Ever heard that phrase?
That hospitals are mere consulting clinics?
I understand this emerged during the coup era when hospitals were not funded. But have you had course to get desperate over the health care system in Nigeria? I have. One thing I had much more than consultations were questions, questions and more questions…And it is not yet about the infrastructure.
And so I had a chat with Dr. Aker Kenneth Ityo, a Consultant Trauma and Orthopaedic Surgeon at Garki Hospital Abuja. His heartfelt engagement and frankness is second to none.
You currently work as a consultant surgeon, meaning you have many years of experience, What can you say are the real issues affecting effective health care delivery in Nigeria?
The issues plaguing Nigerian health care are a myriad and multifaceted and multi factorial, from whatever aspect one views this.
I have worked in both public and now in public private partnership hospital.
In trying to understand the problems plaguing the health system, it’s important to identify these problems, and they range from Poor funding of the health care industry, Systemic corruption in civil service, , ttitude of healthcare professionals to work, Attitudes of patients to orthodox care, Lack of healthcare financing, Lack of policy direction, Struggle for money not worked for, Poor ethics and etiquettes. And there could be more.
It is important to note that all these are not in isolation. There is a popular saying that “Health is wealth”, and it truly is. Modern health care is technology driven on a back bone of a strong and robust health insurance while minimising out-of-pocket spending by the citizens and using the above to train the manpower and enforce standards. Anything short of the above will create a weak system with a diseased society.
This is the situation in Nigeria.
You may hear about WHO recommendation for minimum budget on health and expect that once the funding is high, it will equate to better healthcare delivery, far from it, the United States of America spends far in excess of what France budgets on health but France has a better system with USA ranking a distant 10th place behind France on indicators used to assess healthcare delivery. But, as it stands today, Nigeria has only about 4% of her population covered by health insurance and it is mainly the mainstream Federal Government Civil servants excluding most MDAs, most state government have refused to buy into the scheme, preferring the dubious ways of purportedly subsidizing or making hospital care free for her state citizens, fraught with graft.
The above implies that most patients would patronize the purported cheaper government hospitals, poorly equipped, weak man power with a poorly oriented staff.
The private hospital owners usually have to source for funding and loans at commercial rate, they would have to recoup investment, making healthcare delivery very expensive from the private hospitals and other healthcare providers. The poorly equipped hospitals create a need which the practitioners magnify and capitalise on it to their personal benefit.
This healthcare delivery system is not immune to the general moral decadence, moral and financial corruption pervasive in the civil service. The funds available are misappropriated at various levels, from contracts to padding of workforce to outright theft.
On this foundation above, we now have a work force that has no budget line for training and retraining leading to ill trained specialist compared with their contemporary abroad, or well trained personnel who have nothing to work with.
The consequence is for the skilled workforce to engage in unconstitutional act of having parallel private businesses besides the primary jobs and diverting attention of patients to their personal businesses directly or indirectly.
Remuneration occasioned by the poor funding becomes an issue, with poor welfare and work environment. The healthcare industry run by government just like any other government agency has a poor reward and punishment system, people are paid for possessing an appointment letter and not for actually doing the jobs so employed, at best they are paid for showing up at work, not necessarily working; those who work very hard are paid same with those who don’t work at all, progression is not measured by productivity. This has rather caused most people who would ordinarily be productive to fall in line.
This struggle for money not worked for, a skewed reward system, and potential for graft in certain position has largely led to the intra- and inter-professional rivalry in the health sector.
So How Can We Really Make the system effective?
The public hospital and healthcare from the foregoing could be seen as non-existent or at best dysfunctional with poor foundation. For this system to work, it needs total overhaul or concerted efforts at reforms from within the ranks- this might be difficult as intra-professional and inter-professional wrangling has entrenched mistrust and distrust with suspicion from across the rank and file.
There are simply no quick fixes in healthcare industry. Certain things will have to give and a cascade of events would need to be done, in no particular sequence; and these must involve all tiers of government and the organised private sector. Most of these are captured by the National Health Act that was signed into law by the last administration. There has to be a clear cut system of health financing. All federal government parastatals, Ministries, department and agencies which also have to be enrolled into the scheme, the state government needs to buy in, there should be established community based health insurance scheme, funds for emergency and indigent, aged and destitute-these are all factored into the act. This would now guarantee adequate funding, patients would have choices on facilities to attend for health related problems. Nobody would shy away from seeking attention in any hospital from scare of high cost; the private hospitals will then compete favourably with government hospitals. On the short term, the system needs serious total overhaul and needs a shock treatment. Some hospitals are completely dysfunctional and continuously allowing them to run and consume resources is morally not right.
There is need to have some private hands run it in same fashion as Garki Hospital Abuja and Primus Hospital Karu.
The medical practitioners who are the head of the health team need to think without a box, and proffer to government better ways of doing things, they need to design a way out by carrying along other allied health care professionals. The sense of entitlement prevalent in health care professionals need to be abolished, lobbying and constant sustained engagement of the political class to understand the health system and their needs should be done by Nigerian Medical Association. The health care industry as it stands today is over unionised all seeking for turf control and opportunity to grab free salaries, entitlements and embezzlement/misappropriation.
On the part of government at the federal level, there is no want of policy framework, it is the boldness to implement them that has been the issues with a lot of policy somersault. Most people that head the ministry are scared of implementing these policies and the backlash that the unions will have at outcome, which might lead to their ouster from office. Even though the system would be better off for it. For now, the Federal government can start by implementing the frame work for National Health Act, most of the issues may be sorted out.
For the state government, there is need for them to key into the health insurance scheme don to the grassroot with community health insurance scheme, this will benefit them more and it would be cheaper than the political health service being dished out to the masses at the whims and caprices of the governors. The Local Government structure must be freed to work, because the dispensary, and primary health services are in the purview of the local government which as at today have been annexed by various state governors.
So you would see that, a lot of issues in health are interwoven in politics.
For the patients, which everybody is anyway, very little is needed from them, they are the bride, the main existence for establishment of hospitals and all the infrastructure in health system. They should know their right and demand for it, they are the beautiful bride that must be courted. They deserve better and more from government and practitioners alike. Some mass actions by the healthcare workers ought to be denounced by patients as most are self serving and completely ignore the plight of patient care. Currently, most agitations in health care industries are about salaries and welfare with things that may benefit the patients, which are used as “padding”, once the remunerations are sorted, the actions end, to be reused at another date. Hope you have often heard that succeeding coups from 1984 had used the phrase “hospitals are mere consulting clinics”, funding has increased, salaries increased, but they still remain “mere consulting clinics”.
Why Are Medical personnel Seemingly not desperate in emergency cases?
The medical doctors and dentists (collectively called medical practitioners), during their course of studies have been desensitized so that they would not have a nervous breakdown when handling emergencies and patients generally. This does not take away the fact that the medical practitioner ought to have express empathy and sympathy to patients and their relatives. Concealing information from relatives and patients is wrong and unethical, in decent climes, the medical workforce have regular trainings in how to break bad news and other relevant information to patients and patient relatives, the medical practitioner and allied health professional is expected to familiarise him/herself with such information. Down playing emergencies is a mark of poor understanding and training.
How does the code of medical ethics in Nigeria 2008 rule 49 make public service doctors any better?
Public service is not better than private service. I have worked on both sides, it just pays you without productivity, kills your skills, some professionals use it as a place to recruit patients/clients to their private outfit. The system is dysfunctional, lacking equipment, occasioned by years of mismanagement, some deliberate sabotage to create a need which they will provide in their private facilities within or outside the hospital or health facility, this cuts across all the rank and files of various health and allied professionals in health industry.
All laws and edicts must be subject to the constitutional provision and all civil servants are bound by the civil service code. And as a civil servant, the constitution only says you could be involved in farming, and I do not see the above as a “farm”.
Anybody can test the pronouncement, it will deepen our democracy and strengthen our institution.
From my experience, I make bold to say some of our doctors have sometimes displayed negligence to duty, non disclosure and wrong administration of drugs, unprofessional conduct and outright incompetence. Are these not enough reasons for them to lose their licences?
Lots of doctors have lost their licences as a result of negligence once proven. What the public needs to do is to report such to Medical and dental Council of Nigeria, they will investigate and establish that, the council dispenses such within short period, if the person so merit being recommended for prosecution, they do so. The only issues being the fact that the council has had persistent dissolution by government, government needs to allow the council to function, they are supposed to exist in perpetuity, it is not a board, the members are statutory. Once dissolved, the registrar, who is like the secretary of the council has limited authority legally.
Let’s zero in on your area of specialization-the orthopaedic surgery, Has the orthodox and the unorthodox found a meeting point now? I recently had that experience where a traditional bone setter was invited by the doctor,
I am amazed that a qualified medical practitioner would invite a traditional bone setter into his private hospital to manage any case, not just fractures. The fact is that most general duty doctors have poor knowledge of fractures, orthopaedic surgery is a huge area which most medical students try to avoid or just memorise it to pass examination, then they move into the community and get involved in handling obstetric care and medical conditions. Instead of them to seek knowledge and read, they ignorantly go the native way, back into age where orthopaedic and fracture care evolved from. Of course there are only about 350 orthopaedic surgeons to service the more than 180 million Nigerians, they are not enough, the medical school graduates need to have good grasp of what they learn, and after graduation, they still need to regularly attend courses to update their knowledge. The menace of traditional bone setters is a huge topic and discourse that is as large as the current one, and I won’t be fair if I try to use some nice words to encourage it in any form. It is unethical for the medical doctor to do that and could be subject of disciplinary proceeding if reported.
Patients have all the rights to know fully every issues about their care, including drugs, names, diagnosis, treatment outline, outcome, expectations, the patients ought to know everything about their care. If a doctor cannot tell you the diagnosis or names of drugs, walk away and do not take the drugs.
Share your high point as a surgeon.
The high point of my practise as a consultant orthopaedic and trauma surgeon is to see that smile of satisfaction in both the patient and my staff after treatment and surgery; it is far more than giving me a million Naira.
And the lowest?
The Lowest point is when I do a surgery and it turns out bad or not as expected. Death, I will feel as bad as the relatives, it is the lowest of the low.
Tweet
The post Indeed, Our Hospitals Are ‘Mere Consulting Clinics’ appeared first on .