Is The Coronavirus A Silver Lining For Our Health Sector?
No. it is as simple as ABC and as clear as rock water. In the midst of the pandemic, with rising cases in Lagos and in the rest of the country, news filtered in that members of the House of Representatives took delivery of about 400 brand new cars. This is unprecedented in the whole wide world!
At the moment, there are over one hundred and seventy countries with cases of COVID-19, not one has reported anything as unconscionable as the distribution of brand-new up-to-date luxury vehicles by its legislators. In fact, many countries are working out stimulus packages for businesses — small and big — and individuals (employed, unemployed and those who are likely to become unemployed). Admittedly, the Emergency Economic Stimulus Bill 2020 was passed on the 24th of March approving the release of 6.5 billion naira for the National Centre for Disease Control (NCDC) and 10 billion naira for Lagos. But it is not enough reason for ‘Nero’ to fiddle away while the ‘empire’ burns.
Even if we accept the claim that the cars had been delivered before now, it is still sinful to buy brand new cars for yourselves on public funds in the midst of squalor. It is a repetitive cycle that must stop.
Our health sector is needlessly poor. This accounts for why the big men and women and their children never stick around for medical purposes. At the end of the eighth national assembly in May 2019, a bill to mandate public officials to stay home for medical attention was rejected on the grounds of its infringement on their fundamental human rights i.e. freedom of movement. Is that not very altruistic? The bill does not prevent them from travelling, it only says stay at home and get treated much as the requirement that no public official should own or maintain a foreign bank account doesn’t stop you from spending money abroad. My verdict is that Nigerian politicians are selfish through and through and a great majority of them are irredeemable.
As it stands, we have one of the worst doctor-to-patient ratios in the world. For a population of approximately 200 million people, there are only about 45000 doctors while we need over 300000. The WHO standard is one doctor to about 600 patients. This ratio will mean doom if the COVID-19 cases reach the thousands, we are not adequately manned.
The progress made by Professor Olikoye Ransome-Kuti from the mid-1980s until 1992, should now be continued after a long hiatus. The focus should be on preventive medicine that prioritizes basic healthcare which is in the purview of primary health centers. Only a small percentage of the existing primary health centres are fit for even household pets — they are completely unfit for humans, but they are still in use because our standards are low and hapless Nigerians have to make do rather than die, which is what eventually happens in many cases. We have made strides with certain indices not because of deliberate government efforts but because of the diligence and consistency of donor countries and aid agencies.
This year Nigeria would be declared polio-free. The work done to reach this milestone must be continued with the same diligence. Successive appropriation laws lend credence to the fact that health, education, water, and other critical infrastructure are not the major concerns of government officials. It is always about the next local government or general election. They have unabashedly outsourced the advancement of key development indices to USAID, DFID, UN, etc. and are quite comfortable to be described as leaders of a developing country after 60 years of self-rule. We are never going to achieve the Sustainable Development Goals (SDGs) this way, just as we missed the Millennium Development Goals (MDGs).
Nigerian politicians are not dumb — they know that people want to see results, they want instant gratification. That is how they can keep them in power. But they have got the method all wrong. A 200-bed hospital or a well-articulated and efficiently-run health insurance scheme is instant gratification. Many Nigerians still fall sick from malaria, typhoid, and there’s a growing number of cancer and diabetes cases. Almost every family has a birth or two somewhere in the family chain almost every year, this majority has a good reason to use the health centres — primary, secondary and tertiary. A good hospital that doesn’t require out-of-pocket expense is instant gratification for the bricklayer, the pepper seller or the neighbourhood hairdresser. For now, only private-sector employees get the full benefit of the NHIS — civil servants still face hurdles.
In 2020, we should have the best health insurance scheme in Africa. This is easy — not many countries are doing anything about it so competition is effectively absent. In 2020, we should have a surfeit of primary health centres. For the love of GOD, health is on the concurrent legislative list. It is not exclusive to the federal government, heck even a house of representative member or a councillor can establish a small hospital for his or her constituents.
We should have over 100, 000 standard and functional primary healthcare centres in my estimation because our population keeps growing, estimated to exceed 250 million by 2030, thus we have to be futuristic with planning. This is the thinking that should be going on in the heads and documents of public office holders, not sybaritism. We must also be aggressive with our recruitment of medical staff, not only doctors. The nurses are overworked as well. It is also vital to raise the pay and general conditions of service in the health sector. Health workers, teachers, and security personnel should be the highest-paid public sector employees in my estimation.
It is pointless to reproduce here data from our past budgets — it is common knowledge that allocations to health have been eternally appalling. We are one of the many countries that have failed to adhere to the Abuja declaration of 2001 where African countries pledged at least 15% of their annual budgets to the health sector.
Many commentators online, and off it, have expressed hope that the global lockdown, preventing our ‘crème de la crème’ from bailing out to the UK and elsewhere in Europe and America would bring about a new era in our healthcare administration. Wake up folks, that isn’t going to happen. Lagos must get kudos for its excellent stewardship at this time, ditto for the NCDC and the minister of health and his deputy. However, we must institute a culture of excellence. We should not only stand erect in times of grand emergencies. There are daily emergencies in the lives of millions of unlucky Nigerians, many of whom never get adequate responses because of the decrepit system.
It would be easy to call on the government to fix the system but that would be very platitudinous. Opinion leaders and columnists have been calling for decades to no avail. I think the government — federal, state and local — is a lost cause. But, boy, do I wish to be proved wrong!
What should be done when the pandemic is over is what is already being done in the midst of the crisis. Private organisations and individuals are contributing to or setting up funds to combat coronavirus. This should not stop, for the sake of all of us. The organized private sector can band in teams to set up not-for-profit funds that would set up and run PHCs across the country in both rural and urban areas. There could be as many as 200 of these funds with capital of between 500 million naira and 2 billion naira depending on the preferred areas of operations by each fund.
Once established, the centres would be run through a reinvigorated health insurance that considers the hoi-polloi. Models can be drawn up to see workable price points. Would it be possible for an individual to pay 1000 naira, or a family of four 5000 naira per annum for basic coverage at the PHC and so on? This is just an instance but the cover should be as inexpensive as possible so that everybody can be carried along.
Some of the best societies are not the ones that thrive on extreme profit taking — which is inevitable — but the ones that reckon with its vulnerable and makes them strong through policies and actions that eventually make the entire fabric of society a resilient one for all to find refuge. The coronavirus has shown us that we are all in this together. It should be a silver lining but I am despondent.
