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Experts call for human resource for health strategic development plan

By Chukwuma Muanya and Adaku Onyenucheya
29 May 2019   |   3:06 am
All things being equal, President Muhammadu Buhari has started the second lap of his journey towards bringing Nigeria to the promise land. But the first part of the journey has been tortuous. It was filled with among others things unmet promises, frequent medical trips by Mr. President and some other political office holders especially to…

Minister of Health, Prof Isaac Adewole

All things being equal, President Muhammadu Buhari has started the second lap of his journey towards bringing Nigeria to the promise land.

But the first part of the journey has been tortuous. It was filled with among others things unmet promises, frequent medical trips by Mr. President and some other political office holders especially to the United Kingdom (U.K.), strikes and threats of industrial action by various groups in the health sector, brain drain as young Nigerian doctors move in droves overseas in search for greener pastures.

Also, until now, there has been rise in cases of drug abuse and misuse as well as fake drugs; and some local drug manufacturers are winding up because of unfavourable business environment, high tariffs and poor patronage by government.

Some of the promises made by President Muhammadu Buhari on how he intended to improve the health sector, which he has not met include: ban on overseas medical treatment by government officials; improvement on budgetary allocation to health from the paltry average of five per cent since 1999 to meet the 15 per cent recommended by the Abuja Declaration by African Heads of State in 2001; to refurbish 10,000 Primary Health Care (PHC) centres nationwide; to resuscitate the Yaba Vaccine plant and begin local production of vaccines; to institute free/ highly subsidized medical care for children under-five years, pregnant women and people over 70 years; to expand the National Health Insurance Scheme (NHIS) coverage from about four per cent to cover at least 40 per cent of Nigerians.

However, despite some of the shortcomings, President Muhammad Buhari made some remarkable achievements in his first tenure. Top on the list is the signing of the 2014 National Health Act (2014 NHA) into law which establishes the Basic Health Care Provision Fund (BHCPF) and the setting aside of the one per cent of the Consolidated National Revenue for basically the development of PHC and NHIS.

hospital ward

Perhaps one of the most valuable long-term investments of this administration is the passage of the Act establishing the Nigeria Centre for Disease Control (NCDC). This agency, which was established in 2011 to lead the response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics, had existed for over 10 years without a legislative mandate. This led to some uncertainty about its role and mandate. This has now been resolved by the leadership of Buhari, providing an unambiguous mandate to NCDC as contained in the new Act.

This agency, which was established in 2011 to lead the response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics, had existed for over 10 years without a legislative mandate. This led to some uncertainty about its role and mandate. This has now been resolved by the leadership of His Excellency, President Muhammadu Buhari, providing an unambiguous mandate to NCDC as contained in the new Act.

For the first time, a National Action Plan for Health Security was developed and launched in December 2018.

Prior to 2015, Nigeria depended largely on other African and Western countries for laboratory testing. In 2017, the new National Reference Laboratory was operationalised in Abuja, and now leads public health laboratory diagnosis in the country.

Also, in the last two years, there have been minimal industrial actions in the health sector compared with what was obtainable in the past.

President Muhammadu Buhari’s promise to stop health tourism
Dr. Osahon Enabulele is a former President, Nigerian Medical Association (NMA), member, Executive Committee of the World Medical Association (WMA), coordinator, Coalition of African National Medical Associations (CANMA) and Vice President, Commonwealth Medical Association (CMA).

Enabulele told The Guardian: “This is one area where President Muhammadu Buhari failed to keep his promise in his first term in office. Most of his frequent foreign medical trips were not only conducted in violation of section 46 of the National Health Act, they unfortunately worsened the trend of outward medical tourism with the attendant huge capital flight out of Nigeria.

President, National Association of Resident Doctors (NARD), Dr. Segun Olaopa, President Muhammadu Buhari broke promise to end medical tourism. He said President Buhari flew to London to be treated for an ear infection when the nation has more than 250 ear, nose and throat (ENT) specialists, as well as a National Ear Centre.

Olaopa said in April 2015, months before his first medical trip to London, President Buhari condemned the use of Nigerian resources on international medical expenses. “While this administration will not deny anyone of his or her fundamental human rights, we will certainly not encourage expending Nigerian hard-earned resources on any government official seeking medical care abroad, when such can be handled in Nigeria.”

The NARD President chronicled President Buhari’s foreign medical trips
* February 5, 2016- Buhari embarks on a six-day medical vacation to London.

* June 6, 2016-Buhari takes to the skies for a 10-day medical vacation. Presidency says Buhari has to travel to deal with a “persistent ear infection”.

* January 19, 2017-Buhari is off to London again on a medical vacation.

* February 5, 2017- Buhari writes the national assembly, asks Lawmakers to extend his London medical leave. March 10, 2017-Buhari returns to Nigeria but does not resume work immediately. Presidency said: “He is working from home”.

* May 7, 2017-Buhari embarks on trip to London for another medical vacation. He returns after 104 days. August 19, 2017- Buhari returns to Nigeria and it takes him a while to resume work because rats have reportedly damaged furniture in his office. Presidency announces he will be working from home,

* May 8, 2018- Buhari is off to London for “medical review”—another name for a medical vacation. It is his fifth medical trip since he was inaugurated President on May 29, 2015.

Olaopa said the chances are high that the President or other politician that leave Nigeria to go abroad for medical treatment may end in hands of one of the 3,000 Nigerian-trained doctors United Kingdom (UK), or any of the more than 5,000 in United States (US).

He said the President have spent more than 170 days, more than five official medical trip, in London on official medical leave since becoming President in 2015

Olaopa said the President family is not left out. “After what was reported to have been a motorbike accident in January, the President’s son, Yusuf Buhari, had post-surgical rehabilitation abroad,” he said.

Chief Executive Officer/Managing Director, Fidson Healthcare Plc. Dr. Fidelis Ayebae, said the per capita income of Nigeria is one of the poorest in the world as the leaders and the elites are doing nothing to address the situation, adding that other countries that are equal to Nigeria, such as Singapore, Malaysia, Indonesia, India have long moved forward leaving her behind

He said the health sector is not in good shape as the government’s promises for it has never been fulfilled.

He said as President Muhammadu Buhari and his ministers have been reelected by Nigerians because of their believe in the ‘Next level” slogan, he should ensure his promises for the nation would be fulfilled this time.

“Next level for us is job creation, good infrastructure, access to good medicines, affordable drugs, quality of life by cheap prices of food. We want locally produced foods.

Ayebae continued: “Nigerians are always hardworking people, very supportive and they have long suffered, we will continue to pressure the government to fulfill its responsibilities to the citizens.”

How far has President Buhari realised this? His personal sabotage of this dream
Enabulele, who is also a consultant physician at the family medicine department University of Benin Teaching Hospital (UBTH), Edo State, said: “It was more of a reversal of his promise rather than any form or level of realization of his promise. One hopes that the President can redeem his promise as he gets set for his second term inauguration. He needs to walk the talk and transparently lead by example in reversing outward medical tourism.”

President Pharmaceutical Society of Nigeria (PSN), Mazi Samuel Ohuabunwa, said: “The President has not been able to meet this promise. Perhaps nature played a fast one on him in this respect. Indeed he seems to have actually promoted it. From all indications Nigeria is not yet ready to stop health tourism.”

Olaopa said President Muhammadu Buhari has repeatedly promised an end to outbound medical tourism, it was even an electoral pledge.

The NARD President said Nigerian health system could handle many of these ailments. He said this is in tandem with the NMA’s previous statement saying that Nigerian doctors ‘are capable of handling any ailment if optimal working conditions are provided.’

He said the government has refused to answer questions on how much the state has paid for his many tips to the United Kingdom (UK) for medical care nor has President Buhari put any timescale on the promise to end medical tourism and to send an executive bill to the National Assembly to ban publicly funded medical tourism. Olaopa said the bill was thrown out of the House of Representative on May 16, 2019.

Poor budget for health
Enabulele said this has virtually become perennial despite the promise made by every new government to give expression to the 2001 Abuja declaration of African Heads of Government to commit a minimum of 15 per cent of national budget to the health sector.

He said with the recurrent poor budgetary allocations and releases to the health sector, it will be near impossible to attain universal health coverage and the needed transmogrification of Nigeria’s health system.

“So, there is need for greater investments and improved budget allocations and releases to the health sector with appropriate mechanisms put in place to track, monitor and evaluate the utilization of the investments and funds for the health sector,” he said.

Ohuabunwa said Nigeria’s allocation to health budgets remain paltry at less than five per cent, despite the National Health bill, which was expected to vastly increase funding to healthcare. “The law is yet to enjoy full implementation,” he said.

The Minister of Science and Technology, Dr. Ogbonnaya Onu, said there is inadequate budget allocation to research and government regulatory agencies, which he said is limiting certain functions that would improve the lives of Nigerians.

“Government is putting in resources to fund the science and technology agencies, though the funds are not enough, but it is better than what we had before and definitely as the economy becomes more buoyant, more resources will come,” he said.

Also, the Chairman and Managing Director, Orfema Pharmaceuticals Industry limited, Orimadegun Agboade lamented that in sectoral allocation of funds, the pharmaceutical industry has never benefited, which he said has limited the effective functions of the industry, while he urged the government to give ‘Pharma fund’.

This, he said would be put into use by the industry as the money would be used to upgrade factories and buy more equipment, noting that the ambience for production should be what is obtainable outside Nigeria.

He said the pharmaceutical industry, which should be providing jobs for over 1000 graduates, is employing not up to a 100, stressing that no nation’s economy can progress without productivity

“We are producing graduates in sciences, where will they work?” If we can increase our local production we would employ more people, we would pay workers and we will develop some infrastructural items around our factories. But we cannot do that if the doors of the factories are locked,” he lamented.

State of health institutions especially the teaching hospitals
Enabulele said: “While some health institutions seem to be striving hard to improve their infrastructure, processes and practices, what is undeniable is the fact that most health institutions in Nigeria, including teaching hospitals, are in dire need of rejuvenation, rehabilitation and upgrade.

Governments at all levels need to appropriately invest in health institutions and facilities in their jurisdictions, with commitment to sustained maintenance of those health institutions and facilities. There is also need to ensure judicious utilization of funds invested in these health institutions by appointed Managers of these institutions.

“For the Federal Tertiary Health Institutions, it will be rewarding if government reviews the current practice of two-term tenures for Chief Medical Directors/Medical Directors. It is time for the government to introduce the 5year single term tenure currently being practiced in Universities. This will not only help to create opportunity for fresh leadership and managerial ideas to be brought on board, it will substantially reduce the unfortunate, unpatriotic and bitter struggles for leadership position in these institutions, with negative impact on the management of these institutions. I sincerely hope that President Muhammadu Buhari can introduce this paradigm shift in the tenure of Chief Executives of Federal Tertiary and Teaching Hospitals in Nigeria.”

Additionally, Enabulele said, there is need for elevation of merit rather than political and primordial interests in the determination and choice of the leadership and Chief Executives of these institutions.

“A more enabling and transparent environment for the meritorious appointment of would-be Chief Executives and Managers of these institutions is imperative.

The selection process should be made more open, inclusive and transparent. Merit rather than political and ethnic interests, and primordial propensities, should be accorded utmost priority and consideration in the selection and appointment of the Chief Executives.

Indeed, they must be proven to have the right leadership attributes and disposition, leadership experiences within and beyond the four walls of the institutions, the right managerial competences and integrity, clear view and understanding of their mandates, and other job requirements, before they are appointed by Government to superintend over these institutions,” he said.

Ohuabunwa said it is difficult to notice any holistic significant improvement in the state of the health institutions as a whole, though a few new hospitals have been built mostly in States. He said in the Teaching Hospitals some physical changes are noticeable in some of them but equipment and furniture are largely run down or non- serviceable.

The PSN President said a Public private partnership model built on sincerity of purpose might help to improve things.
Frequent industrial action by doctors

Enabulele said: “It has been a long time that medical doctors went on strike. Unfortunately, any strike called by any worker in the health sector is seen as a doctors’ strike, perhaps because doctors are seen as the leaders of the health team with ultimate responsibility and liability for whatever happens in the health sector.

“In reality, it may be difficult to eliminate strike actions in the health sector. This is because of our level of societal development, and importantly because of the poor attitude of most governments and managers of health institutions to the welfare, needs and interests of medical doctors and other health workers. Government needs to be sincere in her engagement with workers and fulfill all collective bargaining agreements.

“A situation where some state governments in Nigeria still owe medical doctors and other health workers months of unpaid salaries is shameful, condemnable and a catalyst for sustained industrial actions.

“So, while government insist on its implementation of its bourgeois policy of ‘No Work No Pay, it must also accept the policy of ‘No Pay No Work’.”

Ohuabunwa said: “I think that in recent times, the frequency of doctors strikes seems to have declined which is a good development. Hitherto it was a major problem, which actually impinged on the integrity of Nigeria’s healthcare system. We look forward to the day when doctors or indeed Health-workers strikes will be an anathema in Nigeria.”

Olaopa said the right to strike is recognised as a fundamental human right by the United Nations, the Council of Europe, and the European Union. He said most European countries enshrine the right to strike in their national constitutions.

In Nigeria, Olaopa said, the reality is that the government is hardly ever sensitive to the challenges imposed by poor conditions of work of the doctor in various hospitals, ranging from improper remuneration to faulty health systems where facilities are not available to work with.

Despite this and prevailing harsh economic environment, he said, the burden of financial care of patients is rested on the doctors and sometimes nurses.

He explained: “In such situation, doctors are sometimes compelled to provide funds for patient care freely, and sometimes by superiors. Sometimes too, the government creates an impression of all-is-well-and-good in the hospitals such that patient can visit hospitals and access care almost free of charge without necessary funding of such political pronouncement.

“In many situations, there is the misconception by patients and their relatives that provisions have been made by government while the doctors are deliberately withholding care. Today, many States government owe salaries for months and in some cases, percentage salaries are paid doctors. When I hear people make unsavoury comments about strikes by doctors and the blackmail of the physician oath, I respond, government should be responsible and responsive without any push.”

Olaopa said many of the visible progress that has been made in the Nigeria health sector, today painfully, have been as a result of doctors’ strike in Nigeria. He said the likes of Beko Ransome-Kuti, Oye Adeniran, Kayode Obembe, Isaac Adewole to mention a few have led most defining struggles for better health care in Nigeria.

The NARD President said, in the last two years, there has not been any national strike by doctors even in the face of provocation by the federal and state governments, salaries unpaid, and arrears of unpaid entitlement, moribund hospitals and inhuman working conditions. He said when strike becomes the only option, the government, and unfortunately sometimes the populace will be quick to throw the physician oath as if the doctors have not right to live.

Olaopa said doctors’ right to strike is enshrined in international labour laws. “It is an unfortunate but sometimes inevitable option, well protected in the eleventh clause of the revised physician pledge that even the government use to blackmail doctors in Nigeria,” he said.

The NARD President said the government needed to be more responsible to the concerns and demand for better access to health for Nigerians and improved working condition of the doctors as well as health professionals.

Brain drain as indication of poor state of the nation’s health system
Olaopa said doctors’ emigration has increased dramatically in the last five years mainly due to the poor state of health system in Nigeria. In the same vein, he said, doctors’ migration is also worsening the Nigeria’s health indices in escalating dimension.

Emigration is the act of leaving a resident country or place of residence with the intent to settle elsewhere. Conversely, immigration describes the movement of persons into one country from another. Both are acts of migration across national or other geographical boundaries.

The NARD President said Nigeria inducts about 2,500 medical graduates every year. “Out of this figure, about 2000 pursue greener pasture across the globe and more than fifty percent of those in this category are successful in their emigration plans within the first ten years of practice. Some take qualifying examinations, get registered and continue medical practice in their new locations, while more than 60 percent of the emigrated doctors abandon medical practice altogether for other vocations,” he said.

Olaopa said emigration of doctors, and in fact health professionals, for better working environment and comparatively higher wages has empowered them to meet basic family responsibilities and provide some security for the future. In 2012, the House of Representative Committee on the Diaspora reported that 77 per cent of members of associations of black doctors in the United States (US) were Nigerians meaning that seven out of 10 black doctors practicing in the US are Nigerians.

He said the same committee also revealed that 25,000 Nigerians travel to India every year for medical care, which could have been provided in Nigeria with effective planning. It becomes obvious that the government is not sincere about righting this wrong.

Olaopa said what appears to be common at critical point of doctors’ emigration from Nigeria whether in the 80’s or now is the unfavorable foreign exchange, reduction in public investment expenditure, especially health sector and hospitals, increase fuel prices and restrictions of capital transfer and worsening poverty.

He explained: “Public hospitals were neglected and the facilities where available though hardly, becomes moribund. Funding for residency training declined to the near non-existent status it is today. The same story, as in the 80’s, senior and experienced doctors are leaving in droves.”

Olaopa said the gloomiest peculiarity today is that fresh graduates have lost faith in the country, and her health sector especially since they witnessed the horror and hopeless states of our hospitals during training.

He said one would be made to believe that doctors leave the country for better wage package but the sad reality is only a part of the many reasons. The loss of trained Nigerian medical and dental personnel to foreign countries is encouraged also largely by the lugubrious condition of our hospitals and very poor facilities available for practice.

Olaopa said, in 2000, the WHO ranked Nigeria 187 out of 191 countries in health system and the United Nations Development Programme (UNDP) reported that Nigerians life expectance had dropped 47 years in 1990 to 43 years in 2006 when countries such as Malaysia, that attained independence at about same time with Nigeria, has attained 70 years.

The PSN President said scanty attention is being paid to the motivation and welfare of healthcare professionals, so many continue to emigrate to countries that value the skills they have, thereby even reducing Nigeria’s only area of competitiveness- healthcare manpower.

Ayebae said the brain drain syndrome also affects the pharmaceutical industry, adding that pharmacists are leaving in their numbers to look for greener pasture in other countries, since the government of Nigeria has refused to provide an enabling environment to the pharmaceutical industry to thrive.

“The entire manufacturing space is much challenged by the not too conducive environments to operate our businesses. It is a shame that those of us that have had the courage to set up manufacturing plant to produce and create employment for thousands of families are the ones that get punished by the system.

“People that are putting money in the Treasury bill are equally Nigerians and are smiling to the banks, and those of us that have billions of naira in the pharmaceutical province are the ones carrying the brunt of an economy that is shallow – an economy that is not productive for anybody. No wonder the poor people are fighting back and they are behaving out of inactive service everywhere,” he stressed.

Enabulele said: “This is one issue I have spoken on for over a decade. It is quite sad that the brain drain phenomenon has worsened in recent times, not only as a result of the poor working conditions and conditions of service in the nation’s health system, but also because of the poor address of social determinants, such as epileptic electric power supply and insecurity of lives and properties.

“For as long as no serious efforts are made to address the push and pull factors propelling emigration of medical doctors and other health professionals, Nigeria will remain a recruitment ground for foreign recruitment agencies and a production factory for the health systems of developed economies, with grave implications for Nigeria’s healthcare delivery system.”

Cancer crisis… non-availability of functional cancer treatment centres
More than 70 per cent of all cancer deaths occurred in low- and middle-income countries. Deaths from cancer worldwide are projected to continue rising, with an estimated 11.5 million deaths in 2030. Risk factors for cancers include tobacco use, alcohol use, dietary factors, overweight and obesity, physical inactivity, chronic infections from helicobacter pylori, environmental and occupational risks.

According to the WHO the most prevalent of cancer cases in Nigeria included are breast, cervical, prostate and colorectal cancers.

Olaopa said there are seven radiation therapy machines in the country, six of which are owned by the Federal Government, only one of which is functional, prior to the newly installed machine at Lagos University Teaching Hospital (LUTH).

Olaopa said patients with cancer, needing radiation therapy, are delayed before receiving treatment due to shortage of necessary equipment. He said public hospitals in Nigeria with radiotherapy centres where cancer treatment could be done; only four of them are functioning.

According to the NARD President, it is obvious that anybody who has cancer in Nigeria currently is likely to die because those who cannot afford to travel abroad will have to wait which eventually leads to their death because cancer treatment requires more than surgical care.

Olaopa said cancer management includes prevention and early detection, treatment, which is largely multidisciplinary and palliative. He said one of the identified risk factors for cancer is malnutrition, and large cross sections of Nigerians are undernourished.

The NARD President said it is unfortunate that even prevention, in form of proper nutrition, which seems to be the cheapest in this approach, is quite inaccessible to the people. He said early detection of cancer is a mirage because such diagnostic equipment is not available or unaffordable to Nigerians.

“Many cancers are actually curable, if detected and treated early. To achieve this, continuous public enlightenment and financial access to well-equipped hospitals for cancer treatment are critical,” he said.

Olaopa recommended: “Cancer remains a very traumatic diagnosis and its treatment is very expensive. The government should endeavor to alleviate the suffering of cancer patients by providing improved treatment opportunities at affordable rates. Government should provide funds for equipping selected hospitals in the country to provide comprehensive cancer treatment. They should also use the instrumentality of NHIS to provide a subsidy for cancer care.

States and local government should also complement the efforts of the Federal Government by building modern cancer care centres.

“Philanthropic organisations and individuals should also help cancer care centres. Existing centres should be strengthened with modern treatment facilities. Power is central to the functionality of a cancer treatment centre, so there must be alternative power sources to reduce the cost of diesel and treatment. The country should limit the equipment types to major vendors who should be required to provide local support for the machines. There is also the need to train biomedical engineers that can attend to equipment faults in any part of the country at short notices.”

Enabulele said the cancer crisis is real and demands the accelerated efforts of government at all levels and other stakeholders, including the private sector, to effectively manage the cancer crisis.

Enabulele said this has been a real challenge for cancer patients in need of treatment, and also one of the reasons for patients opting for foreign medical care. “I still have vivid recollections of the traumatic experiences my own father went through in the course of seeking treatment for his medical condition. It was truly horrible,” he said.

Enabulele said while he recognises the recent efforts of the Federal Government to respond to this challenge, he said they need to do much more to satisfactorily address the huge deficit in the number of functional cancer treatment centres in Nigeria. “They must not only provide enough to cater for the teeming population of cancer patients, they must build into their procurement policies effective, efficient and sustainable maintenance policy frameworks to prevent the usual experience of frequent breakdown of these facilities in institutions where they may be available,” he said.

The physician urged state governments and other investors to sincerely support efforts at expanding the number of cancer treatment centres in Nigeria.

The PSN President said there is indeed a cancer epidemic ongoing in the country. He explained: “All of a sudden cancer has become perhaps the third biggest killer in Nigeria after malaria and hypertension. In the adult female non – pregnant population particularly I suspect that cancer has become the biggest killer. No day passes without hearing how a promising young woman is cut down in her prime.

“While breast cancer and cervical cancer are decimating the female population, prostrate cancer and colon/intestinal cancer are visiting untold havoc among middle age males. I believe that the crisis requires a national emergency call but the response I hear is tepid. Perhaps the killings by Boko Haram insurgents, Fulani herdsman and sundry marauders have dulled our sensitivity to human suffering and death.

“Patients queue for weeks to get a space for radiotherapy in the very few functioning centres in Nigeria, and that is for those who can afford to pay the very high cost for treatment- be it surgery, chemotherapy or radiotherapy. Many are left to die by poor relations and the nation trudges on without caring a hoot. We need many cancer centres across the nation and emergency training of oncologists and physicists.”

Rising cases of fake and adulterated drugs
Ohuabunwa said: “To be sure, we still have a high level of falsified medicines in Nigeria, but it may not be correct to say that the incidence or case is rising. At incidence rate of about 15 per cent, we have come a long way from the days when the rates were strong double digits.

“Nevertheless this incidence level remains unsatisfactory and troubling. The regulatory work of National Agency for Food and Drug Administration and Control (NAFDAC), adoption of new technologies by the pharmaceutical industry and the high level of enlightenment and sensitization by the PSN and its technical groups have tempered the incidence but 15 per cent is still troubling and a tighter control of the distribution channels is mandated to bring the incidence down. A maximum of five per cent can be tolerable and Nigeria must push to get to this point.”

Ayebae debunked the news of 70 percent fake drugs in the Nigerian market, describing it as a “ blatant lie”, noting that there are no statistics to prove the statement to be true.

He said the rate of fake and adulterated drugs in the country are two to three percent, which he said are mainly imported, adding that non is locally produced.

“There is no single locally made drug that is faked, that is why the only panacea for fighting fake drugs is developing and supporting local manufacturers. Made in Nigeria products are efficacious, cheaper, of good quality, effective and it is a patriotic thing to do when you patronise made in Nigeria because you are helping us to sustain employment and to deepen the economy of Nigeria and it will even invest more into the economy of the country,” he stressed.

He said Bangladesh locally produces 90 percent of the medicinal products the citizens consume, which he said was done by protecting its local industry.

“The only way India and China was able to recover all of its finished products and machineries in the pharmaceutical industry was by protecting their local industries. Today the cheapest drugs in the world are coming from India. Their own people are been protected because the prices are so cheap,” he added.

Ayebae maintained that as part of efforts to stop the influx of fake and substandard drug in Nigeria, government should ban importation of every product called essential medicines.

He said Ghana has 48 of the essential medicines under its banning list, while Ethiopia has 87, adding that Egypt and Ethiopia, with a population lesser than Nigeria also has it on their list of banned products.

“Nigeria and its manufacturing companies can build such an economy that is home grown focused. We should stop deceiving ourselves that foreigners are going to come and help us build our nation. Any foreigner that comes is taking advantage of you because they will do things that will make you to patronise their products because they are investing here.

He continued: “They will bring in the raw materials from their countries and will never develop our capabilities to do the raw materials here. Nigeria is not a haven for dumping and once it is stopped, local manufacturers will begin to manufacture in their millions and then fake drugs would be eliminated, I guarantee that.”

Enabulele said at some point it was thought that Nigeria was overcoming the malaise of fake and adulterated drugs, particularly with the efforts made by NAFDAC and other bodies some years ago, but it looks like there has been a resurgence with worsening of the scourge, and the consequent deleterious effects on the health and wellbeing of Nigerians.

Increasing cases of drugs abuse and misuse, Codeine and Tramadol saga
On the issue of rising cases of abuse and misuse of codeine and tramadol, Ayebae, said weak border control is responsible, as the drugs circulating the Nigerian market are all smuggled products through the ports.

He said government’s ban of codeine and tramadol drugs have not only reduced the capacity of local manufacturers, but has opened the front gate for smugglers.

He said the government of Nigeria is killing its people as countries like Ghana, Togo, India and China are now producing codeine products, which they bring and dump in Nigeria.

Ohuabunwa said this indeed is the main matter of the moment because of the disorganized distribution system for pharmaceutical products in Nigeria, unauthorized people have access to drugs and through them unauthorized people obtain the drugs and use them for unauthorized purposes or in inappropriate ways.

Central to this, the PSN President said, is the fact that the role of the pharmacist as the custodian of medicines has been compromised and people obtain all manner of drugs without his imprimatur. He said some of these merchants of death as I like to call them only see drugs or medicines as items of commerce.

Ohuabunwa said the short answer to this unfortunate development is to restore the sanctity of distribution chain with full oversight by the pharmacist who is the trained and statutory custodian. “That is not to totally ignore the underlying psychosocial factors that seem to be driving people especially the young to abuse substances including drugs.

For me the new Pharmacy Bill and the Federal Government mediated Controlled Wholesale Centres (CWCs) will bring sanity to the pharmaceutical space and help stem unlawful access to medicines especially those prone to abuse and misuse,” he said.

Enabulele said this might not stop until there is commitment to the implementation of the extant prescription laws in Nigeria. He explained: “Today, virtually everyone in Nigeria prescribes. This should not be so. The prescription law is very clear: only medical doctors, dentists, and veterinary doctors are legally permitted to prescribe ethical drugs. Outside Nigeria, particularly in the developed parts of the world, prescription laws are strictly enforced. Even a medical doctor in those climes need the prescription of his/her physician to procure his/her medications when he/she is ill.”

The physician said to stem the abuse and misuse of these drugs, there is need to activate certain strategic steps, including but not limited to: improved regulatory frameworks, massive public enlightenment on drug use and the prescription laws, strict enforcement of the drug prescription laws with imposition of stiffer penalties for violators, as well as the effective reform and management of the drug procurement and distribution chains and processes.

Weak regulation of drugs and medical practice by government agencies
Ohuabunwa said: “Three issues are at play here. The first is, that Nigeria is becoming largely a lawless nation. People disobey laws and regulations with impunity, including the high and mighty. The Police and the Military drive against traffic.

Politicians and their escorts, some with horsewhips terrorize normal road users as they break traffic rules. Politicians buy votes from bullion vans and rig elections while everybody is watching. Things are so bad that we do not only fail to punish many acts of misdemeanor and breach of the law, often we reward the lawbreaker!

“Second, the high level of endemic corruption where everybody has a price. And given the high level of poverty, many people including some regulators are motivated to look the other way. But in a number of cases, these regulatory agencies are poorly resourced to execute their mandates. And so often some of them turn into fund raising to remain alive which detracts from proper and effective regulation.”

The PSN President said government need to also strengthen the laws as in the Pharmacists Council of Nigeria (PCN) case and provide more resources to enable these agencies cover the large expanse of Nigeria.

Enabulele said the Federal Government is largely to blame here. He said the indiscriminate and frequent dissolution of these health regulatory agencies and bodies has not allowed for sustained focus and commitment to their mandates. “It is therefore imperative for the government to respect the statutory tenures of these agencies, while also empowering them with the needed funds and facilities to undertake their legal mandates,” he said.

The physician said aside from this, there is need for urgent reforms in the governance and management system of these agencies, including the mode and quality of the selection process for the Heads and managers of these agencies.
Suggestion for better health system

The minister of science and technology said Nigeria needed to engage in local production of its medicines to help boost the economy and solve many challenges ravaging the country.

He said traditional medicines, especially herbal products constitute a very big multi-billion dollar market globally, noting that there is no reason for Nigeria to continue spending huge money in importing these products from other countries when it can be manufactured in Nigeria, thereby providing employment opportunities and wealth for the nation as well as help the country in solving many of the health problems it is facing presently.

“We need to find jobs and create employment opportunity for our people, we need to create wealth for the nation, but what is happening now is that we depend so much on other countries. Many of the things we need as a nation, we import from outside and this is not good for our economy, which is why we can’t have job opportunities for our people.

He continued: “There is too much pressure on our currency. Many of these products come from countries like China, India and they make a lot of money, but imagine a situation where we start producing locally, the way the other countries do their things, not only would we find jobs for our people, but we will fight and defeat extreme poverty and eliminate epidemic,” he added.

Enabulele said: “Amongst other strategic imperatives which I have severally advocated in different fora for over a decade, there is need for improved political commitment to the health of all Nigerians. Importantly, there is need for greater commitment to the social determinants of health by governments at all levels. The component parts of the national health system, including physician-led primary health care, need to be strengthened. The various provisions of the National Health Act need to be given due and accelerated expression.

“The NHIS needs to be urgently reformed to enable it deliver on its core mandate. In the same vein, the ongoing effort to review the NHIS Act needs to be brought to completion so as to make for mandatory subscription to the scheme, and thus expand the possibility of Nigeria achieving universal health coverage.”

Enabulele said there is urgent need to address brain drain in the health sector through the development of an effective and efficient human resource for health strategic development plan. He said there is need for strict regulation of the health sector and strengthening of the health regulatory agencies and bodies. “Importantly, the extant drug prescription and distribution policies and laws need to be strictly enforced,” he added.

Ohuabunwa recommended:
*Bring harmony to the healthcare team by ensuring equity and fair play

*Do not make both ministers in the Ministry to come from the same branch of Healthcare. A mix will create better team spirit and ownership

*Take a decided action to expand the scope and enrollment into the National Health Insurance Scheme. Reorganize the NHIS to achieve this key goal. Most African Nations are doing much better than Nigeria. Out of pocket healthcare funding is the major disincentive for big-ticket investments in the healthcare industry.

*Fully implement the National Health Bill

*Establish a special health care funding window by the Central Bank of Nigeria (CBN) to enable private sector expansion in health care services as is being done for agriculture and entertainment. If medical tourism is ever to be reversed in Nigeria, it is the private sector that will lead the move.

Ayebae said while the president and his administration would be sworn in, May 29, 2019, he should specifically focus on boosting the economy.

He also urged the government to support local manufacturing in every sector to remain productive by providing access to loans at single digit interest rates, which will make every industry more productive and ensure companies begin to operate at full capacity, “which then means more employment for Nigerians.”

“No Nigerian wishes to do Yahoo, Yahoo plus, take codeine or tramadol. These practices are fallouts of idle mind, which the saying goes ‘is the devils workshop’,” he added.

Also, the Orfema Pharmaceuticals boss called for government support for the local manufacturing industries, adding that the anti-malarials being imported can as well be produced locally.

“Government is the main buyer in any economy, a lot of these products that we import into the country can be produced locally. When we can produce antimalarial here in Nigeria, why do we have to give it to foreign country’s to produce for us.

He added: “Why should we take gifts that can kill us, somebody will say they brought global agencies to bring in anti-malarials in Nigeria and say they reduced the price. We know how much they buy it there and we know how much they sell it to us. We do not need that, we should not be giving jobs to foreigners, while we are closing shops for the same business in Nigeria.”

Olaopa said the function of a healthcare system is to regulate the maintenance, provision and improvements of adequate and timely medical care to humans in a nation. “It is done via providing primary care, secondary care, tertiary care and public health to the people.”

He said the Nigerian healthcare system has made progress in some areas in the last few decades. But there are still some nagging issues concerning healthcare in Nigeria that needs to be addressed.

According to the WHO, a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained health facilities and logistics to deliver quality medicines and technologies.

Olaopa said: “A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies. In all honesty, it is easier said than done. To improve the quality of healthcare and healthcare delivery in a developing nation can be a real challenge, but with consistent effort, teamwork and support from the government improvements can be made.”