By Mr. Oseloka Henry Obaze
I am glad to be here and to have been invite to this forum. I thank the convener and the organisers. Healthcare delivery is a very important public sector and private sector issue. An unhealthy nation or society is in a crisis and a profound on at that.
As a person, though I pray every day, my one singular wish is not to fall sick or have any reason to end up in a Nigerian hospital. Sad as it is to publicly admit that reality, it is a feeling that is broadly shared, even by most of the people in this auditorium. As a public policy expert and someone who is seeking public office in our state, I know that our healthcare delivery is in serious crisis. People still die of preventable causes in Nigeria. This is sad, worrisome and scary, but it is the reality.
My disposition to problem solving is first to determine or diagnose the problem then find the appropriate solution. When that is done then we can start filling the critical yawning gaps. Prevailing healthcare challenges in Nigeria and Anambra State, could be attributed to limited funding, diminished professionalism, dearth of infrastructure, poor policy focus and regulation and absence of critical partnership between the state and the churches and private investors.
Healthcare delivery anywhere in the world is not cheap. But a slant towards social healthcare delivery is possible. What is more important is to start on the premise that quality and affordable health care should be a right, not a privilege. But to attract investors, both domestic and foreign, we must focus on the right policies, the correct regulation, insist on full compliance and have a commitment to service delivery.
We must train and retrain our personnel, ensure continuing medical education and respect for environment where investors will deliver very costly equipment. We must incentivize those who work in the rural settings.
I believe that to address the existing void in healthcare delivery, healthcare firms that could be erected for quality Medicare by individual/private interests should address the following gaps.
Human Resources for health: This is deficient both in quantity and quality. The quality refers to the specialists available. We claim to have Primary Health Care as our health policy in this country, but indeed we cannot honestly say that we are practicing primary health care.
In primary health care, every sick person must first see a primary healthcare physician, who can treat the case or refer to an appropriate specialist after thorough investigation. The numbers could be addressed on the long run by good policies that will train more primary health/ specialist health personnel. The current situation could be addressed collaboratively by outsourcing the deployment of our human resources mix to health managers, who after a baseline assessment of our current situation can deploy available staff for maximum benefit. This aspect has a public policy angle to it.
Lack of Diagnostic Centers: In advanced societies there is division of roles in every sense of it. In house or external laboratories and other ancillary aids in hospitals are very necessary and are pivotal in the accurate diagnosis of a patient.
I am not a physician, but I am married to one. But as a member of the attentive public and a public policy expert, I know that any wrong diagnosis could be deleterious to a patient. Some persons have lost their lives because of wrong diagnosis or no diagnosis at all. We have moved from the stage of treating every fever as a case of malaria or typhoid to really getting a laboratory confirmation of malaria before using the anti malaria. By treating every case of fever as malaria especially in children under 5 years old, we might be over using the drugs and the issue of resistance could arise.
Indeed we may lose the child to other causes of fever like urinary tract infection and its sequel. Individual/private sector interest could be in the area of collaboration with government. Individuals could establish a well-equipped centre under a Public-private partnership (PPP) arrangement. Methods of assessing this should be in place and rigidly/strictly carried out.
First Responders and Emergency Medical Units: Disasters and medical emergencies occur frequently and always unannounced. They come unannounced and of different magnitude. Such crisis results from variants of causes– building collapse, fuel tanker fire, motor vehicle accident, stampedes, motorboats collision, etc. Natural causes include cardiac arrests, and aneurism. Such crisis could be overwhelming atimes.
Unfortunately our level preparedness for emergencies is lacking and indeed alarming. The aftermaths of accidents are injuries to human beings. Private individuals could establish Emergency Response Units, Emergency Transport Units and Emergency and Trauma Units that could be easily put to use in case of disasters/ emergencies.
These so-called First Responders must consist of well-equipped Ambulance Units with well-trained personnel who are trained in Bascis Live Support (BLS); Pediatric Life Support (PALS) and Advance Live Support (ALS). Beyond reaching those in crisis quickly, these personnel must be up to date with their certification and continuing medical education.
First responders must also be familiar with resuscitation including management of periarrest condition, management of acute coronary syndromes (ACS). They must be accustomed to the use of automated external defibrillators (AED). By Law, AEDs and various appliances to free trapped victims should be available in strategic locations in public and privately owned businesses and hospitals. An operational public access number that ties the public, security agencies and first responders by telephone or other smart telecommunications to hospitals remain imperative.
Funding health care: We must adapt our healthcare delivery services to global best practices. The recent clamour to retain Obamacare by the Americans was spearheaded by the democrats who cried wolf when it was first instituted under President Barrack Obama. The cost of health care is a huge challenge to the citizens of Nigeria. Healthcare is said to be available when it is accessible, affordable and of good quality. The advantages/benefits of health insurance could be harnessed by the private sector to make healthcare available, affordable and indeed accessible.
Outside the Federal Government funded National Health Insurance Scheme, HIS, additional and alternative insurances funding could be pooled by a private sector consortium for the purpose of providing healthcare. The managers of such fund would ensure the proper use of the fund to provide quality healthcare. Of course when the contributors don’t get value for their money questions would be asked and refund issues/litigations could come up.
Sectoral schemes are also possible. It is all about demand, supply and accountability. Indeed there are some existing functional schemes, such as those at Annunciation Hospital in Emene and Mother of Christ Hospital in Enugu. The public makes annual contributions to the scheme and get quality healthcare.
At present, Anambra State has not joined the NHIS and is still tinkering with the idea of establishing a community-health insurance scheme. The risk and I can say this with some degree of authority having been in government, is that such schemes, like the community bank scheme, the social-welfare for the aged scheme soon enough become transaction-driven instead of public-interest driven. So far in Anambra, it has been all talks and no work.
A US-based private group has just started a scheme to take care of their kit and kin in Nigeria when they fall sick. They have credible laboratories, pharmacies and hospitals register under the scheme. Their relations get Medicare from these registered facilities. Then reimbursement is done electronically to the facility for the service(s) rendered.
Provision and management of efficacious, affordable, and potent Drugs: Nigeria can be proud that it inherited and has expanded its pharmaceutical and drugs production base over the years. Foreign drug companies are also investing in Nigeria. Individuals could undertake drug manufacturing in this country and state. So far what is going on in this area is a far cry from the demands. Generic drugs could be manufactured to lower cost and thus making healthcare affordable.
Since its establishment, NAFDAC has done well to combat illegal and fake drugs. But there is more to be done. The collaboration between doctors and pharmacists is sadly very poor. So the prescription and dispensing of drugs has fallen to non-professional and quacks. There must be a law restricting the prescription and dispensing of drugs, especially controlled substances to licensed professional only.
WATERSHED: If I were to offer a synoptic overview of our state of healthcare delivery using Anambra as a yardstick, I will identify these areas of unmet needs.
• No general hospital in Anambra state can or runs a 24-hours service.
• No functional toilets for staff, patients and patient-relations in any of our general hospitals; waiting areas are dismally poor.
• No constant water supply in our hospitals; despite numerous boreholes.
• No alternative power supply in our hospitals. Most not connected to National grid.
• Construction of Helipad at General Hospital Onitsha was most senseless. Where is the helicopter coming from or going to?
• Recently Anambra lost its hard-earned UNICEF award for state performance on immunization though all vaccines including the cold-chain are donor-funded.
• Despite the fact that HIV/AIDS services, which include counseling and testing, treatment and care are sponsored by foreign donors, including, PEPFAR (Presidents Emergency Plan for Aids Relief); The Global Fund; The World Bank etc. Tuberculosis drugs are provided by GLRA (German Leprosy Relief Association), our people are not being tested robustly, and availed these services.
• Our World Bank funded save-a-million lives programme is being used for political patronage.
Summation: Let’s talk frankly. When nit come to healthcare delivery, Nigeria has really not gotten it right both at national, state and local government levels. Our healthcare delivery remedial measures must begin with a re-energized collaboration, state funding support for mission and faith-based hospitals. We must look anew, how we fund our university hospitals.
Private endowments, donations in cash or buildings and equipment by corporations and individuals remain imperative. In return, the names of the donors can adorn the specific wings and facilities funded. Above all, government healthcare policies must be proactive and focused.
All said there is a vast scope for collaboration and involvement of private and individual investors in promoting healthcare delivery in Nigeria and in our state. We just need to make it our priority or pet and niche project.
I thank you for your kind attention.
Mr. Obaze, MD/CEO Selonnes Consult Ltd. and Anambra State 2017 PDP Governorship Aspirant presented this keynote address at the Public Brainstorming Forum on “Ideas That Can Propel Individual/Private Sector Interest To Erect World-class Health Firms For Quality Medicare To Man” at the St. Cletus Auditorium, Otolo Nnewi, On Saturday 8 July 2017