Written by Dr Mahmud Abdulwahab
That the Nigeria’s health care delivery system is bedeviled with endless and arguably needless strikes by all categories of health care workers is no news. The news is when will the strikes end? The aim of this write up among other things is to generate and initiate robust discussion especially within policy and health care workers union cycles on how best to avoid the incessant strikes in the health sector.
At the slightest opportunity and provocation the Nigeria health care worker will down tools leaving his clients who are often helpless to their own devices thus confounding their woes in a vicious cycle of ignorance, poverty and disease.
To begin with, procuring health care in Nigeria whether at a public or private facility is not only costly but catastrophic to most Nigerians- at least to the 30% of Nigerians that use public health facilities for their health care needs. Catastrophic health expenditure is when one uses more than 70% of his income to procure health for himself or for his dependent or when the act of procuring health makes one to significantly reduce his expenditure on other important households needs such as feeding or paying children school fees! Add this to the fact that more 60% of Nigerians are leaving below the poverty line and that health care spending in Nigeria is largely out of pocket- up to 70% according to some estimates. And what you will have is a picture of citizens that are faced daily with health care uncertainties and inequalities.
Moving forward how does our health care delivery system fare in relations to other countries in terms of financing, quality, human resources, governance, research, etc.
Talking of health care financing the Abuja declaration quickly comes to mind- In 2001 the African head of states meeting in Abuja under the auspices of the then Organization of African Unity (OAU) now African Union (AU) having realized the enormity of the burden of HIV, TUBERCLOSIS AND MALARIA facing Africa, resolved to devote at least 15% of each of their countries yearly budget spending to health.
It is also unremarkable to note that very few countries have matched this declaration with action and certainly Nigeria is not one of them. In the 2016 federal budget Nigeria has only allocated a paltry 3.7% of its 6 trillion budget to health sector. Putting this declaration in context one will realize that devoting 15% of National or state budget to health is not the bench mark for achieving adequate health care delivery in Nigeria or a state for that matter as most health care financing advocate usually insinuate. The fact is if Nigeria or any state within it really needs to adequately and effectively fund its health care delivery then it has to look beyond the National or state budget.
This brings us to the critical question of how much should Nigeria spend yearly on health care?
This question was initially asked as how much should countries spend on health in a WHO policy document and it was thus paraphrased. The question is of course not very easy to answer. Many people will jump to conclusion and say 15% of the state budget according to the Abuja declaration of 2001. However to answer this questions 5 other questions need to be adequately answered. Thus-
- What health problems do we face as a country?
- What health status do we aspire to?
- How effective are our health services, activities and policies?
- What are the prices of inputs?
- Are there better uses of funds for other ends?
From the above scenario one will see that financing health care in Nigeria has to find innovative ways of going outside the box of National budget. how about universal social health insurance, how about Sector wide approach to donor funding how about ear marked funds akin to TETFUND etc. etc.?
A certain WHO ranking of health care system across countries done sometimes in 2000 put Nigeria’s health care delivery system as 187th out 191 probably just ahead of Somalia and Afghanistan. Any wonder why medical tourism to Egypt, India and Israel and even to Ghana and Uganda is our bane.
Looking at the above scenario one can rightly look at the present unhealthy rivalry between different cadres of health care workers in the context of resource control in an environment of resources scarcity within the health care delivery system. Rivalry within the health care system exists all over the world but in Nigeria it can be described as “warring” and today it one of the greatest problem confronting the health care delivery system in Nigeria and unless it is resolved at the earliest it has the potential to reverse the little gains that the system has achieved over the years. The case of medical laboratory scientists and medical pathologists (specialist Doctors in Pathology) is a testing ground for that rivalry and is a case of rivalry taken too far!
Looking at the governance structure of our health care delivery system especially at the tertiary level one will see that the management structure is very top heavy and the paraphernalia that accompanies executive offices in Nigeria is certainly bound to attract envy and jealousy among inter professional peers. This is of course another angle of looking at the current fight within the health care sector of every one wanting to be a CMD, a Director etc. What are the international and global best practices in relation to clinical governance? Can we emulate them?
The health care team is in disarray, no doubt about that. And at the heart of this is lack of management and leadership capacity on the part of the natural leaders of the health care team. The natural leaders of the health care team will do well to make leadership and management training an integral part of their curriculum and must be taught with the seriousness and the depth it deserves! Management and leadership are too important and too serious to be taken for granted! When you have a team leader that every team member is rebelling against then that team leader needs to do some introspection.
Dr Mahmud Abdulwahab, is a health economist & writes from Hadejia in Jigawa State
To be continued