‘State govts must fix public healthcare facilities’
EMMANUEL Onwubiko a former Federal Commissioner of the Nigerian Human Rights Commission (NHRC) is the Executive Director of Human rights Writers association of Nigeria (HURIWA).
In this interview with EMEKA ANUFORO in Abuja, he speaks on why state governments must be put under intense pressure to fix dilapidated public health care facilities. Excerpts:
How would you describe the healthcare system in Nigeria?
The health care system in Nigeria can at best be described as abysmally perilous and degrading. The country is regarded as one of the largest black democracy.
Indeed, Nigeria is the largest black nation globally but the over 170 million populations are substantially lacking in functional primary and even tertiary health care centers all across the 36 states of the Federation and the Federal Capital Territory of Abuja.
Most of what we have in existence as primary health care centers and general hospitals are glorified consulting clinics that lack the necessary facilities and even competent medical professionals to cater for the large number of patients.
I have visited all the 36 states and now I live in Abuja the Federal Capital of Nigeria. I can confidently state without any fear of contradiction that our health care system is in a shambles.
What we have in many local government areas, as health centers are ramshackle and decrepit structures that lack basic hygiene and totally bereft of all the modern medical equipment necessary for effective and efficient health care services. This negative trend has exposed a lot of Nigerians to untimely demise from easily curable ailments such.
Most medical centers across board even lack standardised pharmaceutical departments thereby compelling patients to patronise roadside drug dealers who are known to be selling fake and substandard drugs.
National Agency for Food Drug Administration and Control (NAFDAC), that is constantly in the print and electronic media claiming credits for achieving holistic anti fake drug successful battles, is no where most Nigerian localities where fake drugs are sold in stalls and other outlets.
Many communities take their sick loved ones many miles, far away from their villages to the nearest hospitals for care. Sadly, these general hospitals are glorified village dispensaries. In most states in the Southeast the only available health centres run by churches.
Government must work out effective partnership with these faith based health providers since they are actually doing what these governments ought to do.
The state governments must be put under intense pressure to fix these dilapidated public health care facilities to provide quality services at affordable cost to the thousands of people that need health care but who do not have the wherewithal to consult private hospitals.
The standard of facilities in private hospitals spread across the states are also not the best and certainly do not comply with global best practices. With high unemployment the Nigerian government must provide health palliative to the jobless Nigerians to stop them from going extinct.
How would you link adequate healthcare provision and human right?
The most fundamental human right is that of RIGHT TO LIFE. This basic right is constitutionally guaranteed and supported by several international humanitarian laws including the Universal Declaration of Human rights (UDHR), the International Covenant on civil political Rights and the African charter on Human and Peoples Rights. Again the Right to life cannot be attained if the country does not have the basic well equipped medical facilities to take care of the multifarious health challenges confronting our citizenry. Right to life is codified under chapter four of the constitution of Nigeria and so is binding on the government to enforce policies that will enhance the enjoyment of this fundamental human right.
Right to life cannot be attained if there is no quality health care and this then demands that government has a constitutional obligation to create the enabling environment for the institutionalisation of quality and effective healthcare system that is functional and effective.
There is also the issue of promoting the dignity of the human persons and so there is no how human dignity can be achieved if the public health care system and services are not in the best of shapes. The right to adequate housing and even such rights as Child’s rights are interrelated with human rights and the health and well being of the citizenry.
The promotion and protection of human rights will remain a mirage if the right to quality health care is not strictly enforced to stop the menace of untimely deaths from diseases that are easily treatable. Government indeed has legal and constitutional obligations to guarantee adequate and quality health care and for the millions of indigent citizens that lack the finances to pay for health care services the government must make provision for functional and effective health insurance. Old age health allowances should be provided as a matter of priority so the millions of retired Nigerians and other senior citizens can access quality health services.
What are the possible issues plaguing the sector in Nigeria?
The first issue of concern is that there is lack of professionalism in the Nigerian health care system. Medical workers are atomised into several quarrelsome trade unions that pursues mundane and parochial selfish interest to the detriment of the sector. Doctors are diametrically opposed to Nurses even as other non-medical health workers are ganged up in their own cocoon waging trade wars consistently in their selfish and ambitious attempts to earn same salaries with the medical professionals such as doctors and Pharmacists. The incessant industrial action in the health sector is a grave threat to the stability and effectiveness of the Nigerian healthcare.
Nigeria is about the only country whereby the public healthcare are perpetually on one industrial action or the other over wages and allowances and patients are left to either die or for those with means to now patronise the highly exorbitant private health centers and hospitals that generally lack standardised health facilities such as well equipped laboratories and pharmaceutical departments.
The mechanisms for resolution of industrial actions in the Nigerian healthcare system have collapsed and must be revived so the medical workers are discouraged from embarking on whimsical strikes. Government must instill discipline to stop these annoying strikes in the public health facilities. Many poor patients have died whilst these meaningless strikes go on untended.
Secondly, the healthcare system in Nigeria is poorly staffed and those in the health industry are poorly trained and therefore lacking in professional competency substantially.
There’s is the need to address the standards of medical trainings given to medical students and in fact admission to medical faculties must be made a second degree programme and the prospective medical students must be recruited or admitted strictly on merit after strenuous competitive entry requirement tests.
Cheating and other manifestly fraudulent examination related crimes must be strongly frowned at in the medical faculties because the profession of medicine is sacred and inviolable because they are involved with human lives.
In medical schools there must be no provision for carry over’s and so any student that genuinely fails in the main examination should be thrown out. The hygiene levels of most hospitals in Nigeria are abysmally dangerous and sickening. Many patients go to hospitals and end up been infected with even more deadly illnesses because of the polluted and dirty environment of those hospitals. The Nigerian ministry of health must upgrade the cleanliness of the public and private health care facilities.
There’s currently a general state of environmental pollution in most hospitals and this does not augur well with the highest state of cleanliness expected from the health institutions. There has to be a mechanism in place to regularly monitor the environmental sanitary conditions of hospitals. Nigeria is overdue to have functional health insurance for all categories of the citizenry to check the arbitrary high costs of healthcare services.
Hospitals must establish desks and units to enforce strict environmental sanitation and another functional department for consumer protection and complaints resolution. Nigeria must revive primary health centers all across Nigeria because over 60 percent of Nigerians reside in villages and these places lack good and workable health centers. Doctors and health workers should be provided attractive incentives by government to work in rural areas. Secondly, Nigeria does not have functional psychiatric hospital system and there are signs to suspect that insanity has become prevalent going by the nature of strange crimes that are now been committed.
Insanely crazy persons as masterminded by a range of terrorists and other rogues can only do such atrocities like mass killings. Nigeria must build and equip more psychiatric hospitals to handle the largely unreported insanity cases. There’s the urgent need for health ministries to set up mobile clinics to be strategically located in major highways to be on standby to assist in providing health care services as first responders at the point of accidents.
The public healthcare must be well funded but the way and manner these public hospitals employ persons who while away time without providing any form of services must be discouraged. It is immoral for public hospitals to fail to hire quality doctors but to fill up the space with waitresses and stewards who simply mill around the hospitals doing next to nothing but chattering away.
What can we learn from the experience of other countries?
Nigeria has a lot to learn from foreign jurisdictions such as United Kingdom and a place like Malaysia. In UK health is highly regarded and the government prioritises the sector and there are checks and balances that effectively regulate and enforce standards and professional discipline.