Professor Eyitayo Lambo between July 2003 and May 2007, became the first non-medical practitioner to serve as Minister at the Federal Ministry of Health under the Olusegun Obasanjo administration. As a renowned Health Economist, Lambo pioneered the first Health Sector Reform Programme for the country and succeeded in launching the National Health Insurance Scheme, which had been on the drawing board for 40 years. Sharing his thoughts with Group Life Editor, YINKA SHOKUNBI, Lambo takes a look at the hiccups in the country’s health system over the years and concluded that for the nation to forge ahead, there is an urgent need for government to redirect investment in health and for partners and stakeholders to cooperate to achieve a more sustainable healthcare delivery system.
Why are we where we are in 2014?
Nigeria’s healthcare system is truly not excellent and it is not where we want it to be. But, we are praying that it should be what we want it to be during our lifetime. The health system is still suffering from many problems, chief of which is under funding. Nigeria’s health system is grossly under-funded, particularly when you look at what the norm is; that is, what is recommended and what the government is spending, the total expenditure or per capital expenditure is, it is far from what is prescribed as the minimum by World Health Organisation (WHO).
Apart from the underfunding, you find that about 70 per cent of the spending is coming from private pockets, which is not acceptable by any standard. When that magnitude of funding is coming from people, it has implications and it is like cash and carry. When you are sick and you do not have money, you would not seek health services. People would only go when things have gotten bad and it has become difficult to rescue; that is not acceptable.
Then, the physical health facilities are not in good condition; they are not well equipped, not well stocked with drugs and then, the providers of services, the human resources are inadequate. The distribution of human resources is urban biased, whereas the majority of the people live in rural areas.
The same thing is with the distribution of the infrastructure – like the health centres and hospitals are still largely located in urban areas and very many rural areas do not have health facilities. Where there are at all, they are badly staffed, because, most of the healthcare workers do not like to go to the rural areas. Now, where you find healthcare workers present and even where they have drugs or equipment, since not many do, the other problem you have is the poor attitude of the human personnel.
Because they are not as motivated as one would expect, commitment is a problem. There are some that are good, no doubt about that, but we are still trying to get to the situation whereby you go to a health system with stomach trouble and you come out well taken care off, not a situation whereby you go to a hospital with stomach trouble and when you get out of there, it is still there. Yet, you have added another one, headache, because of the kind of attitude of the care providers, which is not always friendly. These are some of the things that constitute our health system not being in good shape. That is why there is lack of confidence, particularly at the lower cadre, the Primary Health Centre (PHC), which is supposed to be the bedrock of the health system.
The people by-pass the PHCs for the Secondary Health facilities, which are operated largely by the state government; even those are still badly equipped and badly staffed. So, what we see then happen is that many patients would still by-pass he General Hospitals and we find them at the Out-Patient Departments of the Tertiary Hospitals when they have malaria or cholera, which amounts to misuse of limited resources. So, the three layers of healthcare delivery, needs a lot of revitalisation.
The last time we did that was when I was there as the Minister of Health, during the Obasanjo administration. We started the revitalisation of the tertiary centres and many of them can now boast of the state-of-the-art equipment. But then, there is still a problem. Many of the state-of-the-art require 24-hour supply of electricity which is not available and these hospitals now have to rely on generators, with diesel costing so much, living so little money for any other things in the hospitals.
Besides, where there is the availability of the state-of-the-art equipment, that would not translate into good service, because, we still need professionals who have the equivalent attitude to make the system worth any investment.
In summary, I would say that my dream of where the healthcare system should be by 2014 is not where we are at all in spite of the Health Sector Reforms Agenda that we must even improve upon immediately. There are areas where there have been some improvements, but we need to take our healthcare system more seriously with government providing more funding. Also there must be attitudinal change among our healthcare professionals. They should stop this beauty contest that has permeated the system. We enjoin them all to give recognition to each other’s professionalism and each must allow one another to practice what he knows best with all putting the patient at the centre of concern rather than concentrate on their beauty contest.
Is Nigeria truly capable of containing most of the diseases ravaging her people as it has successfully done with the Ebola Virus Disease, particularly the non-communicable diseases?
It is the adequate and sustainable political commitment that is still lacking and once that is there, that is to say, once there is adequate and sustainable political commitment to healthcare, then there would be adequate budgeting and then whatever needs to be done about some other aspects of the health system would be done.
As for the Ebola Virus Disease, I am really impressed about the way we handled it as a country. I actually commend the Health Minister as well as the Lagos State Commissioner for Health for their great roles at containing the disease. When the index case broke out, I was out of the country, but nervously following up what was going on and was pleased when the Federal Government announced its commitment of about N2billion to fight the disease. I want to believe the ministry would use the money to do the right thing, apart from getting materials to also engage in massive public enlightenment.
About two weeks later, I arrived at the airport and there was screening of everybody and I was really happy about that, and so, I am not surprised that we were able to contain the disease in a short while. The way we all took the disease as a challenge was amazing. As a nation, we have got what it takes. Given the right political will and human resources, we have more than any other African country what it takes to make our system work. If government and all stakeholders can join hands, including the public, to cooperate as we did to fight Ebola, and play the role expected in unison, we would certainly be able to contain whatever disease that confronts us.
On the issue of the non-communicable diseases, we are all suffering from double jeopardy. We used to say the communicable diseases like diarrhoea, malaria and so on, are diseases of poverty of the developing countries, while non-communicable diseases actually were those for the affluent countries.
But, what we have today is that while we have some of these communicable diseases still with us, the non-communicable diseases like hypertension and diabetes are now generally here with us, even at the rural areas where hitherto these were rare. The unfortunate thing about the non-communicable diseases is that people are now very careless due largely to lifestyles.
There is inadequate awareness and attention being paid to non-communicable diseases. We need to take care and pay more attention to enlightenment of the people on non-communicable diseases, especially since by the WHO projection, by the year 2025, non-communicable diseases may be killing more people than communicable, especially when we include road traffic accidents as part of the non-communicable diseases.
So, government need to get more serious in terms of paying attention to our healthcare, because, health is wealth; it is the health of the people that drives the wealth and economy of a nation. Any country that invests in the health of its people or in its human capital, is surely investing in the engine of the country.
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