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National Health Act should be activated for improved healthcare delivery’

By Chukwuma Muanya, Assistant Editor,   |   01 October 2016   |   4:10 am

Perhaps we need to start from basics. At the level of a geographical expression called Nigeria, we have never built institutions in any endeavour. The health sector therefore cannot be an exemption. Recall that it was not until 2014 when the poorly implemented National Health Act was enacted that we first had a national health legislation. The National Health Act in the ideal; should have been a supreme health legislation from which other sub-sectoral laws should flow. When you compare this to Pharmacy practice which had regulatory laws laced in substantial antiquity because the Pharmacy ordinance was enacted as far back as 1887 with some amendments in 1902, then you begin to appreciate some of the foundational defects rocking healthcare plans and policies in Nigeria. In 1979 Health matters was on the concurrent list and strangely today it is not listed under the Exclusive, Concurrent or Residual list which means it is just floating. That shows you the importance people attach to health in our country.

The last straw appears to be deficiencies and lacuna embellished in most health statutes and laws which often times super-imposes one profession over others in a multi-disciplinary sector. If you reckon with the input of one interest to the detriment of a multitude of others, then you will institutionalize a consuming evil of voracious appetite on the operating template.

Healthcare was reduced to medical practice and all the requisite paraphernalia/structures in the care process were inclined on this unfortunate agenda.

This encouraged devilish diabolism as one group was empowered to trample on others without looking back. it created a fundamental distortion of a familiar grab-grab syndrome of all privileges and resources appropriated to the health sector by privileged persons.

How do you explain a situation whereby bastions of excellence like the University College Hospital (UCH), Ibadan which was rated as part of the best five health facilities in the commonwealth when health administrators managed our health facilities (House Governors), Pales into infamy or is it sinks into oblivion when late Olikoye Kuti came up with the obnoxious decree 10 of 1985 which vests leadership in health facilities on doctors who are not routinely trained for this responsibilities). The rest like they say is history because the legacies of the involvement of these guys in health management are our legendary negative health indices that every stakeholder is familiar with.

The solution
The solution is to begin to open the restricted boundaries in healthcare to all concerned by reckoning with their areas of competence. We fought the battle of our lives as representatives of Health workers on the Allied Health Professionals Association (AHPA) and Joint Health Sector Union (JOHESU) platform to ensure the National Assembly enacted a justiable Health Act. It is the first time we have a law acceptable to the majority in our sector. The major legislative tool I kept emphasising at the turbulent public hearing on the erstwhile National Health bill was the need to factor the proviso in section 42 a(1) and (2) of the 1999 constitution which forbids discrimination to a citizen of Nigeria on the basis of his social, cultural, religious, sex and professional affiliations.

As former PSN President I took this matter to both former Senate President David Mark and Rt. Hon. Tambuwal who was the Speaker of the House of Representative on the same day at difference scheduled appointments. The National Assembly subsequently amended all clauses that conferred exclusive privileges to any profession.

Some of the erstwhile Senators, who are now Governors and Ministers resisted but our unity of purpose propelled us to sustain the inertia to change the unfavorable status quo. We got a good National Health Act. Whether the implementation is right is a matter for another day.

Some of the benefit package inherent in our struggle against discrimination is that a few bills, which the National Assembly has worked on subsequently took cognisance of section 42. This includes the National Health Insurance Scheme (NHIS) amendment bill in the 7th National Assembly and the Cancer Institute bill of the current National Assembly. Today the emerging principle is that any competent care-provider can lead healthcare endeavours. I insist this is the road to travel.

Health care services delivery 56 years on
The obvious answer is we have not made significant progress. It is always difficult to move ideas and concepts forward once they are grounded in contraptions. It will be too painstaking to begin to delve into the amplitudes of the contraptions in the health sector. In most climes healthcare delivery is sustained through Social Health Insurance, a viable form of healthcare funding. You need to appraise the charade called NHIS in Nigeria. The NHIS has become one of the biggest avenues of thievery in our sector because what I see is sharing of resources. Little wonder the NHIS is stalled in growth and statue. It has covered less than 3.5 per cent of the citizenry since 2006 when it was inaugurated. If separation of professional roles and responsibilities, payment mechanisms, segregation of capitation for different facilities pose a challenge, it will be naturally difficult to expand the frontiers to Community Based Social Health Insurance which serves the dominant informal sector.
Olumide Akintayo is the immediate past President of the Pharmaceutical Society of Nigeria (PSN) and Chief Executive Officer (CEO) of Togmed Ventures Limited.

The new NHIS boss observed some of the wrecklessness I just highlighted because I read his comments on the contributions of Health Maintenance Organisations (HMOs) to the NHIS.
Nigeria’s investment on healthcare delivery
Nigeria especially in recent years does not have enough money to spend on any sector. We must manage the little we have for the benefit of our people. Even when we take a position that there is a dearth of resources, what did the managers of our sector do with what was made available to them in the past?

Let me say the National Health Act gives a window for improved healthcare funding through first line deductions from the federation account. Today section 10 provides that 50 per cent of this accrual must be channeled towards health insurance, 10 per cent will be for procurement of medicines and equipment at primary care level and five per cent for the training of personnel.

On paper this is beautiful and laudable, but will government actualise this to become deliverables. I can only say we are watching.
On skilled manpower in the health sector
We may not have sufficient manpower, but we definitely have well trained personnel who can match their counterparts globally.

Today, we have about 20,000 pharmacists, over 50,000 doctors, 250,000 nurses and about 25,000 laboratory scientists. The figures do not meet World Health Organisation (WHO) projections certainly.

How do we incentivise and motivate the care-workers who have decided to work here? Not anything too palatable.

One area that is very painful which we seldomly highlight is Research and Development (R &D). What is our budget for the trained personnel in research institutes? There are at least two prominent research institutes in our sector Nigeria Institute for Pharmaceutical Research and Development (NIPRD) and Nigeria Institute for Medical Research (NIMR).

Both parade a galaxy of experts who are frustrated because there are no resources or tools to advance research.

Olumide Akintayo is the immediate past President of the Pharmaceutical Society of Nigeria (PSN) and Chief Executive Officer (CEO) of Togmed Ventures Limited.

NIPRD developed Niprisan an anti-sickling agent which was first isolated in Fagara by late Prof. Abayomi Sofowara, Fellow PSN (FPSN), of the Drug Research and Production Unit of the University of Ife: Paucity of funds have however ensured it is impossible to commercialise this initiative. I am aware that the PSN, which spearheaded the establishment of this research institute is now trying to raise funds in collaboration with Pharma-stakeholders to rescue the situation. It should not be that way.

How do we run our professionally driven regulatory agencies like Pharmacists Council of Nigeria (PCN), National Agency for Food and Drug Administration and Control (NAFDAC), National Primary Healthcare Development Agency (NPHCDA), Centre for Disease Control (CDC), Medical and Dental Council of Nigeria (MDCN) and others? By bringing incompetent political acolytes at like we saw in the immediate past dispensation thus creating an avoidable stress junction, which de-motivates the handful of so-called well trained staff.

Frequent strikes in the sector?
Ordinarily strikes should always be the last option available in trade or labour disputes. Government insincerity has promoted strike actions to the front burners like never before in our sector. Health professionals and workers under the JOHESU/AHPA coalition have been negotiating on the same issues that I was privy to be involved with as a vintage PSNIST in the last couple of years. Government violates collective bargaining agreements, memorandum of understanding, court judgments and so on even when chieftains of government mouth a rule of law mantra. The disgusting part of it is that when government negates dialogue with representatives of organised labour, it encourages and facilitates negotiations with groups, which are not even trade unions contrary to the norm and relevant statute. These acts of double standard bring out a propensity towards emotional conflagration of persons who feel oppressed.

I am told that JOHESU has shifted strike ultimatums about 15 times since the incumbent administration came on board, but government has not reciprocated this goodwill. In fact at the last round of negotiations which was botched a representative of the Federal Ministry of Health was said to be raining invectives on JOHESU/AHPA representatives to the chagrin of all.

This concatenation of events is what encourages people to suspect rather than respect the persons who dominate the leadership of the Federal Ministry of Health.

I want Prof. Adewole who leads the Federal Ministry of Health to succeed because he shows more respect to some of us in the array of professions than all his immediate predecessors put together, but he will have to perfect a human relationship management model that will be time tested.
How can the country achieve inter disciplinary harmony in the health sector?

Very simple entrench an equitable structure which is laced with fair justice. In simple and practical terms, how do you expect a harmonious relationship between contending groups when you foister representatives of one of the groups to superintend over all.

At the inception of this administration, President Buhari improved on the aberration of the Jonathan government which, was the first to have the two Ministers in charge of the Federal Ministry of Health coming from one profession by appointing a Permanent Secretary from the same profession. The ripple effect played out immediately until even non-health workers demanded albeit violently the removal of that Permanent Secretary.

If you ask me, I would appoint non-healthcare professionals to lead the Federal Ministry of Health until we can achieve some stability. Please check the progressive era we have recorded in the Federal Ministry of Health and you will discover it was when this cadre of persons were in charge. The last of such noble appointments was with Prof. Eyitayo Lambo.

If government however insists on having health workers then let us have a spread of the available options in the health professions. Perhaps government can start by placating us with a portfolio for Special Adviser (Health) to a care provider that is not a doctor. President Buhari can then follow up with lawful appointments in our various regulatory agencies in the days ahead.

• Akintayo spoke with the Assistant Editor, CHUKWUMA MUANYA

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