Surgeons at work/.
As the new minister of health settles down for work, expectations are high from stakeholders, who believe that he will address myriads of seemingly intractable problems bedeviling the sector and have therefore, set an agenda for the new helmsman, CHUKWUMA MUANYA reports.
In recent times, the health sector has been in the news for all the wrong reasons, from nationwide strikesdoctors under the aegis of Nigerian Association of Resident Doctors (NARD) to agitations for better remuneration by health workers under the umbrella of Joint Health Sector Union (JOHESU) among other entities crippling activities and escalating morbidity and mortality rates in the country.
Not to mention the Japa syndrome, where doctors, pharmacists, nurses and other health workers are moving in droves abroad for greener pastures.
The sector is in dire need of a leader who is prepared and ready to hit the ground running, having in hand the solution to the myriads of problems in the sector.
What are the solutions? How can Nigeria improve health outcomes? How can the health sector function optimally? Stakeholders in the health sector have set an agenda for the new Health Minister on how best to develop the sector.
National President, NARD, Dr. Emeka Orji, said there is a need to properly match clinical manpower to the number of patients. Orji said whether it has to do with doctors or nurses or other health professionals, there is significant imbalance in this area. For instance, he said instead of 1:600 doctors, Nigeria has almost a ratio of one doctor to 10,000 patients.
Orji said there is also an imbalance in the distribution between urban to rural areas with the majority of the workforce being concentrated in cities and urban areas. Hence, he said there is a need to produce a healthier workforce and seriously provide incentives to retain them. The NARD President said these incentives include significantly improved and attractive wages as well as mortgages, support for acquiring cars and foreign training as these are some of the attractions for leaving the country.
The physician said special incentives should also be provided to encourage health workers to take up jobs in the rural areas to address the imbalance.
Finally, in terms of manpower, he said there is a need to redesign the health system to create more job opportunities to absorb the workforce that is constantly being produced by training institutions.
“At the moment, despite our grim manpower imbalance, we still have a lot of health workers who cannot be absorbed because of inadequate employment opportunities. This is often because much of the heavy lifting, especially for specialist care, is being borne by the Federal Government owned tertiary hospitals with the secondary and primary health care levels almost non-existent in many states,” he said.
Orji said a related issue to the above is that of the weakness of the primary health care system, which is supposed to be the closest to the grassroots. He said apart from finding creative ways to get the states and local governments to take more responsibility in terms of funding, human resources and management of these facilities, arrangements should also be made for some specialty care to be provided on selected days to improve health access.
Furthermore, the medical doctor said there is an urgent need to properly equip and upgrade the facilities in hospitals. This, he said, should be data driven and targeted towards conditions that account for the most morbidity and mortality in the country. Orji said selected tertiary hospitals should also be upgraded to medical centres of excellence with capabilities for treatment of complex medical conditions. He said the aim of this is to address medical tourism and provide opportunities for Nigerians in Diaspora who wish to contribute their rare specialist skills back home.
Either by directly subsidising the hospitals through health tax or health insurance, Orji said there needs to be a solution to the ability to pay for medical care because this is the bedrock of the entire system. He said no matter the investments made in manpower, facilities or system design, there would be no improvement in health indices if people can’t afford the services. “Hence affordability of health care is very crucial,” the NARD President said.
A Harvard Scholar in Health Economic and Director General of Delta State Contributory Health Scheme (DSCHS), Dr. Ben Nkechika, said the country requires a primary healthcare service revamp, a baseline database and study of the demographics, the social characteristics and statistics of the human population that will utilise the primary healthcare service, to ensure ‘fit for purpose’ that meets the actual needs of the people.
Nkechika, who is also a public health expert, said all persons irrespective of their socioeconomic status and geographical location, should have access to the quality healthcare service they need and where they need it without a consequential financial burden that distorts their economic status.
A cancer expert and professor of Radiation and Oncology from the University of Nigeria Teaching Hospital (UNTH) Enugu, Prof. Ifeoma Okoye, proposed, “a viral agenda to revolutionise Healthcare in Nigeria.”
Okoye said healthcare is a fundamental aspect of any nation’s development. She said, in Nigeria, the new Minister of Health has a crucial role to play in boosting the healthcare system, ensuring access to quality healthcare for all citizens. Okoye said her proposal intends to formulate a viral agenda that addresses key challenges and recommends strategies to enhance health care in Nigeria. She said by implementing these measures, Nigeria can transform its healthcare system, resulting in improved health outcomes for its citizens.
On enhancing infrastructure, the oncologist said one of the top priorities for the minister of Health should be to address the existing infrastructure deficit throughout the country. Okoye said it is essential to establish well-equipped hospitals, laboratories, and health centres, particularly in underserved rural areas. She said by investing in infrastructure development, the government can ensure equal access to quality healthcare facilities across Nigeria.
On empowering healthcare professionals, the cancer expert said they are the backbone of any healthcare system. She said the minister must prioritise the welfare, training, and remuneration of healthcare workers to attract and retain highly skilled practitioners. Okoye said strengthening professional organisations, promoting research and development, and encouraging international collaborations are essential steps to elevate the expertise and effectiveness of Nigerian healthcare professionals.
On the primary healthcare system, Okoye said to improve access to healthcare for all citizens, the new minister must focus on strengthening Nigeria’s primary healthcare system. This, she said, can be accomplished by developing robust training programmes for primary healthcare workers, expanding the reach of community health centres, and creating awareness campaigns to educate citizens about the importance of preventive care.
The physician said by prioritising primary healthcare, Nigeria could combat the burden of disease at its roots, reducing the strain on secondary and tertiary care facilities.
On health insurance coverage, Okoye said a comprehensive and accessible health insurance system is crucial to ensure that all individuals have affordable access to quality healthcare services. She said the minister should work towards implementing a universal health coverage scheme that encompasses both the formal and informal sectors. This, she said, will alleviate the financial burden on individuals, encourage preventive care, and provide a safety net for vulnerable populations.
On the digital healthcare revolution, Okoye said, in the era of technology, the new minister must spearhead a digital revolution in Nigerian healthcare. According to her, by developing an integrated healthcare database and implementing electronic health records (EHR) systems, healthcare providers can efficiently manage patient information, monitor disease outbreaks, and identify health trends. The cancer expert said, furthermore, telemedicine initiatives can bring healthcare services to remote areas, saving time, and improving outcomes for patients.
Okoye said: “The transformation of Nigeria’s healthcare system necessitates a vigorous viral agenda, focusing on enhancing infrastructure, empowering healthcare professionals, strengthening primary healthcare, implementing health insurance coverage, embracing the digital healthcare revolution, promoting health education and awareness, and forging strong partnerships. The new Minister of Health needs to fervently advocate these strategies to bring about positive and lasting change. By prioritising healthcare, Nigeria can ensure that its citizens receive the quality care they deserve and ultimately pave the way for a healthier and more prosperous nation.”
A consultant Pharmacist and Managing Director, Merit Healthcare Limited, Dr. Lolu Ojo, said the new Minister of Health should be transformative and a man with a broad vision. “He must be able to manage the diversity in the Health sector for progress and development. The persistent strife and friction amongst the different components must be brought to the barest minimum,” Ojo said.
Ojo, who is also a fellow of the Pharmaceutical Society of Nigeria (PSN), a past chairman, Association of Industrial Pharmacists of Nigeria (NAIP) and Chairman of the Nigerian Academy of Pharmacy (NAP) Committee on drug and substance abuse, said the new minister should ensure that the hospital system works for everybody and the patient remains as the centre of focus.
“We need an effective, efficient and sustainable health insurance system and all the man-made obstacles to universal coverage must be removed,” he said.
The pharmacist said the pharmaceutical sector deserves a focused, well thought out and consistent attention. He said medicines availability should be treated as a security issue because a situation where more than 70 per cent of national consumption is imported should be tackled with deep concern.
Ojo said Nigeria needs a policy and decided government action to encourage local production of Active Pharmaceutical Ingredients (APIs) and drugs.
He said the burden of unpaid debt should be resolved as government hospitals, institutions and agencies are the highest and most notorious debtors. “We need a vibrant pharmaceutical industry that can compete well with others around the world,” Ojo said.
Another consultant pharmacist and immediate past National Chairman of Clinical Pharmacists Association of Nigeria, Dr. Joseph Madu, said, according to the six building blocks of the Public Health Policy which include: Service delivery, health workforce, health information systems, access to essential medicines, financing and leadership/governance, the new health minister should always remember that leadership/governance is key.
Madu said when there is good leadership, finance will not be a major challenge and also every other building block of the public health policy can be adequately taken care of.
He advised the minister to kill corruption in the health sector because corrupt leaders embezzle the money that is meant to finance the health care facilities. According to Madu, the implications are that essential drugs cannot be provided, the health workforce cannot be maintained and service delivery becomes suboptimal.
He said a very good example is the Drug Revolving Fund (DRF) issue.
The clinical pharmacist said the minister should warn Chief Medical Directors (CMDs) or MDs against usurping the potential workings of the DRF and allow separate accounts in line with the 1987 Bamako Initiative Policy.
Madu said the minister should motivate the health workforce to minimise brain drain and encourage local pharmaceutical industries by improving availability and reducing importation tax on raw materials for finished products.
He advised the minister to ensure that all categories of health care professionals are fully carried along in the scheme of things and that each can aspire to rise to the peak of his career in government service irrespective of his discipline, as obtainable elsewhere around the globe.
The pharmacist said the minister should abrogate the illegal establishment of the office of the deputy Chairman, Medical Advisory Committee in tertiary health institutions, which is not backed by any extant law.
Regarding public health education, Madu said the minister should recommend and utilise campaigns by grassroots frontline healthcare professionals such as clinical community pharmacists, general practitioners and community nursing personnel to raise public awareness about preventive measures, vaccination and healthier lifestyles in reducing the burden of preventable diseases.
A public health expert and former Commissioner for Health, Ondo State, Dr. Dayo Adeyanju, said health is cardinal to national development and is an integral part of human capital development. He said for a nation to be productive, the citizens must be healthy. Adeyanju said, in realisation of this fact, the minister must know that healthcare is a significant part of the Renewed Hope Agenda. He said the current health situation is very pathetic as shown by the health indices.
Adeyanju, who is also an Independent Consultant (Health System Strengthening), said there would be a need to review the current situation to project into the future.
He said the three levels of health care need total overhaul and Primary Health Care (PHC) must be strengthened to ensure sustainable financing, effective utilisation of basic health care provision and state government programmatic provision. This, he said, will ensure a functional PHC per ward. He said with a functional PHC, there will be a step towards Universal Health Coverage and the need to create demand through a functional National health insurance, which must be strengthened. This, Adeyanju said, will ensure access to affordable and quality health care.
The public health expert said state governments would be encouraged to invest in secondary health care to provide advance care for referrals from primary health care. “Make secondary health care self-sustaining through effective supervision by deploying a monitoring tool,” he said.
Adeyanju said the tertiary health care should be repositioned to reverse medical tourism; and this could be done by investing in specific teaching hospitals across the country for specialised intervention.
He said other areas of focus include the emergency medical services and this will take care of road traffic accidents that are the leading cause of death for productive and vibrant age groups. Adeyanju said attention also must be paid to public health emergencies. He said there is a need for adequate preparedness to combat these emergencies.
He noted that all of these would not be possible without adequate human resources for health. “In recent times brain drain has also constituted a major challenge for the sector. Adequate remuneration and an improvement in welfare packages may help reverse the ugly trend. The government must also ensure a reward for excellent performance,” he said.
The former commissioner for health said paying attention to these would help improve the sector to provide qualitative health care for the citizens and make them more productive to contribute to the economy of the nation. He said it will also help reverse medical tourism where the nation loses close to a billion dollars each year.
President, Nutrition Society of Nigeria (NSN), Prof. Wasiu Afolabi, believes the health care system in Nigeria is currently in limbo. Afolabi said it is weak both in terms of personnel, capacity and infrastructures. He said the reform of the health care system must be approached at three levels: recruitment of qualified health personnel, capacity enhancement and overhauling of medical infrastructure.
Afolabi said beyond this, to ensure health is brought closer to the people and achieve health for all, the primary health care system must be revitalised with nutrition at the core of investment in PHC. He said with nutrition being the foundation for human capital development and improved health and wealth, investment in nutrition will have a multiplier effect in terms of return on investment. The nutritionist said the last administration directed that about 11 or 12 line Ministries, Departments and Agencies (MDAs) should create the department of nutrition, which up till now has not been implemented by many MDAs.
Afolabi said if the new administration can implement this and invest in nutrition through the implementation of the National multi-sectoral plan of action for food and nutrition, this would go a long way to reduce malnutrition, which is the underlying factor for 50-60 per cent of childhood mortality in Nigeria. He said investment in nutrition would generally solve more than 60 per cent of the health problems being faced by Nigerians.
A vaccinologist and Chief Executive Officer (CEO) of Innovative Biotech, Nigeria, and Innovative Biotech United State of America (USA), Dr. Simon Agwale, said one of the immediate priorities of this new government is to support local production of vaccines, because presently, less than one per cent of all the vaccines used in Africa are manufactured locally, a situation that makes the continent vulnerable to epidemics and pandemics.
Agwale, who is also Board Director, Africa Vaccine Manufacturing Initiative (AVMI) and Lead, Technology Transfer and Intellectual Property (IP), Africa Centre for Disease Control (CDC), said learning from COVID-19 pandemic (where Nigeria experienced health products nationalism, ban on export of health products), this should be a top priority for this administration.
Agwale said to achieve 60 per cent locally manufactured vaccines in Africa by 2040 (a goal set by the AfricaCDC), between 1.5 and 1.7 billion doses must be produced on the continent each year. This, he said, will require significant investment in new and existing vaccine technologies and production processes.
The vaccinologist said the diseases that plague Nigerians are not necessarily the diseases that plague the West, so capacity for Research and Development (R&D) has to be built to enable Nigeria to address the peculiar diseases that are endemic to the country and continent. Agale said this strategy would enable Nigeria to be self-reliant and allow Nigerian scientists to develop IP that could be used locally.
