Prof. Mike Ozovehe Ogirima, a consultant orthopaedic surgeon at the Ahmadu Bello University Teaching Hospital, Zaria, is the new president of the Nigerian Medical Association (NMA). In this exclusive interview with Pharmanews, he speaks on why health professionals must learn to work together with mutual respect.
The NMA boss, who explains how the maturity of the new leadership of the NMA and the PSN can help to end disharmony in the health sector, also reveals the challenges facing the NHIS, how to curb medical tourism, as well as measures that should be taken to standardise trauma services care in Nigeria. Excerpts:
Congratulations on your election as the helmsman of the NMA. What prompted your interest in the activities of the NMA and what are your objectives for the association during your tenure as president?
Thank you. My interest in the activities of the NMA stems from the fact that I am a physician and the welfare of my colleagues counts topmost. My desire has always been to give qualitative leadership to the association, in pursuit of the overall vision and mission of NMA.
My objectives during my tenure as president of NMA can be summarised as moving the NMA to the next level as concretised in The BRIDGE Agenda. In essence, it is making the care of the patient central in my activities by building bridges across the various divides in the memberships of the association and the health sector as a whole.
There seems to be a new accord between the leadership of the NMA and the Pharmaceutical Society of Nigeria (PSN) since you and Pharm. Ahmed Yakasai emerged as leaders of these bodies. What necessitated this, and how will the two professions and the health sector benefit from this new development?
The new leaderships of NMA and PSN are experienced, mature and focused. Over the three decades of our practice, we had seen the good, the bad and the ugly sides of the practice. We may now be sharing similar dreams about how to improve on the level of care for our patients. The division and so much disharmony among the various professions in the health sector must not be allowed to continue, otherwise the public will lose confidence in our practice and we may find ourselves becoming irrelevant in the care of our people. We must make our patients number one and central to our practice.
The reason we associate is to bring the best for our patients. Welfare issues should not be seen to affect the quality of service to our patients. However, the leadership must be seen to be transparent, fair, just and sensitive to the plight of the health team while the government on its part must be seen to obey agreements and attend to all the welfare issues of her employees.
Mutual respect must be imbibed by all in the health team. In a family, there is always a leader who commands respect if he is leading well. In the health team, NMA will lead to fight for all the team members’ welfare issues. We shall be sensitive to all the components of the health team. Anything short of this will not improve our already battered image in the public.
There has been more clamour in recent times for Nigeria to adopt universal health coverage to ensure all Nigerians have access to health care. What are your thoughts on this concept, considering that the health sector is underfunded?
Universal Health Coverage is achievable in Nigeria in spite of the poor funding, if the government redirects its resources to making sure that health care is on its priority list. We have mechanisms on the ground to making sure funds are available. The National Health Insurance Scheme (NHIS) should be extended beyond the current level of only the federal civil service to involve community based schemes.
State governments must also adopt a form of health insurance scheme and the local government authorities must key into a system that will enrol all persons residing in the area.
The government must rehabilitate, equip and employ various health personnel to all the primary health centres (PHCs) across the country. The PHCs must be made to be preoccupied with common ailments. A functional multiway referral system must be instituted. A close monitoring and evaluation system should be left for NGOs to audit the system complement the government structure.
A major reason many Nigerians embark on medical tourism for conditions we should be able to treat in Nigeria is the serious deficit of required infrastructure in our hospitals. How did we as a nation get to this point, and what should we be doing to solve this problem?
The cost of medical tourism to our country is enormous. In 2014 alone, we spent over $1 billion on seeking better medical services outside the country. This is a huge capital flight. Our global ranking on health indices is poor and respect for Nigeria is low.
Certain factors encouraging medical tourism in Nigeria include inadequate specialists in all fields and poor funding of the health sector (less than 15 per cent of annual budget). Nigeria has budgeted only about 3.5 per cent for 2016. The brain drain problem by professionals is also there because of poor working conditions (paucity of equipment and facilities), corruption within the government circles for estacodes on accompanying officials or persons, and stipends paid to referring practitioners.
There is also lack of awareness/illiteracy of the populace on existing spectrum of practice of different areas of specialisation; and there is also the tendency of the elite class to want to flaunt their wealth.
The solutions to these lie in the need to train and retrain more specialists on modern techniques of patients’ care. In most countries where health care is very well developed, there is more private sector participation than government input, and the possible cost burden of this on the populace is cushioned by Health Insurance Schemes/Public Private Partnership (PPP).
As a country we can’t shy away from this innovation. Advocacy for government to invest more on health should be holistic by all health-related NGOs. There is need for sanctions on erring professionals who encourage deliberate referrals, in order to accept overseas referral fees. Health intervention policy, including, but not limited to, low interest credit facility for health industries must be encouraged.
Import duty waivers for health care equipment should also be encouraged. There should also be special tax regimes on tobacco, alcohol, GSM calls, etc., dedicated to improving public health facilities and PPP. We should also encourage cooperation among professionals to set up mega hospitals that can compete positively with the foreign hospitals through facilities made available at single digit interest rates. There should be a government-driven health insurance scheme that is compulsory for every Nigerian and that will cover most of the health needs. This is key.
In partnership with the National Orientation Agency (NOA), the NMA shall re-orientate Nigerians’ attitude towards indigenous health care service-professionals and facilities. In as much as we now advocate patronage of local goods, we also need such campaigns in the area of health care. An annual health/hospitals’ exhibition may be helpful to showcase the range of care that can be achieved in the country and the NMA will champion this shortly.
We must also encourage some levels of collaborations with foreign specialists to organise joint workshops in Nigeria, as a way of gradual transfer of technologies and skills. Manufacturers of medical wares and consumables should be encouraged to set up industries in Nigeria. Vendors of medical hardware should also equally be encouraged to go into partnership with local hospitals to make their products easily accessed. There is also need to strengthen our clinical governance system in a way that will guarantee quality assurance, clinical and strategic effectiveness and patient involvement in health care decision-making.
The current war on corruption in government business should be holistic. There is need for a close collaboration with NMA to minimise the level of capital drain in the areas of sponsorship of top government officials to overseas for treatment. NMA shall be a watchdog on the judicious use of resources in our hospitals and ministries of health. This we intend to do by independently monitoring the use of the resources allocated to each of the teaching hospitals and the ministries. NMA shall set up an internal mechanism to investigate and call to order any chief executive that is found wanting.
How can we strengthen the National Health Insurance Scheme (NHIS), considering the fact that the scheme has been facing different challenges since its commencement?
The NHIS was established to reduce out-of-pocket spending on health care. This is to make funds readily available to health care. As it operates today, only federal civil servants, with very few states, are enrolled. The enrollees are supposed to contribute a percentage of their salary to the scheme; their employers are to supplement these contributions. But the workers at the federal level have not accepted to contribute to the scheme. The fee for service charge falls far below the cost of the services rendered.
Moreover, the health workers are not properly reimbursed for the services rendered. The scope of implementation of the scheme is not optimal. The NMA will champion the extension of the scheme to cover all Nigerians. The scope of services rendered under the scheme must be improved.
The NMA will support compulsory contribution from all civil servants and inclusion of all employed Nigerians to contribute to the scheme. There must be an upward and urgent review of the bills paid to service providers, and this review must be periodic. All primary health centres must be accredited to provide primary care to all Nigerians on minor ailments.
Many Nigerians that could have been saved through prompt and proper medical interventions die from road accidents and other mishaps, due to improper interventions from well-meaning Nigerians and even care providers. You are a distinguished expert in trauma care; how can we standardise our medical emergency services and reduce deaths and complications from accidents?
The trauma services in the country are not yet standardised. This is responsible for high morbidity and mortality from our roads. Attempts by the federal and few state governments on the improvement of trauma care have not been felt much. The federal government has established few trauma centres but a lot needs to be done in establishing more high-level trauma centres in all geopolitical zones.
To minimise these wastages from accidents on our roads, certain urgent measures must be put in place. New trauma centres and the existing ones need to be well-equipped and adequately staffed. All emergency rooms in our hospitals must be manned with at least four doctors who are properly certified to handle emergencies and these doctors must possess certificate in Advanced Trauma Life Support programme (ATLS).
Medical centres along our highways – private or government-owned – must be made to function fully 24/7. Our roads needs 24/7 ambulance services and this is the least we expect from our government. Emergency ambulance services must be manned with well-trained rescue workers/paramedics who are certified and recertified periodically.
Our roads must be rehabilitated and provided with communication facilities networked with our ambulances to ease evacuation. A national toll-free code must be introduced in these ambulance services. The government may also encourage private firms skilled in this business to key into private public partnership.