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Craze for money, root of crisis in health sector – Ogirima, NMA President

Magnus Eze, Abuja

The outgoing president of Nigerian Medical Association (NMA), Mike Ozovehe Ogirima, a professor of orthopaedics and trauma surgery, has condemned the rivalry between doctors and other health workers, saying there is no basis for it.

According to him, doctors make a lot of sacrifices in the health care system, and, therefore, deserve to earn more salary.

In this interview, he spoke about the country’s poor health indices and National Health Insurance Scheme, among others.

Nigeria dropped in the last world happiness rating. What do you think cause this?

The rating we have is still that of 2013/2014 and no country has come out to dispute that. Nigeria doesn’t have the capacity to disprove it because we don’t keep statistics. We are still bound to use the World Health Organisation (WHO) and World Bank rating of 187 out of 191 and in the happiness index, we have moved down from being Number 3 to 90. The reason for that may not be far from the poor health indices we are having. Of course, if a man loses a wife during child birth, it’s 100 per cent for that family; that family will not be happy; and we are now saying that 554 out of 100, 000 women die from child birth. If it’s happening in one family, it’s 100 per cent; if it’s happening in a community of 100,000, it’s sad; it doesn’t make people to be happy.

If children are dying like rats, no king; no governor, no ward chief or local government chairman would be happy. These are the health related issues that are causing sadness in the society. I don’t want to go into the economic because I’m not an economist. If a head of family that earns less than N18, 000 monthly is going to spend N20, 000 to threat a child that has typhoid fever, is he not going to be permanently impoverished? He won’t be happy. If somebody wakes up in the morning and he’s not even sure of breakfast, he won’t be happy throughout the day. Happiness and health indices are related.

What is the problem of healthcare financing?

Sixty per cent of what we spend on health in Nigeria is out of pocket. The National Health Insurance Scheme (NHIS) is not mandatory. The government should bring out a policy that mandates everybody in Nigeria to contribute centrally to the NHIS. That’s what is obtainable in those countries that have achieved enough for their people. The Cubans operate the socialist way of government; and they have the best health indices in the world. Only three per cent of Nigerian population are covered by NHIS; yet those ones are happy because anytime they visit the hospital, they usually get service.

There are issues about HMOs everywhere.

Initially, there were teething problems; but for now, you are sure you can get service. However, if you say whether the services you have enjoyed have been remunerated to the provider, that’s where the HMO comes in. The HMOs are sitting on providers’ money; they are middlemen, they keep the money that has been deducted and give it out based on services provided. But once you give out money, it’s like an arrears of services you have provided about six months ago; it becomes a clog in the process. That’s why the NMA says we don’t need middlemen.

In the NHS in UK, they don’t have middlemen. The Americans, who were using middlemen, are running away from HMOs; they don’t want it. They are holding on to people’s money and that transmits to holding on to people’s welfare. So, if government is sincere, we should make NHIS mandatory. We have traditional means of contributing to the system. The farmers have a way of gathering their produce once in a year and valued by the Local Government Chairmen or Department of Agriculture and pull that into NHIS. What we call social insurance scheme is community insurance scheme at that level.

What’s your take on the Basic Health Provision Fund that the minister recently launched?

That’s not what the law says. The law says that one per cent of the consolidated revenue of the country will be for health and domiciled in the Central Bank of Nigeria. It’s not only what you appropriate in the annual budget. Is the minister saying that the one per cent has been set aside; how are they running the pilot studies in Abia, Niger and Osun states? Is there any budget for that? The National Health Act says that at least one per cent of the consolidated revenue should be put together and called the Basic Health Provision Fund and this one is shared into.

What causes mutual mistrust between the doctor and other health workers?

The main issue, which is diverting attention, is money and the care of the patient is suffering. The value in the system has changed from being patriotic to chasing money for everything you put in and the patient is suffering. The last administration set up the Alhaji Yayale Ahmed committee to resolve this inter-professional rivalry in the hospital. The white paper is there with the government and they are refusing to implement it. Once it is implemented, it will go a long way in solving this problem because the committee went out of this country to find out what is the situation. They know the true situation as covered by the Yayale Ahmed Committee report. Government should be sincere enough to use the contents of that report.

So, the rivalry is that any worker in the hospital wants to earn the salary of a doctor. Why is the doctor’s salary different from all other health workers all over the world? Here in Nigeria, the people who are not supposed to be in the hospital are the ones agitating and mobilising other health workers against the doctor. What do I mean by people who are not supposed to be in the hospital? You have clerks, accountants, administrators. They have now come together to form a force. Of course, the doctor-patient ratio is too much; even in the hospital, other workers outnumber the doctors. You may have a general hospital in a local government with one doctor. What does that mean? The doctor is supposed to be there 24 hours, seven days a week, no leave, no casual leave, no emergency leave; he may not even have leave to attend to his family. Every other worker will come on shift and go but leave the doctor there.

I am not talking of how the doctor was educated; the cost of his education, the sacrifice he has made while others were enjoying holidays in school. This is the sum total of why relativity should exist between the doctor’s salary and other hospital workers.

Access to maternal health is difficult to most women. What do you think should be done to improve access?

Health as a whole is expensive and that’s why Public Private Partnership (PPP) arrangement is there. An individual can go to a facility and maintain the facility. The Aisha Buhari Foundation has demonstrated that will. She went to General Hospital, Daura and built a fully equipped maternity centre. The only partnership there now is that the government is responsible for the emoluments of the staff working in that environment.

The bill are borne by the Aisha Buhari Foundation. This is what wealthy people in the society should emulate instead of throwing money about in capital projects. That is a viable project that anybody can go into; PPP arrangement. That is the global trend; the hospitals outside the country where our big men run to are private hospitals. There’s no government hospital that they patronise outside Nigeria. They have developed their own beyond what is happening in Nigeria.

So, primary health centre can be owned by an individual. You can adopt a centre; they are so many moribund primary healthcare centres in Nigeria. About 30 per cent of what Prof Olikoye Ransome-Kuti left is remaining; most of them are sited away from the people; not equipped, not staffed. So, the way to go is PPP arrangement to minimise the suffering of our people.

Of course, government in its magnanimity brought SURE-P in those days. I don’t think this government can maintain the SURE-P but they brought in another programme called N-Power. Maybe, more people are enjoying N-Power than a few women getting N5, 000 for having delivery at the primary healthcare centres.

What’s the surest way of attaining Universal Health Coverage in Nigeria?
If we make it mandatory for everyone to key into the NHIS, funds would be available. There are NGOs coming up whereby they levy themselves; some people are saying one million people; if they can give us N1, 000 per annum, they can take care of some emergencies. It is still boiling down to the principle of health insurance because the N1, 000 you are contributing is not going to be used by the one million people; it will be used by 10 per cent, which is like 100,000 people and you still have excess money to take care of more people as the fund increases.


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