What Buhari must do to reposition healthcare delivery, by Akintayo

Olumide Akintayo is a Fellow of the Pharmaceutical Society of Nigeria (PSN), West African Postgraduate College of Pharmacists (WAPCP), Fellow Nigeria Academy of Pharmacists (NAP) and Fellow of the Nigeria Institute of Management (NIM). Akintayo, the outgoing President of the PSN, in a chat journalists, critically appraises the health sector as well as providing insight into the controversies surrounding the National Drug Distribution Guidelines and the alleged plan by the federal government to privatize or rather ‘sell’ teaching hospitals. Akintayo wants President Muhammadu Buhari to redress the impending damage the restructuring of healthcare sector will occasion, in the public interest by directing appropriate quarters to embrace rational and home-grown initiatives to tackle challenges in the health sector. CHUKWUMA MUANYA was there. Excerpts

What is your assessment of the health agenda of the Buhari Administration?
The Joint Health Sector Unions & Assembly of Healthcare Professionals (JOHESU/AHPA) has in recent times continually paid glowing tributes to the 7th National Assembly and the Goodluck Jonathan’s Presidency for allowing Nigeria to have its first ever National Health law.

It is important to put on record that the National Health Act is probably the only statute that attracted the attention of a wide spectrum of stakeholders in health and the larger society. There is, therefore, an urgent need to factor in this broad-spectrum solidarity in fashioning the implementation of the National Health Act.

Recently the Federal Ministry of Health (FMoH) was reported by a section of the media as having sworn in a new Technical Review Committee (TRC) for the National Health Act (NH Act 2014).

The Committee, which was said to be ‘cautiously selected’ to guarantee representation of the key institutions has the mandate to guide the implementation of the National Health Act.

Naturally, the JOHESU/APHA accept the principle of setting up Committees, which is also within the powers of the FMoH.

As a follow-up to the Technical Review Committee on the National Health Act 2014, a series of other implementation templates of the National Health Act have emerged with only members of one profession (medicine) dominating all. In fact, representation is not sought from other professional associations and unions in the health sector.

We are however worried that the members of the 26-man Technical Review Committee and other related committees are unknown to the larger portion of key stakeholders. Of more concern is that representation in the Technical Review Committee has not been extended to professional associations and unions in the health sector.

The government must face the reality that in the context of the National Health Act 2014, the professional associations and trade unions in the health sector constitute major stakeholders. Why will they sideline key stakeholders in fashioning the implementation of the National Health Act? It will not augur well for the sector.

How about the alleged plans to sell drug distribution in teaching hospitals nationwide to foreign companies or rather privatize them?
We have it on good authority that the health sector is one of those sectors placed under the supervision of Vice President Yemi Osinbajo.

If we assume that this was premised on a good knowledge of the healthcare sector, then emerging trends clearly indicate we are headed for more discord and conflicts in the health sector.

In a rather bizarre and most undemocratic process, six doctors including agents of Western donor agencies in Lagos State that championed the commercialization of health facilities were charged with the responsibility of crafting the health policy of the administration.

One of the key recommendations of the six-man committee not too surprisingly was to canvass a ‘reform of the Federal Ministry of Health and reduce the number of agencies from 14 to three based on alignment of scope and deliverables.’

Curiously, the administration has sought views and position papers on health care agenda from strange templates especially a particular group of entrepreneurs in healthcare rather than the true representatives of healthcare providers and who are well structured into various healthcare professional associations and trade unions.

The pecuniary motives of the entrepreneurs in healthcare who belong to an array of professions and background remain an inclination to access funds provided by the IFC. They plan to lord their concept of privatization and commercialization on the health sector, notwithstanding the damaging effects it will bring to consumers of health services and the economy of the Federal Republic of Nigeria.

It is apt to put on record that the operatives of IFC who are citizens of Nigeria have no respect for our laws.

They insist on a version of reforms in healthcare that are self-serving in terms of their narrow commercial interests and those of their foreign paymasters.

The team has been canvassing the agenda of bringing foreign chain retail promoters in pharmacy practice into Nigeria for instance.

Where will these leave Nigeria in the foreseeable future?
The answers are very clear. No to foreign company domination, which prevents us from building capacity through Nigerian providers. If the IFC truly wants to assist, the funds available should be made available to local investors to drive chain retail outlets in the health professions.

The foreign legion naturally will invade our shores with their own brands of essential medicines, which will destroy the remains of the struggling local pharmaceutical manufacturing industry. We say every nation desires self-sufficiency in local production of drugs for both welfare and security reasons, which President Buhari effectively upheld as the Executive Chairman of the defunct Petroleum (Special) Trust Fund, PTF.

How do we attain this goal of self-sufficiency in tandem with the National Drug Policy, if this craze for foreign profiteers is not immediately checkmated?
It is illogical to continue to suggest that the products foreigners, multinationals and their local collaborators want to ship to us will bring any blessing, as the hallmark of such relationship has always been capital flight. Any agenda that encourages more importation of goods and services that we can produce at home promotes an unfavourable naira-foreign currency exchange.

This is already heavily skewed against us and, therefore, has more tendencies to destroy the national economy.

So what is the solution?
In the light of the foregoing, we call on President Muhammadu Buhari to redress the impending damage the restructuring of healthcare sector will occasion, in the public interest by directing appropriate quarters to embrace rational and home-grown initiatives to tackle challenges in the health sector.

Some pressing challenges and distortions in the health sector which have lingered for so long compelling a dire need to appeal to Mr. President Muhammadu Buhari to urgently call the authorities in the Federal Ministry of Health and the Management of Tertiary hospitals to order.

What grouse does JOHESU/AHPA have with the management of teaching hospitals?
The gross mismanagement of our hospitals by some Chief Executives of tertiary hospitals has assumed an alarming proportion. A case in point is the Federal Medical Centre (FMC), Owerri, Imo State. For over three months, health professionals and workers, members of our associations and unions at the FMC Owerri were on strike, practically closing down the hospital for the entire period, subjecting patients and members of the public to untold hardship. It is hoped that the fact-finding committee that was constituted last week would carry out her assignment expeditiously.

Many Chief Executives of hospitals have continued to run our hospitals as if they are private estates without government statutory rules and regulations. Modern healthcare practice is a multi-professional and multi-disciplinary endeavour. Any team is as good as its component parts.

The arbitrary style of the management of most of these hospitals has led to non-employment of graduates of optometry into the federal tertiary hospitals; non-implementation or intake of optometrists for an internship in federal tertiary hospitals even after the former Minister of Health has given directives. Millions of Nigerians are going blind when the necessary manpower that alleviates their problem is being denied of employment either for an internship or full-time employment.

There is also the reluctance of the FMoH to adopt the globally accepted position of optometry as a primary care provider. This has affected the delivery of eye care services to Nigerians who are going blind in droves due to avoidable causes.

Restriction of services being offered by the optometrist by heads of ophthalmology departments across the nation’s tertiary institutions when most of these heads of department allow optometrists in their private clinics to operate at full scope as provided in the law establishing the optometry profession.

But doctors are backing plans by the federal government to privatize teaching hospitals and other hospitals and challenged JOHESU/AHPA to come up with an alternative to the Public Private Partnership (PPP). What is your take on this?

This is always the problem. People always design popularity contest to accentuate the entropy and multiple stress junctions in our sector. The depth of people in a representative capacity must be palpably visible in terms of competence and accountability.

Our friends in medicine, which I always say is a noble profession, have an important responsibility to conduct that nobility in normative civility. For the records, JOHESU/AHPA in the text to the media did not oppose plans to privatize Lagos University Teaching Hospital (LUTH), University of Nigeria Teaching Hospital (UNTH) and other hospitals you mentioned.