by Ayo Olutokun
Let us raise the question then: What is the status of our national health institutions and why are public officials and others so scared of using them?
Nigeria is still reeling from the shock of the exposure of the horrible and dehumanising condition of the Police College, Ikeja. So frighteningly degraded is the shape of the college that President Goodluck Jonathan, following his unscheduled visit last Friday, has reportedly ordered a probe into how matters turned so awry in what was conceived as a top-flight security institution.
Equally, if not more important, but certainly warranting presidential intervention is the status of our much-decayed public health institutions, whether owned by federal or state governments. The impetus for commenting on this subject was provided by the National President of the Nigerian Medical Association, Dr. Osahon Enabulele, who was quoted in The PUNCH of January 20, as advocating the use by public officials including the President and the Vice-President of our national medical facilities rather than spending public funds on overseas treatment and medical check-ups. Pointing up the edifying example of the Kogi State governor, Idris Wada, who insisted on being treated at the National Hospital, Abuja after a auto accident, Enabulele argued that the only way to ensure that our national health institutions get the attention they deserve is to insist that high-ranking state officials should use them. In his words, “If the President stays in the same queue with others at the National Hospital in Abuja to receive health services, people will start to believe in that facility. People will get serious about committing resources and excellence to the development of the hospital.”
To be sure, government itself recently mooted the idea of putting a moratorium on funding overseas medical services for public officials except in acute cases which cannot be handled nationally. Indeed, the Minister of Health, Prof. Onyebuchi Chukwu, said a few months back that President Jonathan emphasised to him the need to raise our health care service delivery to world class standards as well as curtail overseas treatment for public officials at government’s expense. The issue, of course, is not that public officials who can afford overseas medical treatment should be prevented from using it but that the public should not have to pay for such considering, for example, that high state officials usually travel abroad with a retinue of aides also at our expense. It will be interesting to know how much the country has expended on medical treatment abroad for public officials in the last two or three years and what alternative uses that money could have been put into if we had a credible health infrastructure.
True, there are several dimensions of health care crying for attention but we can gain an entry into that Pandora’s Box by considering the NMA’s demand for high state officials to be compelled to use national health care as the Kogi governor did recently. Let us raise the question then: What is the status of our national health institutions and why are public officials and others so scared of using them? A recent document jointly authored by the Ministry of Health and an international institution says, “The quality, access efficiency and service availability of the health care system have stagnated and declined over the past decades.” Some of the well-known problems in this sector include chronic under-funding despite the mark-up of budgetary allocation to the sector in the 2013 budget, shortage of health personnel, rusty and outdated equipment, laggard work ethics, the supply of fake or sub-standard drugs as well as less than hygienic conditions in many instances. In the course of discussing the issue with Prof. Friday Okonofua, former Provost of the College of Medicine, University of Benin, the don noted that things were so bad in the health sector that he would not subject himself to being treated within the country if he were in a critical condition. Okonofua went on to itemise the problems as including outdated medical school curriculum, wrong diagnosis of diseases, poorly-trained doctors, poor health funding as well as the politicisation of appointments into university teaching hospitals and the neglect of training and retraining health workers. Quite a mouthful, if you ask me.
Talking about funding, for example, and to be fair to the Jonathan administration, it is pertinent to note that in 2011, four per cent of the national budget was allocated to health; in 2012, government increased it to five per cent and in 2013 it increased to 6.4 per cent. One can say, however, that this marginal increases are too little and too late to make any significant impact on that deteriorating sector considering that the stipulated percentage of the national budget to health by the World Health Organisation is 15 per cent. The argument is also made that several countries in Africa including Rwanda and South Africa have already met the WHO standard with respect to health sector funding. The point then would be why Nigeria cannot do much better than it is currently doing considering its population and the heavy burden of diseases and epidemics that the country bears.
In the same vein and given the recent revelation that funds annually appropriated to the severely blighted Police Colleges had not made any difference to their worsening plight, it should be factored that monitoring and implementation are just as important if not more important than a slight bulge in health sector allocation. The status of our health institutions often reminds one of an evocative article by Dr. Ngozi Anyaegbunam who after a harrowing experience involving a close relation at one of our apex medical facilities, cried out: “Thou must not be sick.” In other words, we must first appreciate the magnitude of the rot in the nation’s public health care and its underlying as well as contingent causes in order to provide a road map out of the woods. This is so because careful and correct diagnosis should precede scientific prescription. Obviously, a holistic revamping or transformational health agenda must take on board a wide array of issues which, as Okonofua noted earlier, include the quality of medical education as well as capacity gaps in human resources.
To connect back to the demand made by the NMA for mandatory use of national health care by high-level state officials in the mould of the Kogi State governor, it is clear that a government that is truly keen on health care reform would after putting the necessary policies in place seek to granting them credibility by asking its members to submit themselves to national health care. It is contradictory to, in one breath, advertise that health care is being transformed, and, in another, compel the nation to fund overseas treatment for high state officials. Therefore, government is enjoined to fast-track the policy to stop the funding of overseas health care for public officials if it wants to be taken seriously on its pledge to turnaround the health sector.
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