Professor Rowland Ndoma-Egba has attained various milestones in the development of health care system in Nigeria. He is a Professor of Surgery and Chief Consultant Surgeon. Presently, he is the Pro-Chancellor and Chairman of Council, Obafemi Awolowo University (OAU), Ile Ife.
Prof Rowland Ndoma-Egba was Former Chief Medical Director at University of Calabar Teaching Hospital. He’s presently the Chairman, Nigerian Cancer Society; Cross River State Branch.
It is been a great concern by millions of Nigerians over the poor health system in the country.. That’s why this topic; “Health Care Reforms In Nigeria” was chosen to address some of the issues.
The team for this year’s talkshow event was “Elements of Good Governance” held at Sheraton Hotel, Ikeja Lagos. It is pertinent to note that good governance cannot be achieved without good health care system.
Without wasting time, let’s go straight to his presentation :
DEFINITION OF HEALTH REFORM: A broad based purposeful and sustainable fundamental change system(that is: vision, policies, legislation, institutional arrangements, organisation, plans, programmes and projects) in order to deliver efficient, affordable, quality, accessible, effective and equitable Health care services to the populace – FMOH, 2004
- More than 100 Universities…Public + Private
- Each state including FCT has a Teaching Hospital or a Federal Medical Centre. Each LGA has a General Hospital and each ward has a Primary Health Centre…. 23,640 health establishments
- The most populous black nation; 186-200 m.
- Highest Producer of Petroleum and Gas in Africa
- Has NHIS + National Health Act + BHCPF
- Sir Samuel Manuwa, FRS… Queen’s Privy Counsellor for West Africa
- UCH, IBADAN…Among top 5 Hospitals in Commonwealth
- Medical Tourism from Saudi Arabia and West African Countries
- Patients in Federal Teaching Hospitals were Admitted and treated free including drugs and feeding up to the 1980s
- 1 -5.8 % OF Total Government expenditure went to Health sector in 2000-2007
- Country’s Health performance was ranked 187th of 191(WHO, 2012)
- Infant Mortality 80.4/1000, Nigeria, Regional average 57.3… throughout developing countries in 2010
- Life Expectancy: 49.8 yrs; Sub-Saharan Africa 53.5 and developing countries 65.4 by 2007. Now Nigeria 51.7…..2011 (World Bank)
- Human Dev Index(HDI): Nigeria 0.47 or 153rd out 187 below: Kenya, Cameroon and Ghana (UNDP, 2013)
- Maternal Mortality: 545/100,000 live births
- In spite of its huge economic potentials. It is one of the 10 poorest countries in the World
- 38% of under 24 year olds are unemployed (Nigerian stat); 80% by World Bank stats.
- Nigerian GDP 4.1 % against 4.6 for rest of Africa and 6.3 for developed nations
- Poverty 33.1 %
- % of population living under $1.9/day: Nigeria 44.2; Bangladesh 10.1; Ghana 10.0; Croatia0.85
- Role of Tiers of Government:
- Lack of clarity/consensus about which tier of government is responsible for what function/funding…. Consequently:
LGA: Unable to manage Primary Health and PHCs.
State Govts: Unable to Manage/ maintain General Hospitals which have virtually disappeared.
Tertiary Hospitals: Now over-burdened with functions of PHCs & General Hospitals
- Role of tiers of government:
- Create A National Hospital Agency responsible for the management and regulation of secondary and tertiary care
- NHA to develop effective referral system and standardisation of services
- Funding should be Federal with State matching grants
- At the Local Government Level there should be effective co-ordination of PHC & General Hospital services
- Human Capital Development:
In spite of the often vaunted position, there is acute shortage of appropriate manpower in the Health Sector. “Brain drain” is making the situation worse.
- Liaison between the Universities and the Postgraduate professional bodies must be properly defined
- At a certain stage in professional specialist training, posting to the secondary tier should be mandatory
- National Health Insurance Scheme… Since 1999. Should be regulator rather than Institution.
1.The only hope of universal health coverage
- So far has achieved 2-3% coverage
- OUGHT TO BE MANDATORY
4.States, Communities and Private organisation must be effectively mobilised
- “Safety net” for the vulnerable and the too poor to pay must be protected
- Out-of-pocket too high at over 70%
- NATIONAL HEALTH ACT(NHA)…. Since 2014
1.Yet to be implemented
- General ignorance about its existence and content
- The Basic Health Care Provision Fund(BHCPF) although budgeted for at 57.6 billion naira(2018), not a penny released
- Hospital and equipment Standard Commission ought to be in place
CONSEQUENCES OF FAILURE:
- Promotion of “Medical Tourism” to other lands
- Despite higher inputs into the Nigerian Health system, outcomes are better with the Ghana Health system(penetration up to 67.9%
- “Brain drain” of frustrated medical staff
- Poor Health Indices impacting negatively on the economy
- Very high out-of-pocket expenditure
BENEFITS OF IMPLEMENTING THE REFORMS:
- Better quality services that are better organised and linked with a functional and sustainable system
- Services will be available, acceptable, accessible from a wide range of public and private health providers
- Managers will have more evidence-based budgeting and will be able to manage their system more efficiently
- Providers will have further training and retraining to be more responsive to the users
WHY WE MUST REVERSE THE FLOW: MEDICAL TOURISM
- NATIONAL PRIDE
- HUGE ECONOMIC BURDEN >1-6 Billion pa
- “MEDICAL TOURISM IS BIG BUSINESS”
- JOB SATISFACTION AND EMPLOYMENT OF MEDICAL AND ALLIED STAFF
- BECAUSE WITH THE RIGHT POLITICAL WILL IT CAN BE DONE
- OUR POOR HEALTH OUTCOMES ARE A RESULT OF SYSTEM FAILURE
- THE POLITICAL WILL TO IMPLEMENT IS LACKING
- WERE WE TO RESOLVE TO CHANGE THE TREND, WE WILL SUCCEED
- OUR PROBLEM IS NOT “FINANCE” BUT THE JUDICIOUS AND HUMANE APPLICATION OF OUR RESOURCES TO THE GOOD OF THE MAJORITY
- AS LONG AS THE REMAIN ENSCONCED IN THEIR WEALTH AND FREEDOM TO SEEK MEDICAL ATTENTION ELSEWHERE, SO LONG SHALL LEADERSHIP FAIL TO PROVIDE ADEQUATELY FOR THE WEAK & POOR IN OUR SOCIETY
- INVITING ME – Prof. Rowland Ndoma-Egba
- For enquiries contact : firstname.lastname@example.org