Dr. Godswill Okara is the immediate past president of Association of Medical Laboratory Scientists of Nigeria, (AMLSN), he shares his views in this interview with Ndidi Chukwu of Health Reporters, on the challenges of medical tourism and best ways to end it.
Why do you think politicians in Nigeria should priorities health?
Okara; the major problem with the health sector in Nigeria is the issue of management, or what we will call managerial mal-administrative leadership in Nigeria’s health sector, until that is put right we will keep on going round the circles. We cannot be doing the same wrong thing and be expecting a different result. Check round the world you don’t see where health care professionals are directly involved in administering health care. Health administration is an entirely professional affair, if you go through our training curriculum in the university there is just nothing about administration and management, be it curriculum for clinicians, pharmacists or medical laboratory scientists, physiotherapists. I believe this was intended to ensure competence of professionals in the profession not side attractions like doing administrative jobs. Until we go back to where we missed it we will keep on going round the circles. Any government that will make bold to address this issue would have solved 80 percent of the problems in Nigeria’s health sector. What we are seeing in Nigeria’s health sector today is outright politicization of the health sector. Doctors have hijack the managerial leadership of Nigeria’s health sector, that has brought a brand of partisanship in the health sector to a point that government rules and regulations that are articulate by the mainstream public establishment for the running of the health sector are jettisoned and trampled under feet. People who have no administrative and managerial training have taken the functions of professional health service administrators to the point that even the training of health service administrators is almost going to extinction, because they see them as competitors who will take over their job again.
To address this issue, a judicial committee headed by a former chief judge of Zamfara State, Justice Abdullahi Bello Gusau, had addressed these issues and came up with recommendations, but they ganged-up to ensure that the report didn’t see the light of day. It is rare in developed countries, even South Africa, you don’t see a core health professional administering the health system. All these places Nigerians go to in the name of medical tourism you don’t see core health professionals abandoning their area of core competence and dabbling into management and administration.
In order words you are saying politicians’ interest in health is not the problem but lack of managerial skills?
Okara; precisely, that is the issue. Those that lack managerial training and experience are administering Nigeria’s Health Sector, let me give you an example, check through the entire history of health ministers we have had, and compare, the time that Professor Eyitayo Lambo, who is a health economist was the minister there was relative stability, peace and harmony in the health sector as against when clinicians and medical doctors are ministers because you can’t offer what you don’t have. Health economics is a completely different world, they look at things from a broad perspective they look at the economy of health care service, management of human and material resources and even financial resources. All these things are disciplines different from health care profession.
Does this suggest why health get minimal allocation in annual budgets?
Okara; it is part of it, but the truth is that financial resources are not the issue, even if we have all the money from the financial capital of the world poured into the health sector in Nigeria so long as you don’t have the people that have the required skill to manage the resources, it will still not take us anywhere. Leadership is the key, if you don’t get it right in the area of leadership nothing else will fall in place. Even if we have all the resources in the world without a trained and experienced manager, to manage our health system, we will not see much difference. When Professor Eyitayo Lambo as health minister wanted to address many of those things they ganged up against him in the ministry. He said you can’t leave the hospitals where professionals are supposed to busy themselves giving services to our people and cluster in Federal Ministry of Health and be carrying files and chasing after programmes, they asked for his head for daring to say that. At a stage in the Federal Ministry of Health, the top management committee out of 52 members 48 were medical doctors. These are the issue that must be addressed, when you have these doctors in active practice there will be enough room for professionalism and by so doing we improve our health sector. The Yayale Ahmed committee having toured around the world to see how they practice confirmed that professional managers and administrators were the ones administering their health care system, but they rejected it and said they wouldn’t want to copy that.
Now that we have a new dispensation, and a rebirth of democracy in Nigeria, should the President-elect General Mohammadu Buhari called upon to change towards this direction, having non-doctors as ministers?
Okara; I will first of all congratulate our President elect, General Muhammadu Buhari, and President Goodluck Ebele Jonathan and all Nigerians for the peace we have in our nation today. As professional organization and pressure group we have been talking about this to the current president with hard facts, verifiable facts, but it is always a huge challenge to implement. People often are afraid of making changes because they don’t want to step on nerves and make some people unhappy and these are people who do not want to see change. Like I told you about Lambo, prior to his appointment as health minister there were hardly policies for various things in the sector, he set up committees to come-up with policies on various aspects of health care delivery but since he left many of those policies are left on the shelve gathering dust. So if we must have and see change in our health sector, I will encourage our President elect, to curb the issue of medical tourism by ensuring that all those professionals clustered in the ministries of health will be taken back to the hospital, that is where all medical professionals belong, we complain of lack of personnel, yet we have hundreds of thousands of doctors in ministry of health, that is not their place of assignment they should be at the hospital and it is our hope that our president will address this and give us the privilege of having a health economist as the next minister of health.