Professor Chris Bode, chief medical director (CMD) of the Lagos University Teaching Hospital (LUTH), in this interview with SADE OGUNTOLA, says that Nigeria needs to improve on standards in medical education and practice.
Improving standards in medical education and practice
First, I must say that the standards of medical education at the undergraduate and postgraduate levels are quite high and the litmus test of that is the international acceptability of our graduates wherever they go. We have robust training programmes, accreditation at various levels, and safety mechanisms to ensure our trainees uphold commendable standards of medical practice. The many challenges of our country, however, have not brought out the best in our medical practitioners, encouraging an egress of skilled medical manpower the nation has trained at great cost.
If you buy a Benz 600 car but have no road to drive it on, no meaningful support services, and you have to face bandits who make each trip a tough nightmare, the car may be judged a poor performer, but the reality may lie in the environment where it is called to perform.
Having said all that, standards are maintained right from the intake of top-performing candidates into medical schools globally, to the rigorous, long training they are subjected to. The Medical and Dental Council of Nigeria (MDCN) and the National Universities Commission (NUC) strictly regulate and oversee training curricula and perform regular accreditations to ensure optimal availability of infrastructure and manpower for training in approved programmes. There are also state and national watchdogs that register practices and supervise the conduct of practitioners. Professional associations also rein in their members and insist on acceptable practice tenets.
What we must also improve upon is the ambience in which western medicine is practised in the country. Nigeria must decide what sort of medical system it wants and we should clearly define who pays for the work done by medical workers. The modality of payment should cover all, be well spelt-out, adequately compensate hospitals for work well done, and be so regulated to bring out the best our hospitals can offer. Doctors, nurses, pharmacists, laboratory scientists and every member of the medical team will be eager to work in any part of the country where there is prospect of job satisfaction, job protection, good pay, safety of life and property, good roads and all other amenities of life. We are far from achieving that dream now and thus, the persistence of inequality in healthcare between the different parts of the country: urban and rural, rich and poor, etc.
Ensuring universal health coverage in Nigeria
LUTH, as a hospital, can assist in achieving this as soon as the appropriate legislation and machinery for this laudable scheme are in place. We continue to advocate this to free over 70% of Nigerians who pay out of pocket for healthcare.
Topmost achievement of LUTH in 60 years
The recent, innovative introduction of meaningful private sector participation in solving a number of intractable problems and reposition LUTH to accomplish its mandates is the topmost achievement in the past 60 years. As more hospitals sprang up under the Federal Ministry of Health, it became increasingly clear that Government alone could not fund the pace and scope of development required to make our public hospitals run efficiently. LUTH has been enjoying uninterrupted 24/7 electricity for the past 4 years because a private sector player was involved. The NSIA-LUTH Cancer Centre is the best in sub-Sahara Africa simply because of a PPP arrangement. Similarly, our blood bank and a few other essential departments deliver qualitative, affordable and sustainable services because of this sort of arrangement.
What to look forward to in the next decade
I augur that LUTH’s various improving services will coalesce to emerge as a formidable force in the medical landscape in scope, expertise and volume of practice. The combination of service, training and research in a well-run establishment is already attracting relevant attention in government, private, public and corporate spaces and the Hospital will surely be a West African medical hub.
Topmost disease, topmost killer
Diseases of the heart and blood vessels (cardiovascular diseases) such as hypertension, heart failure and stroke are the commonest diseases seen among our patients. These are caused by unhealthy lifestyles, age-related factors, and they may be accelerated and compounded by other factors such as diabetes, obesity, and other things. The same range of diseases also constitutes the commonest killers.
Intervention plans for these conditions
A substantial number of such diseases are best prevented through meaningful public health education targeted at healthy eating, exercising, avoidance of smoking, limited consumption of alcohol, and other measures. These are, strictly speaking, not the primary duties of a tertiary institution as LUTH, but our Hospital is involved in these measures at the advocacy, training and research levels. We are also expanding our facilities to render holistic specialist care to those referred to LUTH for such services.
Autonomy of government tertiary hospitals in Nigeria
These hospitals are over 60 in number and they are owned by the Federal Government. The ownership structure makes the Federal Government the body that controls these institutions through government-appointed boards and headships. The government, which owns the institution, pays the salary of workers, gives substantial financial subventions, has the right to give broad policy guidelines on how they should be run. The board of each hospital interprets the policies in the context of the needs and goals of each institution and the management carries out the programmes approved by the board. There is enough latitude within this structure to achieve good goals in each institution once there are good people at all levels, dedicated to achieving ell enunciated goals.
Poor services in government hospitals
Until the mid-80s, services in government hospitals were quite satisfactory. Then came the many years of poor governance, zero-growth budgets, poor investment in healthcare, and a parlous state of infrastructure nationwide. All these impacted negatively on the healthcare sector and the people lost confidence in public hospitals. Private hospitals sprang up all over the country to mop up areas where public hospitals could not cope.
The local governments dropped the ball and did not invest in primary care which was under their purview. Most state governments also stopped funding and staffing their general hospitals, with the results that all minor and moderately severe diseases that could have been treated at the primary and secondary care levels respectfully, were sent to tertiary institutions. If you add the population explosion that occurred in many urban centres, you can then appreciate why the public lost faith in government hospitals.
It is, however, gratifying to note that in the past few years, that confidence is returning. Our government hospitals were part of the bulwark that confronted the COVID pandemic when it came to our shores. Government, on its part, has begun to invest meaningfully in rehabilitation of its hospitals, leading to an increasing number of capabilities in our institutions and the repositioning of these same hospitals. If we continue at this pace, there are better days ahead, yet.
Free treatment for children under the age of 5
Most good things come at a cost. Good healthcare is not free. If you look at it carefully, somebody must pay for it. I will advocate sustainable, accessible, affordable universal coverage for all. It can be worked out to every stakeholder’s advantage without government putting money into it, if we have the political will to introduce and implement it. Otherwise, if you make healthcare free for the under-5s, what happens to them when they are 6 years or 7 years?
Surgical care for children
Nigeria has about 200 paediatric surgeons, most of them trained locally in the past 3 decades. This falls far short of the expected number to treat our teeming number of children. Under a well-designed universal healthcare coverage, more surgeons can train rapidly to work in this specialty. In centres where paediatric surgeons are present, a lot of incredible child surgeries are being done. This scope needs to be expanded to fulfill our obligations to the children.
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