Bishops and the health care change agenda
An important truth about the marketplace is that it is a social construction designed and operated within particular boundaries by certain stakeholders. It is not by any means autonomous, though certain characteristics develop over time which could give the impression of autonomy – perpetuated by the “invisible hand” perception attributed to the marketplace in many quarters. However, to the truly discerning, there are no invisible hands; the hands that shape the marketplace are very much visible.
Bishops, in this context, refer to individuals in positions of overseership, whose actions and inactions affect the operations of the marketplace. In the Nigerian marketplace, such designation applies to government, academic and business leaders. The title “bishops” is preferred by this author to reflect the spiritual dimension of the influence of these overseers; this is made with consideration of the fact that individuals over whom overseers exert influence are essentially immortals, though undergoing a physical experience.
Marketplace and governments
It is the responsibility of well-meaning governments to ensure fair play in the marketplace by enshrining the rules of engagement. Besides granting business bishops the licence to operate, leaders in government are also responsible for granting access to business leaders who seek to operate within particular domains like raw material exploration, import monopoly, patent protection, government contract execution, telecommunication, power generation etc.
This capacity to decide who has access to certain fields of limited participation is a very important role of the government, considering that the majority of billionaires in Nigeria and elsewhere are beneficiaries of selective government largesse, such as mining rights (e.g. cement), telecommunication licensing, product import monopoly, crude oil exploration, petrochemical distribution and the likes.
Carlos Slim, for example, has a monopoly of the Mexican telecommunication industry and understandably is quite well off, dashing in and out of the world’s richest position. The same applies for the richest men in Nigeria. It is nearly impossible not to have citizens like these individuals who benefit from selective government right of access; however, the role of good governance is to ensure equity – that is, that the booty gets around. It does so through taxation, anti-monopoly interventions, labour conditions and minimum wage stipulations.
Taxation is the government’s major avenue to garner funds for providing social amenities like security, power, education and housing, health care and social welfare. The American Dream and every other successful society were built in like manner – a government that ensures fair play in the market place and that the leaders share proportionately via taxes and fair wages. When this happens, the result is that employed folks can conveniently own their homes, get proper education for their children and enjoy basic social amenities.
The challenge of the USA right now is that somehow they left things to the earlier mentioned “invisible hand” and gradually killed the labour movement. Today a major campaign pitch for the USA 2016 elections is to “bring the jobs back from China”. It was human beings that took them there in the first instance. President Ibrahim Babangida of Nigeria did a similar thing in 1985 with the Structural Adjustment Programme (SSAP) and we are yet to make a full recovery.
Every Scriptural admonition to bishops in the church, the marketplace and in government follow this same thinking – ensure fairplay, good wages, shelter and basic amenities. The country needs to be prosperous for this to happen, hence the need for a slight dose of healthy nationalism in our marketplace thinking.
Case study:The health care agenda
The WHO’s recommended minimum spending on health care is $34 per capita. With Nigeria’s population of 170 million, to spend $34 per capita would be about 6 billion dollars (1.2 Trillion Naira) per annum – about 1.2 per cent of our GDP and almost 25 per cent of our fiscal budget.
On 12June this year, Dr Femi Olaleye, CEO of Optimal Health Care Limited, launched a community health insurance project that provides basic care to the Alagbado community, in Lagos, at less than N2,500 per person per year, with an equal counterpart funding from a corporate organisation, bringing the sum to N5000 per person. His organisation, with a bit less than the $34 recommendation, is bringing basic health care to the okada riders and the suburban Alagbado community.
The point is that, with an integrated community-based health insurance model, with the government spending 12.5 per cent of our fiscal budget and all of us contributing a minimum of N3000 per year, we could have basic primary health coverage for all Nigerians by 2018 (assuming it takes three years to get our acts together).
Note that a co-payment structure at the point of care provision could significantly reduce this 12.5 percentage. Note also that the emphasis for now is basic care – including emergency and maternity care.
The alternative model is to target a N3000 per capita increase in “health tax”, plus 12.5 per cent of current budget, and we would still get the same result. This is what obtains in the UK right now. The UK National Health Service consumes about 9 per cent of the GDP.
Though this is a simplified illustration of a possibility, my aim is to show that such possibilities happen when leaders in government and in the industry go about leadership in a pragmatic way. Consider that if the government should assign 20,000 lives to a health care provider to provide basic care at N5000/annum per life, the outcome would be a viable business. The government need not even build the facilities but can provide some fund from which the providers could borrow.
Observe also that if, say, ten authorities, were responsible for delivering this care to 17 million Nigerians each, they would invest a lot in making sure people do not get sick in the first place. A huge community approach to malaria vector control for example would drastically reduce the malaria episodes and positively affect the finances of the provider.
One of Nigeria’s major challenges right now is the way health care is being funded. Business leaders in this sector must recognise that positive “change” must influence the way health care is funded and, of necessity, the way it is provided.
This same mathematics of governance applies to other sectors such as education and infrastructure development. For instance, in the area of housing, Nigeria currently faces a 14million unit deficit, for which the just launched National Housing Policy and the concurrent National Housing Fund implemented by the Federal Mortgage Bank would go a low way to alleviate, provided that business and government bishops do their part.
Quite often, bishops in the marketplace connive with bishops in government to throw a party. And for us in Nigeria, we have been partying hard for a while. Imagine if, as a health care management organisation, my firm was granted access to provide health care to 17 million Nigerians (10 per cent of the whole) under the thinking above. Imagine if I had to “sort” someone with 10 per cent “facilitation fee”. It would change the dynamics completely and if I were a rogue bishop, it could be “wiser” to share another 30 per cent to a group of rogue government bishops to help them forget about the project entirely, after all, it would only be for just one year – twelve months!
The connivance by bishops in the governance is in two folds – omission and commission. The latter is fuelled by corruption and only a removal would do. On the other hand, the sin of omission, born of ignorance, is simply not good enough, considering that the positions are elective.
For bishops in the marketplace, it is often a deliberate love of money and power, and not just for lack of good intent; for they indeed know that great things are possible, but the need to make the sacrifice is not always urgent and hence can be delayed, especially when considered in light of the actions of their government counterparts.
The great challenge is that in a party, it is difficult to change the tempo and style of the music when the same dancers are still on the dance floor. The emergence of Buhari as president had brought a temporary note of silence in our dance hall; the marketplace bishops on the other hand are obviously not elected into office and are still on the field of play, and if given the opportunity, would decide for the current leadership, the kind of music we need.
Wisdom therefore lies in understanding this challenge and that it is not only a new set of government that would save the day but a unique set of marketplace bishops or bishop culture. It was with this thinking that I drove myself to Abuja not too long ago, clutching my own Compact Disc, who knows, I might just be asked to play the next tune. As the old saying by a wise young man goes, “Is there not a cause?”