Professor Emmanuel Oladipo Otolorin, the current President of the Ibadan College of Medicine Alumni Association Worldwide (ICOMAA WW) and retired professor has served in the field of Obstetrics and Gynaecology as well as public health for over 42 years. In this interview with SADE OGUNTOLA, he describes over-centralisation of administrative processes, poor funding and misapplication of the TSA as the bane of public tertiary education and tertiary health in Nigeria. Excerpts:
Are there reasons to be concerned about tertiary health, particularly because of the state of tertiary education in the country?
Well, I am really concerned about these two sectors: public tertiary education and public tertiary health. For quite some time, based on the global ranking of institutions, Nigerian public universities, like the University of Ibadan, have been among the leading universities in Africa. However, recently, because of inadequate funding and unfavourable government policies, these public tertiary institutions have been going down, including the ones that teach medicine.
There are now some challenges that are impeding the Ibadan College of Medicine’s ranking, which are related to the academic staffing of the university.
Basically, an academician in the College of Medicine has three functions: training of medical students, providing service to patients and conducting research. Now, these public universities as well as their affiliated teaching hospitals are grossly underfunded, and this has already taken a toll on the quality of training and health service provision.
Nigeria signed the 2001 Abuja Declaration on Health, which was spearheaded by the African Union. The declaration stipulated that 15 percent of all national budgets in Africa should be devoted to health, but Nigeria has not been able to achieve this target. In fact, the average allocation to health in Nigeria over the past two decades has been 4.7 percent. This inadequate funding has led to a decline in the quality of public tertiary health institutions, including those that prepare our healthcare workers. As a result, the training of healthcare professionals has been affected and there is infrastructural decay everywhere within these institutions.
The biggest challenge of all is the electricity bill, which is killing these public tertiary education and health institutions across the country. All the teaching hospitals are struggling to pay the commercial rates being charged by electricity distribution companies. For example, the University of Ibadan pays approximately N90 million per month while the University College Hospital has to pay about N50 million monthly. Currently, UCH owes about N450 million to the Ibadan Electricity Distribution Company (IBEDC) of which the College of Medicine and the University of Ibadan have to pay N175 million for electricity supply to the college and to the students’ hostel located on the hospital premises. Government’s provision for electricity to these institutions is approximately N10 million to N15 million per month. Where’s the balance going to come from?
So when the Federal Government muted the idea that 40 percent of whatever internally generated revenue of this institution should be sent to the Central Bank of Nigeria (CBN) for government use, my fear was that it was going to further worsen the problem of funding in the teaching hospitals as well as in the universities.
Is it only funding that may affect the ranking of these public health and educational institutions in the future?
No, there are other problems. For example, you find a lot of senior academic staff are leaving the system at the attainment of 70 years of age, but the younger doctors who ought to be trained to take over their places are also leaving the country in droves (the ‘Japa’ syndrome). Hence, these senior academic staff are not being replaced. Even if you find some young people who want to step in, the Vice Chancellor, the Provost of the College of Medicine, or the Chief Medical Director of teaching hospitals cannot even decide to replace them. Virtually, all administrative processes are over-centralised in Abuja. To even hire a driver, the principal officers of these institutions will have to go to Abuja multiple times, spending money that they do not have. This is killing the system.
Now, the worst part of it all and the last straw that will certainly break the camel’s back is the issue of paying third-party research funds into the Treasury Single Account (TSA). The TSA was set up by the government to monitor all revenue receipts and accounts of the government of Nigeria. But the system is being applied in such a way that even when you get a third-party research grant from, say, the US or Japanese government, it has to go into the TSA. When it gets to the TSA, first of all, you may not get timely notification as the Principal Investigator for months. Meanwhile, the people who sent the funds are asking if you have received the funds and you cannot say ‘yes’ because the Central Bank of Nigeria (CBN) is unable to trace this money for research. That is now creating a lack of trust from the donors in the public university system. This is a national embarrassment. This is not happening at private universities where their funds are kept in commercial banks. So, the result is that some of the donors are now diverting their research grants to private universities or to other countries.
In addition, some of the public university professors are now devising other ways of setting up non-governmental organisations (NGOs) and presenting those NGOs to donors for funding. Hence, funds that should come to the university system from which five to 10 percent are used for administrative processes in the institution are being lost.
A lot of the professors and senior researchers who are staying back in Nigeria are doing so because of the image they get from grant-making, publications and travelling to conferences. Now, when TSA kills that incentive and they can no longer get their grants in a timely manner, they will leave the system (internally or externally) and this will adversely affect the ranking of the universities. Research grants are time-bound. If you have a three-year grant and you spend the first year chasing the money in the CBN, you cannot meet your deliverables and your reputation will begin to sink. The government must reverse this policy immediately. Third-party grants that do not belong to the Federal Government have no business being paid into the TSA account of the CBN.
If this trend is not arrested, the public tertiary institutions are going to be the losers. Covenant University, a private university, has already come up and has overtaken the University of Ibadan as the best university in Nigeria. That is worrying because even the University of Ibadan, which has some of the best professors and publications and has always been at the forefront of research and training in this country, is now becoming second fiddle.
Currently, many of these institutions are struggling to maintain quality services. A lot of help is coming from alumni, but there is so much to be done. There is a limit to what the alumni can do. Besides, it is the government’s responsibility to properly fund its own institutions, so long as the government says it owns them. Alternatively, the government can give the institutions administrative and financial autonomy.
Is making these public tertiary institutions autonomous doable?
Absolutely doable, but, of course, once they get autonomy, they have to take certain decisions that may not be popular with the general public. Take, for example, school fees. A student at the College of Medicine of the University of Ibadan pays N475,000 per year to study medicine. Their contemporaries in private universities pay a minimum of N5 million per year. Certainly, this will have to change because poor funding is killing our public tertiary institutions slowly but surely.
If the situation does not change, how do you see this impacting access to quality health services?
If nothing changes, I am afraid the general public will end up having to prioritise patronising private hospitals rather than public hospitals. Already, that is happening in education. More parents now send their children to private schools, though they themselves passed through public schools, including universities, and are now paying a lot of money. That is going to be so too in getting trained as a health worker.
So, what is the way out of this dilemma for public tertiary education and tertiary health institutions across the country?
I am hoping that with the new government in place, there should be a different approach to this matter. The TSA policy needs to be reviewed to exclude third-party funds. Third-party funds should be kept in commercial banks so that they are available whenever they are needed for research and accountability to the donors. Two, over-centralisation through IPPIS needs to be reviewed; it should be decentralised even if it is on a regional decentralisation basis. Everybody cannot go to Abuja just because they want to hire someone for a particular job; it is affecting education and health. Thirdly, social services, health, security, education and, of course, food security should be prioritised. Those are the things that mostly affect the common man. Going to buy expensive luxury vehicles for the National Assembly members sends the wrong message to the people. That is insensitivity of the highest order, when the ordinary people are suffering. Even the proposed student loan programme has yet to be actualised. So we need to have a review of these issues. Otherwise, we are slowly but surely killing public tertiary education and public tertiary health in this country. And this is my concern.
A lot of people are no longer interested in coming back into the system, unlike in those days when it was a pleasure to serve this country. In those days, it was a pleasure to be appointed Vice Chancellor, Chief Medical Director or Provost of a College of Medicine and you had the authority and funding you needed to work and to leave a legacy. But now, all those positions are empty. They are just running around trying to get help from one place or another and it’s very frustrating. For me, keeping quiet when all this is going on is not an option. It pains my heart to see my alma mater going through all these pains. As alumni, we are determined to do everything within our power to keep our institution’s flag flying.
So what are institutions like UCH and LUTH not doing to remain at par with big institutions like Harvard School of Medicine or the University of London?
Most of the Ivy League universities abroad have autonomy; they can make decisions based on reality. They have a budget that meets their expenditures. Here, many of the institutions were established for political reasons, while the funding for them was not provided. Rather, the funding available is spread among all of them and, as such, the available funds for the already established institutions keep going down. It is only the private institutions that are financially stable because they can charge whatever is needed for them to maintain the quality of the services they provide, and sadly, many of the staff who go to work in these privately funded hospitals are moonlighting from the public sector.
If you juxtapose that with the University of London Hospital and the University College Hospital Ibadan, what does that translate into in terms of healthcare services?
The main difference is national health insurance. Places like the University of London Hospital are able to charge their clients what they should because the patients have health insurance.
But in Nigeria, health insurance is just for a few, mainly civil servants. Most of the health expenditure in this country is out-of-pocket, and that’s why people run away from the hospitals until they are almost dead.
They will run to churches, mosques and herbalist’s homes before contemplating going to the hospital. Ensuring that everybody is covered by health insurance is central to reducing Nigeria’s bad health indices, including increasing the life expectancy of the citizens. Also, we cannot improve health without increasing funding for health and making policy changes to help improve healthcare.
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