*Says, Nigeria’s 2030 target of UHC not feasible
By Doosuur Iwambe
Dr Odiah Edozie Felix is a Public Health Physician/Desmotologist.
He worked with the Nigeria Prisons Medical Corps and Retired in 2013 as Controller of Prisons.
In this exclusive interview with the DAILY TIMES, he examined the health sector under the current administration, what Nigeria need to do to manage future outbreak of diseases and more. Read the excepts…
As the clock ticks for the present government, how will you assess the nation’s health sector under President Muhammadu Buhari?
Under the current dispensation, I feel the health sector has done well in some areas and not too well in other areas. Let’s not forget the mere fact that it took the president about six months, to appoint his ministers.
This literally means that the president wanted the best for the country. So the question should be, how has the minister of health performed under President Muhammadu Buhari. I will actually want to look at the sunny side of the performance of the health sector under Buhari.
Just to mention a few successes recorded, these include the signing of the National Health bill by the President into law, the assistance given to the Residency Training Program by the Federal government, improved immunization coverage nationwide, health indicators have improved across board, Establishment of National Primary Health Care Development Agency in all the thirty-six states and Abuja thus bringing Primary Health Care (PHC) under one roof (PHCUOR).
There is also the bill on Universal Health Coverage signed into Law by the President for all levels of the populations. So I think he has done fairly well, though still a lot of work to be done in terms of Doctor Patients ratio as recommended by tye World Health Organisation, WHO which should be about a mix of 23 Doctors, nurses and midwives per 10,000 population, Nigeria has Doctor-Patient ratio of 1:5000 instead of 1:600 as recommended by WHO due to brain drain.
In terms of budget allocation to the health sector, we are yet to get there, only 5.57% of 2023 budget was allocated to the health sector as against the 15% recommended by WHO. This is the verdict of performance by this administration as regards the health sector.
Covid-19 came with so much interruption to services, what is your take on how the outbreak was managed?
Covid-19 was excellently managed in Nigeria. I am proud as a Public Health Physicians giving the way Covid-19 was and is still being managed by the committee headed by the SGF and the then EDNCDC Dr. Okey who is currently with the WHO due to his excellent management of the pandemic in Nigeria.
All the Covid-19 protocols were obeyed to the letter and every preventive measure put in place, restriction of movements were imposed when necessary, face masks and distance maintained in public places, Covid vaccines were made available as soon as they got to Nigeria. Measures were put in place to ensure that everyone got the vaccine and in good time.
Primary Health Care (PHC) emergency was operationalized by setting up Public Health Emergency Operational centres in all states of the federation. This includes molecular laboratory in states, treatment centres were well managed across the states of the federation. This is evidenced by reduction in mortality rate compared to other parts of the world.
Schools in Nigeria were re-opened earlier in most parts of the world. Movements into the country and exits were well controlled and Covid vaccination was made compulsory for every passenger coming in and exciting Nigeria. Covid-19 was professionally and excellently managed in Nigeria.
Do you think the country is prepared for disease management (control) and future re-occurrence of outbreak?
In terms of pandemic response, Nigeria is better prepared than many countries in the world. The challenge is intentional investment in the health sector. We have both human and other resources in abundance as far as epidemic responses is concerned in Nigeria.
In a country where Medical Doctors are forced to retire at sixty years of age, it is very unfortunate. What are all the Public Health Physicians who retired at sixty over the years doing.
Some are running private general clinics mostly in their respective villages closest to the people. What stops the government from engaging them in time of epidemic or pandemic to help with manpower and their wealth of experience. There are emergency funds lying in the health ministry.
What do they do with those funds outside emergency like we had in the Ebola, and Covid-19 years.
Though we never had that level of Ebola outbreaks of Public Health concern. If the young Public health/community health physicians are not willing to go to their rural communities, the government should recall the veteran Public health physicians retired, to duty.
Just like in times of war where reserve soldiers are called back to serve their father land. Data base of retired Public Health/Community Medicine Physicians should be handy in all ministries of health across the country for times like we had. With the structures on ground, and collaboration with international organizations (NGOs) and implementing partners, Nigeria is more than ready to deal with an epidemic or pandemic.
We have trained personnel, though being threatened by brain drain at the moment. Also lesson learned from the Covid-19 pandemic across the globe made us better prepared to combat any epidemic outbreak than ever.
The only challenge we have here is the funding and poor budgetary allocation to health sector, insecurity, brain drain and almighty corruption. Some of the treatment centres are now moribund unfortunately.
The NPHCDA ED said recently that false information slowed Covid-19 vaccination. What is your advise on how to control this in future.
What the ED was referring to are series of conspiracy theories that were awash the social media, videos and print media etc. Mostly coming from North America and Europe spread across the globe. Myths and misconceptions about the Covid-19 vaccines.
Questions such as, how can you within a year produce a vaccine while forever malaria, HIV, etc vaccines are yet to see sight of the day. Other conspiracy theories of course also questioned why blacks and whites where having different centres for vaccination especially in United States. To me, for non-medical oriented persons, I won’t really blame them.
If for years unending vaccines for malaria, HIV and other communicable diseases are yet to be produced, how come for Covid-19 just within a year the vaccines are everywhere. They got reasons for sure.
This to a very large extent slowed down the Covid-19 vaccine uptake across the globe and this led to a lot of casualties and high mortality rate. My advise to government agencies, international non-governmental organisations (NGOs) and donors is going to be based on the realities on ground.
They should engage in serious advocacy carried to the grass roots where health care services are poorly managed. A robust health information and health education designed to counter the false narratives as concerns the Covid-19 vaccines.
Debunk all the conspiracy theories and the proper information about Covid-19 and its vaccines must be passed to them. The question of population control must be aggressively countered, with concrete evidence.
This advocacy must be sustained even when the pandemic ceases to be a public health concern for the future unforeseen epidemics and pandemics. Local Organisations Network (LON) and community based organizations (CBOs) are to champion these advocacies and campaign against the myths and conspiracy theories about Covid-19 vaccines.
The composition of the LONs and CBOs must as a matter of fact be from the communities where these campaigns are targeted. Pastors, Imams, Community leaders, social mobilisers, “bad boys” if known should be incooperated.
Traditional medicine practitioners also must be involved. All these measures must be sustained and ongoing. Composition of these organisations must be gender friendly for easy acceptability by the target population.
More often than none, the organisations in the past are made up of people not from the target communities, and they were faced with rejection by the host target communities. These measures will definitely improve vaccine acceptance and decrease in mortality.
Primary Health Care (PHC) facilities across the country are in a dilapidated state. What is responsible for this and how can it be revived?
First of all, we must understand the concept of Primary Health Care (PHC) before we look at it as dilapidated or otherwise. Secondly, I will rather say that PHC across the country is in a state of dis-function rather than dilapidated because no matter the state of the PHC clinics across the country, you will still find people working there.
Now what is Primary Health Care (PHC)?
PHC is essential health care service that is basically acceptable, accessible, affordable and all inclusive.
It is a service that the community where the PHC facilities are located must assume ownership of such facility and participate in all programs designed to produce services to the community.
PHC is focused on providing preventive services to the people ranging from immunization, environment sanitation, provision of basic shelter, drinking water, etc. This makes it a multi-sectoral project. Even the location of such centre must be acceptable to the communities it’s meant to serve.
Haven given you an insight on what PHC is all about you can now ask why the facilities are in such dysfunctional state across the nation.
The possible reasons for its dysfunctionality could be due to some obvious reasons, first, the people in the community are not encouraged to think for themselves, and see how they can solve their problems, secondly, past attempts to establish PHC facilities was cosmetic, people were not trained, not empowered, new technologies were invented without training the people on how to use them, Thirdly, they only mobilized resources from the community without empowerment so they refused to identify with the project.
Fourth, there is conflict between directed needs as determined by the project donors and the felt needs of the community.
Fifth, absence or lack of medical officers of health. Community must take ownership of such projects, there must be community health development committee (Ward Health Development Committee).
Lack of trained staff, some of the PHC facilities are politically sited, so population coverage is not there, corruption, diversion of funds and drugs. ALWAYS A GAP BETWEEN THE TOWN AND THE GOWN. My advise for revival includes but not limited to the following; address poverty by empowering them economically, because you cannot talk of health without addressing hunger, empower the community with skills and knowledge from health care providers to the community, move from old ways of doing things to new methods. Lastly, the use of appropriate technology must be incooperated.
What policies do you advise that government should put in place to address the state of the PHCs?
To address the state of Primary Health Care in Nigeria, the government must put up policies that are people oriented and community friendly. There must be private sector investment, before the present status of our PHC can change.
The Basic Health Care Provision Fund is to address key issues right, but far from addressing the huge gap. The Primary Health Care Development Agency must be committed to building or renovating one PHC centre per Local Government Area (LGA).
Imagine Dangote renovating all PHC facilities in Kano, Kogi and Benue. They have the cement and trucks to deliver sand. Also if MTN pays 50kobo per minute contribution to National Health Insurance, this will go a long way in improving our PHC status. So also other multinational companies as social cooperate responsibility.
The government must go back to the original plan put in place and fully implemented based on appropriate technology acceptable to the communities. There should be full community participation, equity and cultural acceptability.
There should be full community participation in terms of planning, implementation and monitoring. PHCs must be accessible geographically to the communities targeted, economically and culturally accessible too. Equitable deployment of resources in relation to needs.
PHCs should focus on prevention and appropriate technology should be appropriate for level of health development that is making impact on the health of the people. Focus should be strictly on prevention and not on curative.
There should be inter-sectoral collaboration with basic need approach to help development. Other sectors whose activities impact health like Agriculture, Education, Communication, Ministry of women affairs, Housing and environment should work with PHC centres via the parent ministry or agency. The political will of the government is key in continuous formulation of policies that will impact positively on the lives of the people through PHC.
The journey to Universal Health Coverage seems to be very slow, is the SDG 3 target of 2030 feasible?
Given the present situation, I don’t think it is possible. Universal Health Coverage is the availability of full range of quality health services to all people in need, when and where they need them without financial hardship.
What is SDG 3? This is ensuring healthy lives and promoting wellbeing for all at all ages. To achieve this, we must address the core determinants of health and well-being, including social-economic determinants such as education, income and gender. I want to look at the challenges (Some key ones) to achieving the SDG 3 as all of them are connected.
There is no possibility or rather probability of achieving one in isolation of the rest 16. One of the challenges is funding. President’s Emergency Plan for Aids Relief (PEPFAR) is the main source of funding for the SDG 3.
Most of our health care programs are funded largely by international partners and donors. Investing in health care must be a priority and adequate funding secured if you want to make a long term impact. We need to strive not just to tackle disease but to achieve a healthy society for everyone.
It must be a global effort in achieving the SDG 3. Among the key challenges to achieving SDG 3 are; the problems of health funding in terms of both amount and patterns, the poorly regulated and growing role of private parties, taking multiple forms, the intersectional nature of inequality and the limitation of many current health indices.
Insecurity is one of the major setback in achieving this goal, as many health care providers are being kidnapped, raped or killed. Poor funding and economic instability also is one factor, brain drain is another challenge militating against the goal, weak implementation of health service schemes such as the Midwives Service Scheme (MSS), cultural practices, religious belief and poor budgetary provisions.
Our epileptic health care system is another barrier to achieving SDG 3 by 2030. Also incoherent policy formulation, poor motivation of workers, misplacement of human and material resources, infrastructural decay, federal government breach of agreement, bureaucratic bottle necks and corruption.
I guess it is pretty obvious that our health care sector may have to remain in such deplorable condition until we are able to reverse the aforementioned challenges. God help us.
How has brain drain affected the health sector?
Brain drain in health sector is migration of health workers or movement of health personnel in search of a better standard of living and life quality, higher salaries, access to advance technology and more stable political condition in different places worldwide.
Brain drain is the negative aspect of internet and global connectivity that makes the world a global village. Personnel move across the globe based on pull and push factor. Doctors from US and Europe go to India and other Asian countries for sabbatical to get huge pay.
You cannot restrict migration across the globe. Nigeria has to address the push factors that are even outside the medical domain. Insecurity, cost of living, education cost basically affect everyone including health care personnel.
The factors within the health care sector is poor status of health facilities, poor conditions of service and lack of equipment.
The effect of brain drain on our health sector is honestly unimaginable. Most of the training institutions for medical professionals across the country have lost their best brains to brain drain, especially our medical schools.
People, especially our consultants leave the country in droves to countries where condition of service is at its’ best. Surprisingly, the exodus of our best medical professionals is not just to Europe or America but also to African countries. Not so long ago, about 10 consultants well known to me left for our neighboring country here, equatorial Guinee where they are being paid in euros and given other incentives very attractive.
This happens every day. We might wake up to find one day that we have no professionals to run our hospitals. More to this is the fact that this critical shortage causes a delay in accessing quality health care, low usage of accredited health facilities and higher patronage on orthodox health care.
All this contribute to poor health indices of the nation. Other effects of brain drain that has been identified include loss of human capital assets, lost income from the loss of tax of the migrated man power to foreign countries, and the loss of the capital invested in the subsidized public education of migrated man power.
In summary, there are so many ills of brain drain in Nigeria and these include but not limited to widening gap between doctors/patients ratio, weaker health institutions and systems, loss of experienced experts, medical education suffers due to lack of dynamic young experts who are all gone leaving ageing generation of health care personnel often too weak and exhausted, poor quality research publications also affect the economy of the country.
These are all as a result of bad governance and leadership, and lastly insecurity and corruption.
In conclusion, migration of medical personnel impact more negatively on the health care of the exporting countries than positively.
Moreover, because of the nature and complexity of this problem, sincere and committed effort are needed from both the medical workers and the government of the developing and developed countries.
There is need to change not just the process, but the entire system in most of the developing countries.
The government should choose between politics and the people, while the medical workers should balance their individual needs with ethics. Lastly, the government has to take a concerted, holistic and sincere approach for it to stop and adjust the pull and push factors with a policy that have deep seated nationalistic base.
What is the implication of 1 doctor to 10,000 patients and how can this be tackled?
What we actually have is 1 doctor to 10,000 population and different from 1 doctor to 10,000 patients. This is not news to those of us in the medical practice because it’s been one of the problems facing medical practice in Nigeria. I remember after my youth service in 1985, I was given employment by the Kano state government as medical officer 1.
I was taken to Murtala Mohammed specialist hospital in the city to work at the general out-patient department. My first day at work I was given a table under a mango tree with over 500 patients to attend to.
I am being modest with that figure. All that happened after that first day is now history.
The implication of this gap in doctor to patient ratio is grave. The recommended ratio by WHO is about 1:600. Some of the consequences are but not limited to the following; lower quality of health care services, closure of hospital wards, increase in wait time, reducing number of staff beds, underutilization of physicians or higher medical cost, etc.
Also you may experience loss of productivity, decrease in patient satisfaction. This could result in increase in morbidity and mortality rate.
Talking about measures to tackle this gap, a lot has been said about these measures in this interview earlier on. Brain drain is the major cause of this gap and its consequences.
So to address this gap, the government must address the issue of brain drain for a start. Part of the solution, might require the use of modern technology. Recently a health technology company JOSMOL launched a robust telemedicine offering – DoctorConnent to provide quality, accessible and affordable health care to all Nigerians regardless of status.
Other measures include; improved condition of service for the doctors, provide security, provide conducive working environment, provide appropriate working tools for the physicians, good governance, address the pull and push factors that influence their migration to other countries.
Promulgate policies that control the brain drain menace as already outlined above. Work friendly environment is a factor also, motivation in form of reward for good work.