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The task before new minister of health


Prof. Isaac Folorunso Adewole

Prof. Isaac Folorunso Adewole

For those who may not know, the new Minister of Health, Professor Isaac Folorunso Adewole, is the immediate past and the 11th Vice-Chancellor of the University of Ibadan. I am not surprised that he is given the portfolio of health ministry though like many Nigerians, I have thought he would be made Minister of Education. Be that as it may, because he is a professor of Gynaecology and Obstetrics I see his emergence as minister of health as a “round peg in a round hole.” Having served as Provost, College of Medicine, University of Ibadan, the largest and oldest medical school in Nigeria, he is undoubtedly man enough to man the Ministry of Health.

However, this piece is being written for three major reasons: Reflection on Nigeria’s Health care system in World Health Organisation ranking. Incessant doctors’ strike and sustaining Nigeria’s polio free status.

It will be recalled that the World Health Organization ranks Nigerian healthcare system amongst the worst in the world. Specifically, its most recent report places Nigeria at the 187th position of 190 countries. This is only ahead of the DRC, Central Africa Republic and Myanmar. Even Zimbabwe and Burundi, which are amongst the poorest countries of the world, rank at least 30 places ahead of Nigeria, yet Nigeria has the largest Gross Domestic Product on the continent and many significant mineral resources.

It should be noted that constitutionally, every individual has a right to live healthy and the government, at all levels, is obligated to provide good quality healthcare amongst other social amenities to its citizenry at affordable costs and in a convenient manner. The healthcare system is expected to focus on the prevention, diagnosis and treatment of diseases and ailments for all the people; and the responsibility of the government to achieve these objectives cuts across its various tiers.

As Honourable Minister of Health Professor Adewole will be expected to exert himself to resolve some abnormalities in the health sector, which include severe underfunding, undersupply, inefficiency, decrepit equipment, poor quality, needless deaths and unhappy workforce. The country does not boast of a plausible healthcare agenda and often leaves development agencies to define programs for focus. Doctors exploit the weak system, inviting patients to private practices so that they can earn additional income and consulting at multiple government hospitals so they appear on various payrolls. Nurses yell at patients and refuse to respond to their basic enquiries.

Pharmacists dispense drugs in envelopes and do not bother to write the name of the medication or educate patients on side-effects. Accounts clerks often have ‘no change’ and will therefore tell patients to go find the correct denomination before payments are accepted and emergency cases are overlooked because payments are incomplete. Many general hospitals stink (literally and figuratively) and are breeding grounds for infectious diseases – many also do not have sufficient beds so corridors become sleep pads.

To tackle the foregoing listed abnormalities, in 2016 budget, Federal, States and Local Governments must allocate at least 15per cent of their total budgets to health in line with the 2000 Abuja declaration.

They must establish SHI and CBHI schemes; within the context of the NHIS so as to expand cover to the informal and rural populations, which make up 70 per cent of the population, as a strategy toward universal access.

The government must support states to develop state health insurance schemes to be regulated by the NHIS Support for voluntary (private) health insurance and discouragement of retainership.

The minister will have to identify, adapt and scale up financing schemes shown to expedite universal coverage, such as drug revolving fund schemes, deferrals, exemptions etc.

There should be harmonization of external aids and partnerships for health financing. In addition to these, our hospitals must be upgraded and well equipped to discourage medical tourism.

According to the president of the Nigerian Medical Association, over USD 500 million is lost annually to medical tourism. It will be recalled that the UCH where the minister was once Provost was ranked third best in the Commonwealth ahead of most teaching hospitals in Britain (in the ‘60s) that even the Saudi Princes used to come there with health challenges. Therefore, all hands must be on deck to restore the lost glory of all our Teaching and non-Teaching hospitals.

The second issue deserving of attention is the incessant strike by doctors and other health workers. Interestingly Professor Adewole served in 1984 as President of the National Association of Resident Doctors of Nigeria and he led a nationwide strike that resulted in his dismissal by the then head of state, Gen. Muhammadu Buhari. Professor Adewole had to escape into exile because he was declared wanted, dead or alive by Buhari, who is now President and who ironically has appointed him his Minister of Health! The minister will be expected to bring his experience in the Nigeria Medical politics to bear on his assignment to eradicate the Doctors’ strike by seeing to it that the medical practitioners are well remunerated and catered for, not only to put an end to strike but to also deal with issue of brain drain in the sector.

According to Nigerian Medical Association, over 60per cent of doctors trained in Nigeria practice overseas and the Association of Nigerian Physicians in the Americas has a membership of over 4,000. At various times, these Nigerian doctors have been given awards as best in their fields and they continue to make significant strides in the advancement of medicine outside the shores of our country at the detriment of medicine at home.

Last but not the least the minister must ensure that Nigeria Polio-free status is sustained. Nigeria has reached a major polio “milestone” and has been removed from the list of polio-endemic countries after a year of not reporting a single case of wild polio. The World Health Organisation (WHO) said Nigeria has not reported a case of wild polio virus since July 24, 2014. “All laboratory data confirm that 12 months have passed without any new case in the country.”

Therefore, to sustain this, the community involvement in the immunisation of children under five years, and surveillance activities to rapidly detect any potential re-emergence of the virus are imperative. So is the establishment of emergency operations centres at the national and state levels, which had contributed to Nigeria’s success coupled with continuous domestic funding from Nigeria. All this is essential to keep Nigeria and the entire region polio-free.
We must remember, and this is more for Professor Adewole, that a healthy nation is a wealthy nation.

Ajiboye is a public affairs analyst in Lagos. Email: 08138966292

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