With TSA in health sector, efficiency sacrificed for less corruption — MDCAN President

In this interview, President, Medical and Dental Consultants’ Association of Nigeria (MDCAN), and a psychiatrist, Dr Victor Makanjuola, speaks with Sade Oguntola on the implications of ‘laughing gas’ addiction, why Mmesoma Ejikeme needs therapy and how to revitalise the health sector, among other issues.

The NDLEA recently ordered a nationwide clampdown on illegal sale and use of ‘laughing gas’. What is it and what danger does it pose to health?

Nitrous oxide, commonly known as laughing gas, is a colourless, non-flammable gas and has a slightly sweet scent and taste. Taking the gas slows down the brain and the body’s responses, causing a feeling of euphoria, relaxation and calmness, fits of giggles and laughter – hence the nickname ‘laughing gas’. Apparently, the gas gives what is generally described as a high and that is why it is being misused by the young people. Its abuse as an illegal drug by the young people is not something that has been there for long, maybe some pockets of people may have been using it before but it was not of much public health concern as it is now, based on the directive from the NDLEA. The important thing to note is not just the clampdown, because there will be several clampdowns subsequently, as new substances of addiction are coming up every day.

World Health Organisation (WHO), within a short period, recorded over 61 new substances of addiction, so it’s an ongoing process and there will be other new substances that the young people will find attractive and begin to use. It is the appropriate thing to try and mop up the supply of such drugs. While they’re doing that, it is also important that preparation is made for treatment for those that may have already been addicted to it.

So far, we have not been seeing cases of addiction due to laughing gas in any of our facilities. But that does not mean there are no people already addicted to it, but it is not a common problem in our facility for now.

But we wouldn’t know the exact presentation of someone who is addicted to laughing gas or is abusing laughing gas. Its medical use is just for its anaesthetic and pain-reducing effects, especially in surgery and dentistry.

The Mmesoma result and JAMB saga trended for a while, with people expressing different opinions on the matter. Even Governor Soludo recommended counselling and therapy for the 19-year-old girl. What is your opinion on this recommendation?

Governor [Chukwuma] Soludo’s recommendation is very much in line. It is an appropriate thing to do for someone who has gone through such an experience, notwithstanding the outcome of the case, whether she was fraudulent, guilty or not. For a young person suddenly thrust into public limelight with all the vitriol thrown at her or thrown on her behalf on the social media, she would have suffered a lot of psychological sequelae from that experience, irrespective of whether she’s right or wrong. The fact is, she is a young girl who has been accused of a major crime. What is done in other places, which we should try to achieve in our clime, is to protect the identity of the accused all through the investigations and court trial until the case is over.

To make matters worse, the people supporting her now made a video of her talking about the matter. They made her the face of the protest. That was a major error and that perhaps will be more traumatic to her in the long run than any other thing that has happened. Every other thing could be easily managed, but that video has gone viral and there’s no way of deleting it from everyone’s phone, as it were.

So all these would definitely have done a lot of damage to her psyche and the recommendation for her to have some counselling and therapy is absolutely in order, more so that she has confessed to having falsified the results. Guilt feelings could be overwhelming and, at times, can also lead to depression and ultimately the person becoming suicidal. This is not what we want for a brilliant mind because her regular score in JAMB wasn’t bad at all. So I’m happy that the government thought of the aspect of her mental health and made provision for that.

Insecurity impact on healthcare in Nigeria in 2022 was reported to be widespread and cut across the nation. How do you see this?

It is disheartening that with all the challenges that the health sector is facing in terms of brain drain and most of the qualified hand leaving the country, we have these additional problems of insecurity, targeting health facilities, having doctors and nurses kidnapped. Even beyond crimes such as these, we also have doctors and nurses being attacked by relatives of patients who feel aggrieved and think the only way to address their grievances is to physically assault health workers. It’s really a disturbing trend.

The general insecurity in the country is also now taking its toll on health facilities. We can only call on the government to, as a matter of urgency, improve general security in the country, address the issues of banditry, Boko Haram and ISWAP. That can make the communities safer and also hospitals safer for health workers to do their jobs.

In the meantime, security personnel can be posted to these facilities, especially in areas that are prone to insurgency or banditry and assault. If we can afford to attach mobile policemen to a senator, why can’t we do the same for the district hospitals and general hospitals, to protect these workers and the facilities in these areas. Even personnel of Nigeria Security and Civil Defence Corps (NSCDC) can be posted to these facilities, to de-escalating issues if they arise. This will also give a sense of security to the staff of those hospitals while discharging their duties.

With the myriad of problems in the health sector, is it not appropriate that a state of emergency be declared in the sector?

It goes without saying that we are in a very precarious situation. Our association, the Medical and Dental Consultants’ Association of Nigeria, has severally in our communiqué called on the government to declare a state of emergency on the health sector; there are myriad of problems making healthcare delivery to Nigerians an herculean task and it’s getting tougher and tougher by the day. The fewer hands we have on the ground are also getting burned out because of the stress of managing more than they can cope with.

Virtually, all institutions that have attempted to recruit residents are falling short of the required numbers because there are no young people eager to take up appointments in any of the government hospitals as we speak. So the need to declare a state of emergency is more than justified.

Our parent association, the Nigerian Medical Association (NMA), also spoke in the same vein not too long ago, that a state of emergency is needed in the health sector. We hope the new government will take cognisance of this call and act on this immediately.

When a state of emergency is declared, it means you’re going to prioritise that sector and bring in all the resources, human and material, to stabilise it, because you’re talking of a crisis situation. You’re trying to stabilise the crisis situation or resolve the crisis. We cannot talk about health sector development now because we are actually in crisis – insecurity, brain drain, lack of hospital equipment and poor facilities in hospitals.  It’s when that crisis is addressed that we can talk about our five-year plan to develop the sector and to make it even more useful for Nigerians.

Many assume that all that is required for a vibrant health sector is money. Do you subscribe to this?

Money is not definitely the only problem. It is a major problem, knowing that usually between four to six percent of our total budget is given to health. This is grossly inadequate. Based on the Abuja declaration, it should be at least about 15 percent for health. But even if you put the whole of Nigeria’s budgets in the health sector without concomitant steps, there will still be a problem. Definitely the money is an issue because it dovetails into, of course, enumeration, equipment and facilities and all that. Even if you have all that, better supervision of the existing facilities has to be there. The health ministry needs to play its supervisory role on the limited resources that are being given out to be sure they are being adequately deployed and effectively utilised.

Also, there is the challenge managers of the health sector are facing from the use of the Treasury Single Account (TSA) in all these institutions. Of course, the TSA is put in place to minimise corruption in order that the government knows how much comes in and how much goes out. But, it is also choking the efficiency of running most of the ministries and agencies, not only in health but also in other sectors. We have sacrificed their efficiency for less corruption in the system. No doubt, the TSA must have curbed some degrees of corruption in the system, but it has brought up some other issues. Now the health sector is a very dynamic sector. It’s not a sector that you can wait for days before some expenses are met, the supply chain should be regular. You don’t want to run out of stock. This current system of running those institutions is making out-of-stock fashionable. It’s happening in almost all the systems. So we need to re-jig the TSA to make it smarter and faster.