Written by Dr Mahmud Abdulwahab
Disputes are normal between employees and employers and also between employees in any system. But is strike the best way, the only way to settle disputes in the health sector or are there alternatives to strikes. Have the countless strikes that have been embarked upon by numerous associations within the health sector in the last 10 to 15 years made our health care delivery better or worse? When strikes happen patients are abandoned and for some their conditions may get worse and may even result in death or permanent disability, do such patients have any legal right to sue the hospital or the union of the striking health care workers since by implication any person admitted into a hospital for care has a contractual obligation with that institution. These are some questions that needs urgent answers in order to sanitize the health care delivery system and move it forward. You need to be a patient or a patient relation to understand what it means for health care workers to withdraw their services!
What are the lessons that we can learn from our favorite destinations for medical tourism-India, Egypt, Israel and recently Ghana. The Ghana health system has made significant progress in terms of social health insurance and certainly Nigeria can learn lessons from there in order to move our NHIS forward and of course this has the potential to release significant amount of money into the system. Health delivery in India is a wonderful mix of public private partnership and this is at the core of the India multibillion dollar medical tourism industry- Nigeria can learn from the India experience and if we can get our act together Nigeria has the potential to be a MEDICAL TOURISM HUB in the West African sub region and even beyond. In the Israel health care spending is efficient and worker productivity is a key issue. In Nigeria health care worker productivity is not even an issue- people go on strike at will and get their full pay while on strike. Nobody looks at what you do and when your promotion is due you get it as a right – pure and simple. When are we going to start looking at how many operations a surgeon does per year, how may laboratory tests a scientist does per day, what is the quality of the nursing care a nurse gives-these are some of the issues that take people out for medical tourism.
Looking at global best practices in health care worker productivity let cite an example of a low cost high volume heart hospital in the state of Bangalore in India called Narayana heart hospital -“Narayana’s 1,000 bed heart hospital performs 35 heart surgeries a day on average and a maximum of 60 a day in its 24 operating theatres. Machines, equipment and facilities – a large proportion of cardiac surgery costs – are used at a much higher rate, bringing down per unit costs. By comparison the largest specialist heart hospital in England has 270 beds and 5 operating theatres, and has 58 operating sessions a week. As Dr Devi Shetty argued at Reform’s health conference a lot more for a lot less, “Healthcare is all about numbers. When we do 60 major heart surgeries a day your results will always get better.” Doctors at Narayana are paid the Indian average, but work to a much higher level of productivity. Heart surgeons at Narayana perform an average of two or three procedures a day, six days a week” Very wonderful isn’t it? In this there are massive lessons for Nigeria if we really want to reduce medical tourism and save the country billions of dollars in foreign exchange. Nigerian physicians in diaspora are making waves all over the world in every specialty. It will be worthwhile venture if a fund will be provided for those health care workers at home and abroad willing to form consortium and establish world class multi-specialty health facilities that will compare favorably with facilities anywhere in the world. And this is doable! Our university teaching hospitals can also explore partnership with Indian and Egyptian tertiary health institution for training of our postgraduate health care workers. I said post graduate health care workers and what I mean here is that all cadres- For example it will not make any sense to have say a highly trained nuclear physician without training nurses, pharmacist and laboratory scientists in the same nuclear aspect that concerns their profession. The practice of medicine is a team work and the early health care workers in Nigeria realize this the better for all of us.
I am not unaware that as at today health care workers in many states are being owed salaries by their respective state governments for upward of 3 months. That some of our hospitals are operating under circumstance that are pitiful in terms of equipment, infrastructure and human resources. These are some of the issues that are at the heart of health care workers strike. The question is are there alternatives to strike actions by health care workers?
Stakeholders in the health care sector in Nigeria need to come together and deliberate seriously and come out with a road map on how to holistically move the health sector forward at all levels in Nigeria. With due respect to the current leadership of the health sector at the federal level what they are doing now is not different from what others before them have done. YOU CANNOT DO THE SAME THING TIME AND AGAIN AND EXPECT DIFFERENT RESULTS.
If the wave of change passing through Nigeria now is anything to go by then this is the time for thinking and acting outside the box in the health sector.
Dr Mahmud Abdulwahab, is a health economist & writes from Hadejia in Jigawa State