Funding challenges, brain drain hamper healthcare delivery in Nigeria – Dr. Odo
The ugly challenges in Nigeria’s healthcare delivery system continue to be on the front burner, Dr. Iyke Odo, National President of the Association of General and Private Medical Practitioners of Nigeria (AGPMPN), in this interview, speaks on healthcare situation in Nigeria, brain drain in the sector, funding private hospitals, the need for specialized health sector bank, the association’s centenary anniversary, among other relevant topics.
What is your impression about healthcare delivery in Nigeria?
The system is sub-optimal. It is not performing effectively. It is not adequate or comprehensive in its performance and to a very large extent, the system is weak, unable to meet the needs of the average Nigerian; and it is compromised and struggling. We can do far better.
But the health insurance scheme in Nigeria was designed to enhance healthcare delivery, hasn’t that been the case?
Our health insurance experience can only be described as a distraction. After more than 16 years of introducing it, Nigerians are still suffering because more than 90 per cent still do not have a health insurance cover. And those that have it are not enjoying the full benefit because it is about a different unique healthcare financing system that makes people no longer pay for their medical treatment out of pocket. People are meant to pay in advance minimal, basic regular frequent contribution called premium into a consolidated account whether they are sick or not.
But less than 10 per cent of Nigerians are contributing, and so the money being contributed is very little to sustain the system. And that is why many are outside that net. Those inside the net appear trapped because they are not getting the best that they should have. But for a country like Nigeria, great and mighty, we should have no reason why our health system should not work except for the old reason of lack of good leadership, lack of transparency, lack of coordination and lack of unity because if health insurance works, it is the game changer. It is the solution, the cure and the gateway and the greatest opportunity to promote quality, affordable and equitable healthcare where everybody is happy.
What do you consider the major challenges of private medical practitioners in the country?
I run a private facility. Eighty percent of the time, my hospital is powered by generators. Over 40 per cent of our earnings goes into power supply. We spend over N4million every month on power. It is a major headache. The cost of funding a private hospital is too high. Normally because we are a social welfare industry, we are supposed to be given a rebate, concession, subsidy, waivers. If as a hospital, I need a bank loan, I should get the lowest interest rate. But in Nigeria, there is no difference.
We are clamouring that the government should establish a health bank like we have the Bank of Industry, be dedicated to developing the health sector. Government business is not business. The business of government is taxation and before the government can embark on taxation, it has to provide the enabling environment for businessmen to do their business. We have come to a point where we feel that government sees us as competitors. They are suspicious of their private sector players rather than treat them as collaborators and partners.
Has these challenges affected your response to the COVID-19 challenges in Nigeria?
Private doctors are indeed, the authentic front lines workers that face undiagnosed persons who may be Covid positive in the clinics, suffered great losses in men and material without any form of support or a kind word. We had to buy PPEs at runaway costs and pay many times over for drugs, consumables and medical devices to the extent that many facilities could not recover from the impact.
We have done so much and still do so much for our dear country silently and with commitment, often, struggling against tense and harsh economic odds that limit excellence and productivity.
A typical example of government neglect of the private health sector was demonstrated more openly during the peak of the first phase of the Covid-19 infection when private medical practitioners were excluded from participating in treating Covid patients at a time when the rest of the world was mobilizing their entire medical force to war irrespective of public-private divide and providing PPEs and other supports accordingly.
How bad is the brain drain in the medical sector?
Medical brain drain is the next cancer that is going to run down this country. Nigerian doctors, optometric and radiographers; everybody is leaving. In my own facility alone, last year, seven nurses left my facility for London; five radiographers left my facility last year. This year alone, two radiographers have left, three doctors have left and four nurses have left. Three are about to leave. They are all moving into Europe. Those, who have not left are at various degrees of preparing their documents. The media must do more to raise the awareness on this. It is far more than people know. A time will come when there will be no nurses to employ in this country and no doctors to do the job. Already we are saying that if you keep all the doctors we have in Nigeria, the population you will have is not up to 30 percent of what we need; and yet more than half have left, reducing our capacity. Why are they leaving? We have a catalogue of problems. One is poor remuneration. The Nigerian doctor is about the poorest paid in Africa.
The conditions of living are uncomfortable. We are not secured. People want to live anywhere else outside this country to save their heads. Most hospitals don’t have the infrastructures. Technology has taken over the industry and the equipment is very expensive, especially at the current exchange rate. Many hospitals are folding up. Nigerians are in for a raw time. Government should stop politicising issues of the doctors condition of service. Anywhere in the world, the doctor is the highest paid individual. They are most respected and the most protected. Brain drain is real and a time bomb waiting to explode if nothing is done.
Is there any hope for the Nigerian health system?
There is always hope. But we need to understand how such hope can be converted to reality. Hope is fantasy but it can be translated to reality by looking inwards. The number one component is to stand the health system on the shoulder of the private sector. The future of the Nigerian healthcare system is the private sector of Nigeria. Only the private sector can deliver the system as they have done in America, in UK and India. The government should provide affordable loan, good taxation system, healthy environment, power supply and infrastructures. Nigerian doctors are the best anywhere you find them. We are waiting for that day when the government will call the private doctors and ask them, ‘what shall we do to make Nigeria, the global medical tourism destination? If government calls for such partnership transparently and is willing to advance it, it will not take two years Nigerian doctor abroad will all begin to buy their ticket to return back home.
Your association is 100 years. What does it mean to you and all the private doctors in the country?
It means a lot. I feel excited as a person and as president that my association is celebrating its centenary. It is the same way my colleagues feel. It is remarkable and a landmark. It is historic and a great milestone. We know that 100 years is not a common experience and looking inwards, we have asked ourselves, ‘At 100 years, what have we been able to achieve for our country?’ We have decided that our celebration will not go unnoticed. We have chosen to reflect within this session the healthcare delivery system of Nigeria. Remember that my association is everywhere in this country and we take care of everybody; and because we are everywhere, we understand more than any other group the challenges of the healthcare sector. Nigerians are not living well. Nigerians are living a stressed and compromised life. We are also aware that maternal and child health in Nigeria is very poor. So, as part of our activities, we have decided to engage the private sector in dialogue on health so that the private sector, which is the highest provider of health and the highest consumer of healthcare can come together from all the various discipline on the 12th of August at the International Conference Centre, Abuja, to have dialogue from which we will produce a blueprint to support the government’s efforts as to how best our healthcare delivery system can be run. We want to also launch a N10bn-intervention fund in health to support maternal and child care believing that over the next five years, we will save one million mothers and their children. The agenda is ‘Save One Million Nigerians Initiative’. We have also discovered that one of the reasons health insurance is not working is that most Nigerians are ignorant of what it is. We have accepted to take up the challenge of communicating to Nigerians starting from our consulting rooms to tell them what health insurance is.
In what specific ways do you think government could be of help to private medical practitioners?
I can tell you for a fact that we need a specialized health sector bank in Nigeria to provide single digit loans for long tenures and long moratorium to support and grow the health sector, as has been done to some sectors of the economy. The health sector deserves a bailout fund through a Presidential Intervention Fund.
It is regrettable that the intervention loan approved for the health sector is not being accessed by the greater majority of the health workers who truly need the loans due to the difficult conditions attached to the loan that is supposed to be interventional. I call on the federal government to do the needful in order to save the health sector.
