That Nigeria's healthcare industry needs a breath of fresh air is no longer in doubt. The perennial strikes occasioned by inter and intra professional squabbles, remuneration related matters, poor, inefficient services and the sheer redundancies in this sector reflect this. These are also symptomatic of a larger problem bedeviling the sector, that of a paradigm shift. The organizational, conceptual and legislative framework of healthcare currently is not well thought through, beginning from the philosophy through to the operational and tactical levels.
What are the issues? 1. The lack of a legislative framework for healthcare and practice.
Nigeria currently has no legislative framework for its health sector. The sector's policy direction is superfluous, incoherent, and lacks the bite for effectiveness without this backbone.
The National health bill as submitted at NASS may not address the many ills it is meant to cure. It continues to languish unattended, partly because of the poor conceptual and operational framework. It fails to be far reaching. It fails to represent a paradigm shift. It simply endorses more of the same.
Professional disciplines are at loggerheads over the roles and responsibility of each. A battle for supremacy is the crux.
Come to think of it, if the National health policy & Bill were well thought through in accordance with other international models, would this quagmire exist? 2. This wholly welfarist approach to healthcare by the government.
Policy structures and directions bequeathed by successive military administrations persist. Very little modifications to reflect changing priorities and realities have been made, including the welfarist approach to health care.
A more pragmatic approach to healthcare as both a welfare issue as well as a business is the only way to save the day for Nigeria. Healthcare is business, and business is healthcare!
One ingredient for the success of this model however is the engagement of healthcare managers. Doctors or pharmacists with management training. People who bestride the world of medicine as well as business. Not accidental managers, those health professionals without management education or managers without healthcare foundations.
This is the model that has worked in many a nation including India and which we desperately need locally.
The telecom, agriculture and currently power sectors exemplify the potentials and possibilities in this approach. 3. Regulation
A certain mystery surrounds medicine and healthcare in general. Probably due to its highly professional nature. Another thing that fosters this mystic is the inability of its people to creative engage, articulate and promote the profession. Consequently, it is a sector poorly regulated because of the lack of awareness and understanding of it. No one wants to thread where angels fear....
The poor regulation is visible in many areas. It starts from the indiscriminate proliferation of medical schools. Indeed, the first faculty every new university wants to have is that of health sciences without giving thought to the immediate and long term implications for all and sundry. I aver that there is a gloat of medical schools around, and do not believe this augurs well for the profession or nation as a whole.
Clinical governance-Another area is in the audit of clinical processes, otherwise called clinical governance. Who determines and ensures the standards of care due to patients in our hospitals? Who enforces this and how? What checks and balances are in place? What are the repercussions for a breach? How is the process sustained?
Medical education- Undergraduate medical education has a modicum of excellence and normalcy where it is under the watchful eye of the Medical and Dental Council of Nigeria. The same however cannot be said of post graduate medical education!
To begin with, who regulates graduate medical education in Nigeria? Who defines what is standard in terms of institutional facilities, capacity qualifications, criteria for training director selection, resident selection, course content and learning modalities, examination techniques and peer interoperability and exchangeability with other countries? Who scrutinizes the two post graduate medical colleges?
How come Nigerian doctors cannot just migrate and practice in the UK, south Africa, Singapore etc without been subjected to a plethora of examinations and assessments?
As some people would want us to believe, the problem is not always about funding and lack of equipment, but a lot about oversight, standards and regulations! One suggestion Liberalization of the sector as currently available in the telecom, power and agriculture sectors. In other words, the government must divest direct ownership and participation in running hospitals. In place of this, government must ensure a strong national insurance program, public and private. The swiss and Taiwanese models readily come to mind here.
In Taiwan, all citizens are allocated an electronic card preloaded with funds for medicare up to a limited, and yearly. This card may be used with any healthcare provider of choice who compete on the basis of cost, service delivery among other things for the citizens' money.
What this does is to facilitate competition, innovation and efficiency among the providers whilst giving quality and satisfaction to the consumers. It also ensures that primary health care is given its pride of place as healthcare providers will reach out to all peoples in spite of their geographic locations in a bid to maximize profit. The many redundancies in the hospitals will be addressed and skill, work and dedication will be rewarded.
Of course, a few university teaching hospitals ought to be maintained for teaching, research and tertiary care purposes, but not in the same number as currently obtainable. Likewise, private insurances will be available to those who wish.
This singular act will equally decimate the perpetual rivalry among the healthcare professionals because each will naturally find her niche.
India to which many Nigerians gravitate for medical tourism made a choice to have a competitive advantage in healthcare and began the liberalization of this sector. The annual outflow of cash to India for medical tourism is a testament to the success of this philosophy. Need we say more? Timi Babatunde MD
Lagos Sent from Yahoo Mail on Android
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