The Nigerian health care has suffered several down-falls. Despite Nigerian’s strategic position in Africa, the country is greatly underserved in the health care sphere. Health facilities (health centers, personnel, and medical equipments and funding ) are inadequate in this country, especially in rural areas. While various reforms have been put forward by the Nigerian government to address the wide ranging issues in the health care system, they are yet to be implemented at the state and local government area levels. Health care system remains weak as evidenced by lack of funding, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care.
The health sector in any economy forms the backbone of its growth and development. Factors affecting the overall Nigerian health system performance include: inadequate health facilities and structures, poor management of human resources, poor motivation and remuneration, inequitable and unsustainable health care financing, skewed economic and political relations, corruption, illiteracy, decreased government spending on health, high user fees, absence of integrated system for disease prevention, surveillance and treatment, inadequate access to health care, shortage of essential drugs and supplies and inadequate health care providers.
In a special Interview with the Editor of Skybirdnews Group, Mr. Charles Nwaoguji, the President of Nigerian Medical Association, Dr. Francis Adedayo Faduyile, said one of the major challenges facing healthcare financing in Nigeria is the low budgetary allocation to the health sector, adding that the Nigerian health care system is poorly funded and developed.
“Government should ensure adequate funding with transparent public-private partnership as an integral part. Like we have said time and time again, allocation of the minimum benchmark of 15% of total annual budget to the sector in line with the Abuja Declaration of 2001, full implementation of the National Health Act 2014,” he said.
Faduyile, who is also Associate Professor/Consultant Pathologist, Department of Pathology & Forensic Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, stressed that infrastructural revamping especially at the primary healthcare level, give more attention to care of cancers, addressing gaps in human resource for health with equitable distribution, training and retraining of health workforce, improvement in General welfare and emolument of healthcare professionals, and ensuring prioritization of resources and accountability.
To achieve success in health care in this modern era, the professor called on the government to make provisions for proper funding of the health sector.
“Government must realize the importance of working with stakeholders in the sector especially the professional bodies,” he added.
In this interview, he spoke on Challenges facing healthcare in Nigeria, COVID-19, his Major achievement since he became the president of Association, how the lockdown has affected businesses and etc
Challenges facing healthcare in Nigeria
The health system of our dear country is fragile. This is the results of numerous impediments which have been left unattended for years. These include, distortion in healthcare services in which case common ailment that should be treated at the primary health centers usually presents to secondary and tertiary facilities leading to unnecessary pressure at the tertiary health institution and therefore a major challenge to effective care at this level. This is not unconnected with dilapidated infrastructures at the primary healthcare system and inadequate manpower. The other key issue is poor funding of the health sector. For a long time the average budgetary allocation to the sector is less than 4% of the total annual budget, and compounded with the abysmal performance of the NHIS since inception, individuals and families still rely on out-of-pocket payment for healthcare services with catastrophic aftermaths.
On policy, we have laudable ones, however, the problem has been poor implementation and lack of political will. For instance, the Abuja Declaration by Heads of Government in Africa in 2001 and the National Health Act of 2014 are yet to be fully implemented. We must not also forget that lack of accountability, industrial disharmony, poor emolument, unhealthy working environment and general welfare, have their shares. All these factors have contributed to brain drain with worsening health workforce to patients’ ratio and the consequential poorer health indices.
How tackle these challenges
Our responsibility as a professional body in this regard is to work with Government at all levels to ensure the challenges that are responsible for the deplorable state of the sector is tackled head-on. And we have done a lot by supporting in area of science based approach to problem solving and collaborative drive. The current NMA administration has been engaging the government through advocacy; and we have continued to impress it on Government the need for political will in addressing the challenges.
The NMA was pivotal in the journey to having an all encompassing document like NHA 2014; the blue print generated from the 1st NMA National Health Summit held in 2013 forms the template for the National Health Bill which later became an act of parliament. We hosted the 2nd edition of the National Health Summit in November 2019 and the blue print will be presented to Government as soon as possible, and will hope it will be made use of. Aside this, we have periodically generated advisory/policy documents on critical areas including healthcare financing, primary health care strengthening, public-private partnership among others. It may interest you to know that most times government prefers to do things the old ways. Nevertheless, we will continue to do our part like we are currently doing in the ongoing war against the COVID-19, and despite the disposition of Government, we have recently generated advisory document on the best way to tackle the pandemic.
Having COVID-19 is not a death sentence
Well, my view on COVID-19 is what I believe most Nigerians are aware of…it is what the scientific community is saying. It is a viral disease caused by a novel coronavirus, unfortunately with so many unknowns. The good thing is that it is preventable; regular hand washing, respiratory hygiene (coughing onto bent elbow or handkerchief or tissue paper with proper disposal and hand hygiene, use of face mask, social distancing, avoiding large gathering among others. Also, it is important to note that having COVID-19 is not a death sentence; over 95 percent of those infected survive it. Early reporting of symptoms with volunteering of contact or travel history, case detection through testing, isolation (and self quarantine in those exposed) and care at are designated centres are key tolls on its management.
It is also important to state that those without symptoms can transmit COVID-19. That’s why social distancing and other measures have become so important at this point of community transmission in Nigeria.
Cure for the disease
The fact is that there is no cure as at today. However, there are ongoing trials on some drugs with initial data said to be promising. But let me say this that Nigerians must ignore the misinformation going around on the cure of COVID-19 including traditional cure. There had not been any therapeutic cure of any virus till date!
The way out is for Government to ensure adequate funding with transparent public-private partnership as an integral part. Like we have said time and time again, allocation of the minimum benchmark of 15% of total annual budget to the sector in line with the Abuja Declaration of 2001, full implementation of the National Health Act 2014, infrastructural revamping especially at the primary healthcare level, give more attention to care of cancers, addressing gaps in human resource for health with equitable distribution, training and retraining of health workforce, improvement in General welfare and emolument of healthcare professionals, and ensuring prioritization of resources and accountability. Government must realize the importance of working with stakeholders in the sector especially the professional bodies.
Nigerian Medical Association
The Nigerian Medical Association (NMA) is the umbrella body of all medical and dental practitioners in Nigeria with over 42,000 members from 36 State and Federal Capital Territory branches, and about 19,000 in diaspora. So, any medical or dental practitioner registered under the Medical and Dental Practitioners’ Act CAP 221 Laws of the Federation of Nigeria (1990) as amended has the right of membership. As a professional body, the NMA is committed to fostering effective and efficient health care delivery, high ethical standards and the interest of its members.
The current administration 2018-2020 led by my humble self came on board on 5th May 2018.\
We have made remarkable impact since the current leadership took over in 2018. One of the major achievement is the attainment of reasonable level of stability in the health sector. The NMA took it as a priority to ensure inter-professional harmony in the sector, and it gladdens my heart to say that the NMA is currently working with the Pharmaceutical Society of Nigeria and the National Association of Nigeria Nurses and Midwives on pertinent issues in the health sector and this has reflected in so many matters of national importance in recent time. We are also moving ahead to bring on board other sister Association in the sector.
Secondly, immediately we took over the baton of leadership, we set mechanisms in action to ensure the reconstitution of the Council of the Medical and Dental Council of Nigeria (MDCN) after about 3 years the council was dissolved. What it means is that during this period the medical practice was not properly regulated and that gave room for lacuna in medical practice in Nigeria including the attendant unprecedented quackery and its aftermath. The Council was reconstituted by President Muhammadu Buhari few months after following a well structured advocacy and persistence, and the Council has been performing its statutory functions since then.
Social intervention and corporate social responsibility in the form of free medical and surgical outreach at every National event which is replicated by the branches, and our affiliates like Medical Women’s Association of Nigeria, Nigerian Dental Association, NARD, MDCAN have been impacting the lives of Nigerians in several ways; increasing the relevance of the NMA in the global medical community leading to the emergence of a Past President of the NMA as the Chairman of Socio-Medical Affairs Committee of the World Medical Association as well as producing the President of Commonwealth Medical Association, and also a Nigerian doctor as the President of Medical Women’s International Association; resolution of the age-long dispute on NMA Land in Abuja and the NMA House, an 8-storey edifice is upcoming; robust management of disputes within the Association and the general welfare of members. Of course, it is no longer news that we (with other sister associations) recently signed an MUO with the Federal Government on improving the welfare of members especially amidst COVID-19 pandemic.
How lockdown has affected businesses
It is obvious the lockdown has affected businesses at all levels tremendously with small and medium scale businesses more affected. You can imagine the impact of the lockdown on the livelihood of petty traders. This has also been identified as one of the reasons the lockdown may not have been as effective as it deserve especially considering the gaps in reaching Nigerians leaving below the poverty as regard the various palliatives of Government.
Medical profession in Nigeria
In considering the odds, I will say that the medical profession in Nigeria may not be where it supposed to be at this moment, but certainly, we have made remarkable progress. Most importantly, Nigerian doctors and other health workers have continued to give their best to their father’s land whenever the need arises. Don’t forget during the Ebola epidemic the medical profession rose to the challenge and that we have been doing in terms of lassa fever virus. And currently, the profession has proven its worth in tackling the COVID-19 pandemic so far. In terms of medical education, Nigeria trained physicians are making waves all over the world. However, like every other profession, we are doing our best to ensure professionalism and standards are adhered to at all times.
Measures to tackle this pandemic
Like I have said before, in all we do we must not forget that Nigeria has a weak health system. Therefore, we must make sure at all cost that we do not have a full-blown community transmission in the country. This is from the experience of countries with strong health system being overwhelmed in the face of full-blown community transmission. The best way is to ensure that we prevent the transmission of the virus at this stage, that is why effective lockdown is advocated even with its attendant pains on the populace. It is the same people who will complain if we allow this time to slip in our hands and get to exponential phase of infection. We must ensure massive screening and rigorous contact tracing to take all infected into isolation and to be treated accordingly. The public must adhere strictly to physical distancing, avoidance of public gathering of any form and the universal use of face mask or home-made cloth mask. There is need to strengthen ongoing strategies that have proven to be effective elsewhere. We must continue to monitor and evaluate these strategies with the aim to improve on them whenever the need arises. Others include; intensification of awareness campaign, community engagement and risk communication, opening of new isolation centres with full complement of equipment and properly equipping existing health facilities across the country with adequate personnel protective equipment, review and approve better welfare incentives for medical personnel, transparency in the management of allocated resources, and involvement of all stakeholders.
Again, the need to ensure adequate palliatives and transparency the exercise cannot be overemphasized. We have released a detailed advisory tagged “NMA COVID-19 Policy Advisory Paper”, and it will be good for all Nigerians to make use of it.