How to improve health sector’s performance, by stakeholders
Stakeholders in the health sector have suggested recommendations on how to improve the sector. Specifically, a professor of virology and pioneer Vice Chancellor of Redeemer’s University, Ede, Osun State, Oyewale Tomori; a consultant ophthalmologist at Lagos University Teaching Hospital (LUTH) and Chairman, Lagos State Traditional Medicine Board (LSTMB), Prof. Adebukola Adefule-Ositelu; and Deputy Director Pharmaceutical Services, Federal Medical Centre (FMC) Asaba, Delta State, and former Chairman Association of Hospital Pharmacist of Nigerian (AHPN), Dr. Kingsley Chiedu Amibor, in separate interviews with The Guardian discussed measures on how to improve the sector.
Tomori, who is also a consultant to the World Health Organisation (WHO) and Federal Ministry of Health (FMoH), said that all necessary steps should be taken, and all stakeholders should be on board in a united and coordinated national commitment to start local production of selected human vaccines in Nigeria before the two years in office of this administration, that is within the next 18-24 months.
Tomori, who is also the Chairman of the Joint Venture Company, Biovaccines Nigeria Limited (BVNL), set by the Federal Government of Nigeria (FGN) and May & Baker Pharmaceuticals to begin local manufacture of vaccines, said: “In particular, Nigeria and the FGN will focus on getting the joint venture company – BVNL – set up by the FGN and M&B to start vaccine production locally, while we keep at bay external companies whose interest is not in local vaccine production, but in cornering and flooding the Nigerian vaccine market with imported vaccines. This will require that all and each of the stakeholders, lifts national interest far and above self-interest on the important issue of local vaccine production in Nigeria.”
Tomori said Nigeria’s national health security depends on the government escalating the issue of local vaccine production and supply as a national emergency. “We must improve and sustain our vaccination coverage so that we do not end up having diseases that the world has controlled – like diphtheria- now controlling the life of and killing our children,” he said.
Adefule-Ositelu said Nigeria is a very blessed nation in terms of capable personnel, natural and economic endowments and a healthy nation is surely a progressive and economically wealthy nation. She said there is a need to focus on Nigeria’s natural endowments and capitalise on them.
The ophthalmologist said Nigeria needs a strong and meaningful collaboration between the indigenous that is natural/traditional and the foreign that is orthodox systems of healthcare system practices.
She, moreover, said research shows that 80 per cent of Africans practice and still accept the indigenous products for their healthcare – prevention, healing, restoring and sustenance of their good health. “These natural products are vastly available. They are cost effective, less toxic and understood by the practitioners in generations. There are clear needs for the integration of the indigenous with the well accepted orthodox healthcare system. The purpose of these needs are unavoidable for achievements of good health for prevention, healing and sustenance. This will only be possible when both systems are given fair acceptance, principles in codes and ethics to meet the essential health needs of our teeming populace,” Adefule-Ositelu said.
The professor of medicine said natural products formulated from plants and herbs to standardised products need more attention from the government, commitments in planning, implementation and adequate judiciously managed financing.
She said these medicinal products have in recent times, globally obtained new respect for all the benefits received by testifying users, as they contain privileged inherent structures that are acceptable, tolerable and beneficial to human needs to maintain sound physical, mental and spiritual health.
The advocate of traditional medicine said although challenges faced are stemmed from extreme diminishing perceptions and attitudes of superiority – inferiority complexes, these should be eliminated totally.
She said the Nigerian Government needs to embrace her own natural means of developing and delivering the best possible healthcare system practices to meet the beliefs, cultures and traditions of her people. Adefule-Ositelu said traditional medical practices need better and national recognition; institutions – schools, equipped laboratories to standardise fully, both the existing and other natural medicinal products for the needs of Nigerians and to get the right personnel engaged.
She said these products are projected for effectiveness at home and also to meet the high quality for international standards, exportations and high national economic yields.
The ophthalmologist added: “Furthermore, we need national collation teams from our tertiary institutions, research centres for useful research already conducted on our natural products. Many remarkable works were done but they are only ending up in promotional exercises. Only a very minute few have been developed for human uses. These should be encouraged for job opportunities, better healthcare and great national economic achievements.
“In addition, we need to be sought after as we are endowed and empowered. We can serve the world, health wise with our natural products and practices.”
Adefule-Ositelu said Nigeria should take note that Lagos State is number one and nationally outstanding in the recognition of the relevance and inclusion of Traditional Medicine Practice (TMP) in the healthcare system of the State and this is legally backed by the Reformed Lagos State House of Assembly Law of 2006; recently reviewed in 2022.
She said Lagos State Traditional Medicine Board (LSTMB) has been in existence in the last 43 years and this benevolence has continued to attract large numbers of Traditional Medicine Practitioners from other States of the nation into Lagos for training, regulations and code of ethics practices.
Adefule-Ositelu said the Lagos Board has assisted Ogun and Delta States in inaugurating their Board too. Adefule-Ositelu, who has made several discoveries in natural medicine, including the bitter kola cure for cataract and glaucoma as well as Ewedu cure for Ebola, said the importance and contributions of the TMP and practitioners cannot be overlooked and over- emphasised for obvious and essential results as seen in the last two global pandemics and other uncountable health benefits of our teeming population.
She said more job opportunities will be created and these will surely accrue into great national economic gains. “Let us therefore move to utilise the best of the two systems —- foreign and indigenous to our own best benefits,” Adefule-Ositelu said.
Meanwhile, Amibor said there is urgent need to reposition the Federal Ministry of Health for greater efficiency. He said the Minister should lobby for an increase in budgetary allocation to Health, targeting the 15 per cent recommended by the Abuja Declaration. “Additionally, he should ensure there is strict implementation of all approved Health budgets and plug all loopholes through which funds may be utilised inappropriately in the Health Ministry,” Amibor said.
The hospital pharmacist said the current global health indices have not been favourable to Nigeria, especially in the area of maternal mortality. He said the Minister and Ministry must double efforts to ensure marked improvement in our health indices.
Amibor said the recently signed National Health Act will need to be vigorously implemented, to improve health insurance coverage in Nigeria. He said the new Act seeks to promote, regulate and integrate health insurance schemes and improve and harness private sector participation in the provision of health care services. “It should not be allowed to go the way of the former National Health Insurance Scheme (NHIS) which failed to enrol more than 10 per cent of the population,” Amibor said.
The consultant pharmacist said the Minister should not pay attention to calls to privatise teaching hospitals and federal medical centres in the country. He explained: “Nigeria is plagued with myriads of challenges, health care sector inclusive. Our health care indices are indeed worrisome, with Nigeria ranking 187th out of 191 countries from recent World Health Organization statistics.
“This is why recent calls by Nigeria Medical Association (NMA) for the federal government to privatise tertiary health institutions in Nigeria, raises serious concerns. The models proposed by NMA fall far short of global best practices. The models will set the stage for commercialisation of the health care sector. Knowing the penchant of Nigerian businessmen for profit maximisation without giving back much to the system, the NMA models if anything, will lead to scramble for government hospitals by highest buyers, mass retrenchment of health care workers, confusion in the sector, and eventual collapse of the sector, since healthcare services will become available only to the super rich. This scenario will compound an already bad health situation and worsen morbidity and mortality issues.”
Amibor said the Minister will need to revisit the recent decision by the government to withdraw funding for regulatory bodies, especially the Pharmacy Council of Nigeria (PCN), which has been engaged in running battles with regulation of manufacturers of falsified, and counterfeit medicines. He said withdrawal of funding for PCN could seriously hamper the regulatory roles of the Agency.
According to Amibor, globally, healthcare delivery is a collaborative process, but in Nigeria however, professional rivalry, indiscriminate and biased salary awards to a particular group of professionals by the government while excluding others, unfulfilled promises to workers by government, have fuelled instability and disharmony in the sector, which has witnessed incessant strike actions for some years now.
He said the new Minister must initiate and ensure genuine reconciliation of all healthcare workers. For instance, Amibor said part of the grievances of non-physicians in the sector is that the Federal Government has singled out medical doctors for salary increase more than three times, since 2014, whereas pharmacists and other healthcare professionals have been stagnated on the same salary since then.
He said the Minister must summon the courage to press for unconditional salary increase for non-medical doctors, as was implemented for medical doctors severally.
Amibor, moreover, said the prevailing situation right now where the Ministry does not implement extant Federal Government circulars, or chooses those to implement, is indeed worrisome and should not be allowed to continue.
“Two examples will suffice here; In September 2020, the Federal Government released a Circular, creating the Pharmacist Consultant Cadre, with the enabling Scheme of Service. It is ironic that three years after the Release of that Circular, the Committee of Chief Medical Directors (CMDs) of Teaching Hospitals blatantly refused to implement it, citing all manner of flimsy excuses, even alleging that the former Minister of Health instructed them not to implement. Up till today, that Circular has not been implemented,” he said.
Amibor said Pharmacy Consultancy is not indigenous to Nigeria, but has made a huge impact in countries such as the United States (US), United Kingdom (UK), Ghana and so on where it is being practiced. He said it is no surprise that brain drain to some of these countries is on the increase. Amibor said pharmacy consultants are experts in pharmaceutical care and play huge roles in reducing drug therapy problems, adverse drug reactions, and mortality issues associated with use of medicines.
The pharmacist said international best practices are tilting towards specialisation among healthcare professionals for better managed patient care and Pharmacy is not an exception. Hence, he said Nigerians are missing the pharmaceutical care that Pharmacy consultants bring to the table. “I appeal to the Nigerian President to fulfill his promise on the accelerated implementation of Pharmacy Consultancy Cadre in our public health institutions so that the benefits to patients, public and government can become visible,” Amibor said.
Amibor, who is also a Fellow of the Pharmaceutical Society of Nigeria (PSN), said the Federal Government approved an increase in Call Duty Allowance for holders of Doctor of Pharmacy Degree (PharmD), a six-year programme approved by government, but up till today, the Federal Ministry of Health is yet to authorise her CMDs to implement the Circular for the affected pharmacists. He said the minister should use his good offices to ensure that these anomalies are corrected forthwith.
Amibor said the government should no longer reserve the position of Chief Medical Directors of Teaching Hospitals for physicians only. He said that singular action has been responsible for most of the professional disharmony and instability in the healthcare sector today. “As stated above these CMDs stifle government Circulars that favour professional growth and advancement of non-medical doctors, while they are in a hurry to implement with arrears, payment of benefits accruing to medical doctors,” he said.
The hospital pharmacist said seasoned health administrators should be appointed to manage Nigeria’s public health institutions, as well as serve as Minister of Health, as is the case in organised societies, including the WHO. He said clinicians should focus more on handling clinical cases.
Amibor said of recent, out-of-stock syndrome is beginning to characterise public hospitals as a result of mismanagement of the Drug Revolving Fund (DRF) scheme, resulting in profound drug shortages in public hospitals. He said undue interferences and corruption have led to near decapitation of the fund, with increased risks of patients purchasing false and substandard medications outside the public hospitals’ pharmacies, treatment failures, drug resistance and so on.
Amibor said the government should put in place the legal framework for DRF to operate seamlessly, thereby ensuring continuous medicines availability in public hospitals. He said there should be appropriate sanctions for defaulters and an Act establishing the DRF should be pursued by the minister.
The pharmacist said federal tertiary institutions should commence small scale production of medicines such as creams, syrups, infusions, and so on, in line with the recent directive from the former Minister of Health. This, he said, will not only promote local content, but lead to reduction in prices of medicines.
Amibor said the minister should put in place central posting for pharmacists and other interns. He said the original concept of central posting for fresh graduates was muted by the PCN, but right now, it is being implemented for only medical house officers. He said the government should extend central placement to Pharmacy interns and others, to ameliorate the hardship parents are subjected to, in seeking internship spaces for their children.
Amibor said there is a need to employ more pharmacists in health institutions, in line with WHO standards, to enable pharmacists to provide pharmaceutical care to the populace. He said agencies such as PCN and the National Agency for Food and Drug Administration and Control (NAFDAC) are experiencing acute shortage of pharmacists and must be prioritised.
The pharmacist said current pharmacy and hospital buildings should be completely overhauled and redesigned to incorporate counseling rooms to aid patient confidentiality, call rooms, compounding rooms, quality assurance rooms, and conveniences. He said accommodation should be provided for pharmacy and all interns inside the hospital premises.
Amibor said there is need to abolish hospital policies that restrict pharmacists from having unfettered access to patients records and bedside, as well as use of Teaching hospitals for teaching pharmacy students and residents, in line with best practices.
He said the Minister should seek the appointment of more pharmacists on the boards of hospitals and as members of the Hospital Top Management Committee.
Amibor said there is need for immediate implementation of the National Drug Distribution Guidelines as approved by FMoH, and urgent dismantling of open drug markets, which have become a haven for falsified and substandard medicines.
The hospital pharmacist said the Nigerian Government, through the Central Bank, should make intervention funds available to local manufacturers to enable them manufacture vaccines and other essential medicines. Similarly, he said there should be a reduction in tariff for imported essential and lifesaving medicines, which have become very exorbitant and therefore unaffordable and inaccessible.
Amibor further explained: “It is worth reiterating that any attempt to privatise federal tertiary health institutions will certainly lead to total collapse of the healthcare sector in Nigeria, with disastrous consequences for the Nigerian people.
“Where the Nigerian government insists on privatisation, then public private practice (PPP) must be inclusive, total and non-discriminatory. All clinical and non-clinical staff must be involved.”
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