Welcome to the Octagon Room
Thanks for taking time out to join this conversation which will end in 1hour. Before we go into the discussion, Please let everyone know your name, and a little bit about what you do.
Olamide: Hello everyone. My name is Olamide Craig and I am a Family/Occupational health physician. I also write a column on BellaNaija called AskDrCraig.
Uju: Uju Okoye, public health physician/Healthcare consultant in the US. I work with HIV policy here and also run my own consulting company.
Omolola: Hi, my name is Omolola Sokoya. I’m a Managed care Nurse with with United Healthcare International incharge of case management and quality assurance
Nene: Hi, I’m Nene Usman. I’m a public health physician. I work with Kaduna state university.
Lawal: I’m Lawal Bakare. I trained as Dentist, practiced for two years and have since moved into health communications. I currently run: EpidAlert (formerly EbolaAlert), HEIT Solutions, Chora and also serves as the Technical Assistant on Communications to the CEO of the Nigeria Centre for Disease Control.
Kanyinsola: Hello everyone. My name is Oluwakanyinsola Fowler. I’m a clinician with an MPH. I work as a Senior Analyst at the Private Sector Health Alliance of Nigeria.
The Octagon: Thank’s everyone.
According to an interview with the president of MDCAN. “Nigeria’s Public health sector is an unstable one. The incessant strike by health professionals has been identified as a major contributor to the country’s poor health indices.
Over the years, this has brought untold hardship, sufferings and death to many families and patients across the federation. It has forced many people away from public hospitals to privately owned ones where cost of services is prohibitive and hardly affordable. Many others too have had to rely on traditional medicine as an alternative. “
He further expressed how his professional colleagues had not been able to make any meaningful impact in health care delivery in the country.
While these are valid concerns, we believe that there are many issues with the Public Health Sector in Nigeria. In your opinion, what are some of the challenges the sector faces ?
Uju: My responses will be completely from the outside looking in. I think the biggest issues lie around governance, sustainability, infrastructure and cultural. One of the biggest flaws is expecting clinicians to somehow have the administrative tools to manage the system. Nigeria has a unique problem because of our population. While it is also easy to blame governance, the attitudes of some clinicians sometimes helps to compound the already dire situations. Even with proper financing, there is still lack of understanding even within the healthcare system, on how to create a system that addresses the Nigerian problem, rather than one that copies the NHS and foreign models.
Olamide: It is easy to fault a large chunk of what is Nigeria’s health care system when comparing it to the UK. And while this and other systems in the developed world are a standard to aspire to, my responses will first attempt to assess the Nigerian system in relation to itself and after this I will go ahead to compare it to the gold standard. Nigeria has an informal health care system. There is nominal government oversight but this is perfunctory at best.
Kanyinsola: Governance is the key challenge – Good governance will go a long way to address infrastructure, sustainability and cultural issues.
Nene: The health sector is poorly financed. Human resource for health is also a problem. Health centres in rural areas are poorly staffed and most times d staff available are unskilled in life saving techniques. Primary health care PHC is d bedrock of our health system and ensures that every Nigerian has access to health care. However, the areas with the greatest need are the areas with the largest gaps. There is also the problem of inequitable distribution of resources. Finances, human resources, materials such as drugs, vaccines etc are usually sent to urban areas. Most people would refuse to work in hard to reach areas. Then there is the problem of misuse of government allocated funds. Every health system relies on these building blocks: leadership/governance, financing, health information systems, human resource for health, service delivery, and materials like drugs, vaccines etc… Each one of these areas is seriously lacking in this country… any solution will have to use a multi pronged approach
Omolola: Our health sector is poorly financed and this balls down to poor goverance. Our primary health care system is faced with challenges , and there is an urgent need to improve the quality of service delivery there. There is also a need to expand it to many communities who still lack the presence of any health facility.
Lawal: From my close observation I feel poorly developed consumers have created weak expectations. That may be the reason all key stakeholders have no reason per se to do anything differently.
Olamide: Training. Let’s not forget training. The West African and National colleges are still boys clubs.
Uju: I agree. But are those even leading the healthcare system equipped with the right administrative and healthcare management training to manage effectively? Sure everyone is a skilled and talented Clinician but without that, there will always be an issue. Misuse of government funds and corruption happens everywhere. It is not unique to Nigeria, so we really must work around that issue.
Olamide: Public health is dependent on foreign aid. Polio, Measles, Cold chain, are all funded by donor agencies.
Uju: Great point you just highlighted. This is so absurd.
Kanyinsola: Too dependent on foreign aid.. sometimes I wonder what will happen when the aid ends. Guess we’ll soon find out.
Lawal: Measles funding froze for some months this year and the laboratory surveillance grounded. That’s what will happen when the funds are out. There is an existing solution in our strategic healthcare plan. That document simply needs implementers. In Rwanda all public activities are tailored to their national plan. The reason they seem like magicians. If we can prioritize that plan, we will be fine.
Uju: But wouldn’t it be unfair comparing Nigeria to Rwanda given the enormity of population?
Lawal: That’s a joke Uju. Nigeria’s resources matches our challenges. We are not as complicated as India, Not as complicated as China. Rwandans sorted out leadership quickly. Leadership is the priority of our health system revamp strategy as documented in the plan. I do not think Nigeria should even compare herself to Rwanda. Rwanda is far behind Nigeria in human capital. To fix leadership is a bit of a Long walk.
Olamide: But India like Nigeria is an informal system. Most of the health care is private. And that’s why our challenges have to be tackled differently.
Omolola: I totally agree we have more than enough resources to match our challenges in this country. Our problem is putting this resources into good and proper use.
Kanyinsola: I wouldn’t call our system informal: not organized and poorly managed but definitely not informal. Well we need good leadership that’s ready to get down to business; get their hands dirty. To tackle all of the challenges including the attitude of the health workforce and resource allocation.
Olamide: Okay. Point taken. Poorly organised. However how do we organise it? What do we do in the interim ? Cuba had a repressive got but some of the best health care, as did Libya. So perhaps good leadership is not a prerequisite for good health care?
Lawal: I was at the campaign frontline during the last elections. Nigerians didn’t ask for healthcare. Given that leadership requires us to bring participation from both sides. Good leadership MAY help fix other functions. It is not a stand alone. We never gave ourselves the chance to prove that fact. Leadership here is not political system. An average Cuban physician is driven by a stronger code of participation. Sense of belonging and ownership. The zero PMTCT recorded in Cuba couldn’t have happened without citizens too.
Olamide: True. Sense of Ownership is key. That’s something we as Nigerians don’t really have. That National cake mentality was ingrained in us from small.
Kanyinsola: I don’t think that’s entirely leadership’s fault. The typical Nigerian doesn’t pay attention to his health till an issue arises. We bury our heads in the sand or act like it can’t happen to us. I think the Government’s participation is key. The private sector, CSO, the public and other stakeholders can’t create a sustainable and affordable health system on their own. Proper allocation of resources – Government currently spends almost 70% of the allocation to health on the tertiary level mainly on salaries. You can imagine how much gets to the primary health care level.
The Octagon: Great points raised. What would we consider are the top 3 things needed to be done to solve these issues we are faced with? Is there a way around government participation?
Olamide: Strengthening all arms of our health care system. Our tertiary is very strong and primary is weak. Access to health care in rural areas. Training of doctors and allied health professionals. Strengthening of Institutions. Development of an integrated nationwide health and informatics system to make access to medical data uniform across different.
Lawal: I am achieving some successes and my ingredients have been:
- Participation (for citizens especially elites)
- Revamped Consumers
- Revamped leadership in public sector (civil servants and political actors)
If we can fix these fundamentals in a democracy. The system will define a sound balance for itself. We have records of free but under-utilized health services. I believe in empowering the system to drive itself.
In the last 10 years the leading enabler of governance in Nigeria is participation according to the IIAG (mo Ibrahim foundation). If we can drive this into healthcare we may be heading for that desired success. We saw it play itself earlier this week with telecoms tariffs. When we start participating, we start winning.
Kanyinsola: 1. Improved quality of health services (including capacity building for health workforce)
- Better leadership/ Governance (Proper allocation and management of resources inclusive)
- Increase knowledge and awareness among the public so they can better demand for health services.
Omolola: Access to and afforable health care in the rural areas.
Uju: Great solution strategies raised.Thank you for organizing this platform
Kanyinsola: Thank you for organizing the platform and for inviting me ????
Omolola: Great platform you have. happy to have been a part of it.