?

What is happening in Nigeria is that we look up to government for everything. I think most of the advanced or specialised care should be left to the private sector. They should allow the private sector to develop because the government cannot handle it.

Let’s say that today the ECHO machine is not working in a government hospital, by the time the machine is replaced, it will take months or years due to bureaucracy.  But in the private sector, it will be replaced in less than a week. So, there is no efficiency managing such facilities.

Such facilities like dialysis, open heart surgery and cancer treatment equipment can be best managed in a private sector and I believe this is what the private sector should be encouraged to do. Let government face the bread and butter things.

 

Bread and butter things, do you mean primary health care services?

Exactly. In fact, for PHC, I think we should co-opt more private hospitals into PHC. There are many private hospitals that can provide primary health care services effectively if there is partnership between government and the private sector. They can negotiate with these private hospitals where patients can go to.

We should not think that PHC is only for government, it should involve the private sector, too. Government alone cannot do everything.

 

The condition that Nigeria findings itself is that where we are losing ranks in the rating of hospitals, meanwhile doctors are moving to greener pastures. Of every four top doctors you meet abroad, three are Nigerians? What is really the problem?

There are still top doctors in Nigeria; medicine is medicine anywhere in the world. But if you go to an advanced country, there is water, there is electricity, and there is everything. So it is easier to operate or do things within that milieu.

In Nigeria, where there is lack of basic amenities like water and electricity, it is not as easy. That does not impact on the skill of the person and there are many of them in Nigeria who have been trained both in Nigeria and overseas who have the same skills.  But the problem is the basic infrastructure that we do not have. That is point one.

Most of those who emigrate do so because of financial and economic reasons, although in addition, they have a better milieu to practice there. They have a better job satisfaction.

But in Nigeria, we do not have the infrastructure. I think Nigeria should first of all put its infrastructure right. Like the books say, put right your infrastructures and all the other things will be added unto you. Once we have dependable infrastructures, you will see that things will improve. There are still skilled doctors in Nigeria.

There are still many doctors in Nigeria that can attend to different difficult medical problems, one do not have to travel abroad to India for it unless one have the perception that a black doctor is not as good as the white doctor.

 

Coming back to education, the global rating of our Universities, we are really behind. What went wrong?

It is because again we centralised everything. Now these universities were the top universities before, certainly Ife, Ibadan, Lagos were. And the people who came out from these universities had been running this country. But when we went through a command and control structure, everything slipped. We are now confused because we do not know whether we want to run these universities as parastatal of government.  We need now to decide, are we going to run our universities and our top hospitals as parastatal of government or do we want them to stand alone and do what they are supposed to do? Let me put it clearly, if you ask a University of Ibadan to stand alone, charge its fees and so on, it will change for the better in every aspect.

 

Do you mean full autonomy?

Yes, full autonomy. If I give you autonomy, but say you must not charge fees, there is a problem, things will deteriorate and you will have problems. That is where we are. That is why I am saying that it is either we decide to run them as parastatal or independently. In my valedictory lecture, I suggested that what we should have a form of education bank, an investment bank where all students who are admitted to universities, whether private or public can go and assess fund to study in high quality universities rather than government saying “do not charge, do not charge” but it does not reimburse universities for not charging. You have universities that are crippled financially and they cannot function as they should, and if the staffs there want more money, they have to go on strike to get it. So that is the mode we are running.But we are suggesting that they should be independent entities. Now, the charges would be a lot and it could go beyond many people. That is why we are saying that we should have an education bank. If we invest say, N50 billion, in the economy and it is meant for students alone, then the students can go and access it to pay fees in universities once they have admission. You do not need to pay back if it is in form of scholarship or bursary. It will be easy for government to do that since they had invested the money and it is from its profit that they will be used to sponsor students. This way the quality of our university education will improve since universities will be independent.

 

How about industrial strike action both in the health and educational sectors?

This is because everybody is dependent on the government; government does not have the money and the only way to get government to even part with the little money it has is to force them to do so. That is the reason, but everything has cost. All these strikes, if they pay you more, what will happen? The salary bills will increase and there will be no more money to do other things- to provide more machines for hospitals and other things. Then there will be again more complaints to do something, so the cycle continues. But the cycle needs to be broken. Okay we have a National Health Insurance Scheme (NHIS); there is no reason why NHIS cannot cover most people. But it is not. Again, we have allowed the NHIS, a beautiful idea wherein we invest money so that people can assess medic care through that, not to function well. So that is the problem.

 

How about the brain drain in universities?

The brain will continue when appropriate factors are not put right. After training abroad, in our time, we came back because the condition at home was much better than condition in Britain, USA and so on. You are better off at home, you can progress home and you have better accommodation rather than remain there. But now because things have degenerated economically and infrastructural wise, we are now saying let’s do a reverse migration.

 

Professor Soyinka was of the school of thought that all universities be closed for a year, and during the period, the government can then sort out all the issues facing the universities, so that everything will be better.

I do not think it will work. We will come back after a year and things will still go the same way unless we really determine the fundamental problems and tackle them. The fundamental problem is that let this educational institutions function independently, let the government face the task of sponsoring their citizens to attend high quality universities, do not dictate to universities. Most of the top universities in the world such as Cambridge, Oxford and Yale are not under government. Nobody dictates anything to them, including students to admit. Right now, the government admits students for us through JAMB. It should not be. The quality of a university depends on the quality of students that is coming in. If I as a University cannot admit my own students and I have to pander to a governmental directive that I must take, the quality will go down eventually. For example, if University of Ibadan or Lagos is asked to admit a student with a JAMB score of 120, the quality will go down eventually. These are some of the issues when there is too much interference. That is we should decide whether we want to run our universities as parastatal of government or we want to make them to run like other universities in the world. That was a point we raised about 10 years ago, as part of a team that did a visitation panel to University of Ghana. The report is on the internet and still valid.It is either you want universities to run as parastatal of government which will not work and will result to strikes and so on or you what them to run as independent entities like they were before, when they were very good while at the same time, those who are doing the infrastructure must do their own. A vice chancellor in Ibadan, for example, spends three quarters of his time chasing after water and electricity. And when you meet your contemporary vice chancellor in other universities, they do not even think of these.Those are the problems, so a vice chancellor will be contending with students who do not have water and electricity whereas his counterparts in Britain and America are not bothered about such things. He is busy doing what he should be doing, like ensuring proper training and maintaining quality. The same thing with all these equipments in the health sector. Rather than think that there are no machines, let the private sector handle this. You can organise the NHIS so that people can be empowered to get health care. That was why when past president of USA, Mr Barrack Obama was saying they should extend the health insurance cover; he did not attack the institution by asking that they lower the standard. If we do not do those fundamental things, I am afraid professor Wole Soyinka’s suggestion will not work, we will still come back to face the real problem. Those problems will remain if the fundamental problem is not tackled.Take for example, when I was VC, the political person said that we should not charge tuition fees but tuition fees go directly to departments to provide facilities, to provide teaching and practical materials to students. But when you cut that off, what will happen? That was why things were deteriorating.Of course, they will tell you, we will give you capital. But you will spend the capital looking for water, looking for electricity and so on so that the students will not go on protest. There is no running cost, that is the problem.  By not charging tuition fees, you have cut off from all the departments. That is what they use in running the place. And so they will die, that is what is happening.

 

But there was a time the Federal government designated some federal universities as centre of excellence for science and technology, and they gave money to them.

Whether you give money or not, the equipments the government brought those days are no longer valid. They had become obsolete; as such even getting those equipments repaired is a problem. But let the private sector do it. All we need to do is to empower this sector. Also, let’s turn attention to empowering our students and our people to be able to pay for those facilities.

 

The issue of corruption was raised against university administrators and government said it was planning to probe them, can we say corruption is actually the bane of the system?

Universities are very democratic; I am not saying that the element of corruption may not be there, it may be there. In fact, at various levels, it may be there. But the universities are very democratic institutions, at least I know of Ibadan, and they will police themselves if they are allowed to do so. If they are autonomous and they collect the money, I am sure they will police it and not allow anybody to steal it. But if undeclared money is coming in from government or other places, it is difficult for you to trace it.

 

We have issues of private universities taking over, is that the way? Where do you get the lecturers, the facilities and so on for these schools, not minding the fact that they are also expensive?

Yes, private universities are the way to go. Eventually that is how we should go, Yes, they are expensive but that is why we are saying that we should have an education bank. You see once government faces its side of helping the students to attend excellent universities; you will have a situation where a student will say I want to attend this private university. With time, this private universities will become like Yale, Harvard and so on. Also, if government okays and establishes a body or bank that fund students to attend excellent or quality universities, be it private or public, including Tetfund, then  you will now have a situation where the distinction between private and public will be blurred and people will now pick Universities to attend not based on cost. People attend the public universities now because of cost. They will not say it is not because of cost but quality and those universities whether private or public will be forced to improve themselves. That is the issue, so unless we do this we are not getting anywhere. So whether we close the universities for two years or whatever, it will not work once you do not tackle the fundamental problems which are infarstural and governance. But if government wants to be doing everything, all the things and running it as parastatal, it will not work.