‘Our healthcare delivery has not reached the stage it ought to be’

What’s your sense of decline in Nigeria’s health system in terms of healthcare delivery?
I would not really say the healthcare delivery is on the decline but that our healthcare delivery has not reached the point we want it to be. And the choice of going overseas for treatment was influenced by availability of fund or change of environment. I am saying this because I have looked into the activities of the health sector as a medical practitioner, as chairman of Association of Resident Doctors, Nigeria Medical Association president and as a commissioner for health in Kogi State. If you look at healthcare delivery at the three tiers of governance, there are stratification in terms of service and service delivery. While the federal government is involved in the area of teaching hospitals, referral centres, specialist hospitals and training of healthcare provider (both medical and paramedics), states are saddled with service delivery but they also delve into areas of research or giving specialized treatment as well as training of medical health personnel through university specialist hospitals. Basically, what happened over time is that certain areas that need to be addressed like areas of infrastructure, equipment, human resource for health or man power are still not done. Looking at it critically, government has not done too badly but it may not be enough.
It is obvious that while the states are responsible for secondary healthcare and the local governments have primary healthcare, there are supposed to be clear demarcation in this area but in practice, they are not there. The key thing here is that the constitution has not really given health a prominent place and so successive government due to one thing or the other have not really looked at it holistically but let be as it is.
There had been a steady progress in healthcare attention in the country both in the area of public health and private health sector, and these two areas tend to complement each other to bring about the best of services to people. But one thing is that why the hospitals have not been able to do what they needed to do was  due to deficiency of the system that makes it impossible for them to operate maximally. For instance, when you have power failure, automatically some of the machines you have to use  will always have a frequent  breakdown. Also we may have a situation whereby we may not have appropriate hands  to maintain such equipment. So if you have professional to carry out certain activities, once the appropriate machineries are not working optimally, you can’t get the best out of it. If these things are not done in proportion to one another, you see a lot of lop-sided activities that will not bring out the best out of the system. If you look at the health indices both individual states and nationally I think there is significant improvement. But there is still room for improvement.

Nigeria still ranks among countries with highest maternal mortality rate. How can this be addressed?
The point is that when you are looking at maternal mortality, any health indices to begin with you must look at it on the premise of population because whatever figure that is being used is done relatively to population. If you have a population of 100 million or 160 million, the low indices of that 100 million may translate to high indices if they have that population of 160 million. So population is very critical when you are looking at indices.
Now coming home to maternal mortality, I think that we are doing well in terms of maternal mortality due to the intervention the federal, state and local governments have put in place to address it. You recalled that as for back to 2008, we had maternal mortality rate of about 800 to 1,000 births; this over time has reduced in 2010 to about 545 per 1,000 live birth. Now, we are talking about 487 per 1,000 live birth. And what’s  responsible for these decrease was the massive interest the government has shown to ensure that there is drastic reduction in maternal mortality rate, also the approach to see that MDG programmes come to stay.
The key approach in all this was to see that more women are provided with healthcare services particularly in the rural area where majority of the people live. These are done through antenatal care and National Health Insurance Scheme. They joined together to bring down maternal healthcare which equally translates into child healthcare. Good numbers of these programmes are funded by the federal government. The federal government also started the activities of midwifery in 2010 and this has ensured that in every state some selected primary health centres based on senatorial area and reporting pattern of attendance to health clinic were picked to roll out the service of midwifery scheme. Midwives and extension workers provide service to the people and when they run into problems they run to the general hospital.  

Tuberculosis and other communicable disease still account for many deaths in the country despite government intervention. Where did we go wrong?
TB and other communicable diseases are ordinarily something one can be immunized against. This is the area the government is calling on parents to bring their children out for immunization. Among the preventable diseases, if people heed to health information, some of these conditions would not have been as rampant as they are. For tuberculosis, HIV and malaria a lot of work is being done on them for the purpose of combating the scourge and reducing the devastating effect on people.
We have good healthcare delivery in this country. The National Health Insurance Scheme which is operational, covering about 3 percent of the total Nigerian population because it is meant only for people in the armed forces and federal civil service as well as organized private sectors, is also helping in this direction. You could see that that has helped people in terms of their private pocket expenses, like going to pay for services. Any person that has access to health insurance, you discover it is the best thing that has happened to you because you go to hospital even when you don’t have money but services will be provided for you through your scheme. This is one of the driving forces turning around the health indices in the country positively. So all these are enshrined in the health bill that would have actually turned around the fortune of this country because we would now have a healthy work force to drive round the processes while economic losses will not be there, as absence from work due to ill health will reduce and productivity will improve. So we are passionate that Mr. President will assent to it when eventually harmonized and passed by the National Assembly.

Where does Kogi stand on the NHIS?
We are fighting assiduously trying to implement health insurance scheme in the state. Our civil servants work force and students in the tertiary and health institutions are on it. Now we are hoping to bring community social-based health insurance scheme for the informal sector, like the artisans. In doing this they form themselves into groups in order to access health service within their vicinity. We have the quarterly free rural service in the state where health teams move round the 21 local governments to attend to peoples’ health. It is a programme rolled out by the state government with participation of the local governments to ensure healthcare delivery.

What’s your sense of diabetes as a fast increasing major concern in the country?
Diabetes is one of the non communicable diseases like hypertension, arthritis, ulcer among others – a condition very prominent now on the drawing board of international forums. Some of the key decisions of WHO 66th assembly held in Geneva this year was focus on non communicable diseases. Again, some of these diseases I think are coming because of lifestyle changes and the way and manner we go about ranging from diet to  physical activities. A lot of things we consume have high carbohydrate content and even then people do not exercise to make sure they are burnt off.  So the disease is derivable from the thing we eat, drink and life style. The solution to this is to go back to natural food and fruits rather than the refined ones. Refined foods contain additives which tend to raise sugar level and once the sugar rises the hormones and agents that are supposed to regulate them will be overworked.

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