By Hassan Zayamu
Honourable Muhammad Usman, is a former member of the House of Representatives and currently the Chairman of National Advocates for Health (NA4H) in Nigeria. In this interview with our guest reporter, Hassan Zayamu, Hon. Usman proffered solution to the recurrent crisis in the country’s health sector among other issues. Excerpt:
As a former legislator and an elder statesman, what do you think are the reasons behind the acrimony and recurrent industrial action in the health sector?
In my mind, this has a long history and it has to do with lack of prioritization of the health sector by successive governments and even the current government that has been in power for the past six years.
This is not just at the federal government level. This is what you also find at the state levels. The most functional levels of government are the federal and state governments. Local governments are completely dead.
The lack of prioritization of the health sector has led to a lot of challenges including that of funding, none payment of salaries and allowances and general poor welfare scheme of workers in the sector and the lack of synergy among the various work force who are in one way or the other working within the health sector.
That is why you discover that once the government discusses with one component of the health sector and reached an agreement, the other component will also want the same thing.
There is lack of harmony in the sector. We are running a sort of disintegrated system because in the health system, even if it is a labourer or a domestic staff working in the hospital, he is exposed to the same risk like a medical doctor and even the Chief Medical Director and any other person. So, when it comes to welfare, it must be looked at holistically instead of segmented as it is being done currently.
From your experience working closely with healthcare workers over the years, what do you think should be done to permanently resolve this acrimony and bad blood among the health workers?
The most important thing government need to do, like I said earlier, is to prioritise issues of health. This is because when you prioritise, you will never allow anything within the sector including the workers and personnel who play key role in the sector to have one challenge or the other.
Let me give you an instance, why is it in the banking industry you don’t have such? Why is it that in the petroleum sector you don’t have such? It is due to priotisation because once you work for them, they will ensure that, apart from the conducive working environment in terms of facilities you are supposed to work with; they also take care of their man power.
They pay you living wage in the sense that you will be comfortable with your take home pay. But as you see it today, because of lack of prioritisation, a medical doctor will rather leave for the foreign country where he can get good pay rather than stay in Nigeria.
We all know that currently in the UK and US, particularly in the UK, almost three quarter of the medical doctors there are Nigerians. It is also said that if all the Nigerian doctors in the UK will withdraw their services and come back to Nigeria, the health system in UK will collapse. Why are they there? It is simply because of two major factors- one; is the facilities because you have the equipment there which will enable one perform his job and then the second one, they get very good pay.
Recently, in Canada doctors had to call on the government asking that their salaries and allowances should be reviewed downward because, according to them, they were being over paid during the COVID period.
But back home here, because of lack of prioritization, the money is not given to the health sector. I have always argued that is it a shame that in 2001, the famous Abuja Declaration was made in Abuja here and getting to almost 18 years after, Nigeria is yet to meet up with the commitment of providing 15 per cent of the national budget to health which was signed here in the Federal Capital Territory (FCT).
Our sister countries who are smaller than us in Africa have since implemented it. Some countries are even earmarking as much as 18 per cent of their national budget to health.
That is the lack of prioritisation I am talking about. Sufficient money has to be voted for the health sector, if not, we cannot get it right. We will continue to experience these challenges we are seeing now for a long time.
You have worked closely with the health sector in Nigeria over the past few years and you are conversant with its challenges. Do you see any ray of hope that we are going to overcome these challenges in the near future?
Of course, we can overcome these challenges because people are getting enlightened. All we need to do is to get Nigerians to speak with one voice that enough is enough and demand that health must be prioritized.
Currently, the only thing that is prioritise in Nigeria is the security which is number one. I have no problem with that giving the current security challenges. Health must be number two on the agenda of the government.
Sadly, currently, it is number 8 or 9 on the agenda. All stakeholders must come together and speak with one voice.
By stakeholders I mean, the Civil Society Organisations (CSOs), the traditional rulers, the media should all come and speak with one voice. They should study what is obtainable in other countries and educate and also insist that this is what must be done to get it right.
This is because if we don’t do that, we will continue to remain where we are. So, I am very optimistic that while people are getting enlighten, many things will change.
The COVID period was supposed to be an opportunity for us as a nation to further strengthen our healthcare system in Nigeria, unfortunately, that did not happen.
For example, I saw the stimulus fund of about N500 billion under the name COVID, but when you look at how the money was allocated; only N126 billion was allocated to health. The greater part of the money, N374 billion was allocated to none health issues, Why? The World Bank gave this money because of the COVID-19 situation, why are they spending the money in other areas. Why not totally revatalise the health system.
Is it not a shame that currently, in all our Teaching Hospitals in the country, none you can say that there is 100 percent guarantee of excellent services. Not to talk of those at the state level. Why not spend the N500 billion on giving our hospitals first class facilities. Why not use the money to place those working in the hospitals on special salary in order to motivate them to give their best. When that is done, most of our doctors in other countries will come back and those that are here will not have any reason to want to go out of the country.
You earlier talked about the role of the CSOs, what specifically, do you think should be their role in revitalising the health sector to make it work?
The CSOs should engage in advocacy, because they are also part of the society and they are conversant and knew the challenges very well. They are more or less the mouth piece of the people. They can ask leaders questions and there must be a change. CSOs are very important.
The CSOs can play a major role in terms of advocacy to the parliament, executive and other critical stakeholders on the need for the right thing to be done.
As a former legislator, you are now seeing from the outside. Do you think our legislators are doing enough to ensure that our health sector works?
Well, I think they are doing their best given the circumstance they find themselves. The issue is that most times, the lawmakers are not given free hand when it comes to budgeting. Most times, the lawmakers are just like the rubber stamp of the executives. This is because when the budget comes to them, they are expected to be allowed to work it out base on the reality, but here the lawmakers are constraint. The executives will want to have the budget the way they brought it without any change.
Most critical stakeholders are not being carried along when it comes to budgeting as stipulated by the Fiscal Responsibility Act in Nigeria. Critical stakeholders are only brought to the picture and asked to bring their input when the budget has been worked. At that level, what again can they do? They are expected to make their input at the time the budget is being prepared not it has been prepared already.