Politics Ruining Nigeria's Healthcare Workforce

The pioneer chairman, National AIDS Control Programme, (NACP), Professor Ibironke Akinsete returned to Nigeria some 50 years ago from Canada to work at the Lagos University Teaching Hospital (LUTH).

She exposed to the media on ‘Nigeria @ 55’ that there was unadulterated empathy among the workforce to give healthcare to the sick in those days, unlike today, “We seemed to have missed it at some point and nothing seems to work anymore.”

The former President of the Nigeria Medical Association (NMA) and Vice President, Commonwealth Medical Associations (CMA), Dr Osahon Enabulele frowned at the unfortunate political assurance given to the healthcare sector.

Dr Enabulele said, “It is sad that in what has become a recurring decimal, Mr. President could not spare a critical thought on his plans for Nigeria’s Health Sector in his Independence Speech.”

Workforce Marred By Politics
Governments at different levels in Nigeria are yet to accustom the universal uplift programmes of health workers.

The outcome of the lackadaisical approach being shown to Nigerian doctors was experienced recently: Medical doctors were outraged over what they described as “anti-life” policies of Governor Rochas Okorocha, where taskforce was being used to standardise medical practice in Imo State.

The doctors were not happy how taskforce was being used against them; they said that this is against the Medical and Dental Council of Nigeria’s policies. Hence, they voyaged for a protest on February 4 2016, disclosed as anti-concessioning protest of public health institutions by Governor Okorocha.

The protest latter turned bloody. An account by the News Agency of Nigeria (NAN), stated, “It was gathered that when the doctors got to Orlu Road Junction, Owerri, riot policemen in about 10 Hilux vans started throwing tear gas canisters at the group, during which a gun was suspected to have been fired, which injured a doctor.”

A Consultant Physician with the Federal Medical Centre, Owerri, Imo State, Dr. Bede Azudialor was supposedly shot in the head by the riot policemen drafted to monitor the demonstration by doctors. Aftermath, the Nigerian Police denied shooting him.

Politics Of Shooting And Denial
The Police Public Relations Officer in the state, DSP Andrew Enwerem, said, “Police did not shoot anybody and nobody who is shot in the head will ever remain alive. Let them produce a doctor’s report to confirm that it was a real case of shooting in the head. Anybody can pick any blood stained material from anywhere and claim that he was shot.”

Dr. Azudialor was said to have been rushed to a hospital for prompt medical attention, where he is believed to be receiving treatment. His colleagues spurred for a three day warning strike, as was made public by the state Chairman of the Nigerian Guild of Medical Doctors, Dr. Darlington Akukwu, following the incident.

Why The Doctors Protested
There was the Third Global Forum on Human Resources for Health, HRH, held in Recife, Brazil, from November 10-13, 2013, which represented the largest-ever global gathering on HRH.

IntraHealth was an official co-host and, with CapacityPlus, served as the organiser of one of the themes, “Empowerment and incentives: Harnessing health workers’ voice, rights, and responsibilities in moving toward universal health coverage.”

In that forum, Pape Gaye, President and CEO of CapacityPlus lead partner IntraHealth International, said, “The health worker is the most important element of the health system."

On-the-contrary, the health worker in Nigeria is estranged. The Imo State chairman of Nigerian Medical Association (NMA), Dr. Hyacinth Emele was very angry that the governor did not consider the plight of doctors in the state upon their advise not to concessionise public health institutions.

Part of reports made available by Emele on their dilemma in the hands of Governor Okorocha read, “Despite NMA repeated advise government went ahead to concession virtually all the state public health institutions from primary to tertiary (health centre, general hospitals and Imo State Specialist Hospitals, and Imo State University Teaching Hospital) and their management.”

The furious NMA chairman, added, “The state will stand to lose completely from the assistance of donor agencies and partners like the WHO, UNICEF, UNFPA, World Bank, Global Fund among others that sponsor immunization, malaria, tuberculosis, family planning and HIV/AIDS services to these institutions.”

The Governor Reacts
While the Police denied shooting any doctor, Governor Okorocha in a swift reaction in a statement purportedly made available to the public by his spokesman, Sam Onwuemeodo, regretted that the protest turned bloody, even as he added that the protest embarked upon by the doctors was uncalled for and a ploy to blackmail him and his administration.

Part of the statement read, “It has also become important at this stage for Nigerians of goodwill to tell the doctors to publish the reasons for their protest for Nigerians to see and give their verdicts. The doctors involved have not been able to tell their audience their grievances or why they took to the street if not to blackmail the governor and his administration.”

Failed Healthcare Workforce Data
The workforce is important and one of the eight pillars of the National Strategic Health Development Plan.

Nigeria knew about this and in 2011, the Federal Ministry of Health aided by the WHO, and the Centre for Diseases Control, CDC, instated the National Steering Committee for the National Health Workforce Registry and the Committee on Nigerian Public Health Training Initiative.

Conversely, the aim of the pursuit has been defeated, which was to achieve a formidable HRH data for all health workers in Nigeria. Carter Foundation was in the formation for a working Health Registry with the Federal Government (FG). The initiation was called “Health Workforce Registry”.

In all of this, politics now rule over. The torment that the health workers in Nigeria face and followed by the economic depression of the late 80's and till date, have made them to look beyond their nose and move for greener pastures outside the country.

Greener Pastures Elsewhere
The world over, how to improve on the physiological wellbeing of health workers, has been a topmost priority.

Organisations like the World Health Organisation (WHO), seek ways to reduce healthcare costs and improve on the universal health coverage. WHO has a publication with the title: “Establishing and Monitoring Benchmarks for Human Resources for Health: the Workforce Density Approach.”

The international organisation was worried in the report concerning the shortage of health workers in Nigeria and as well, the daunting situations that surround the issue, which have made finding solution impossible.

The shortage of health workers in the country has reduced the workforce. The Human Resources for Health (HRH), which represents the foundation of the health structure, has been touched.

Many Patients, Few Doctors
There have been incessant strikes by health workers across the country at different times, at primary, secondary or tertiary health centres. At most of the hospitals the question is always where have the over 30,000 medical doctors, 150,000 registered nurses nationwide, gone to.

In Imo State, Governor Okorocha sacked over 3000 workers. In Lagos alone it has become habitual to keep ‘vigil’ in the hospitals by patients, so that they could see a doctor to attend to them in the morning. Most times, a chance of seeing a doctor is slim upon the stretched long hours of waiting for a doctor.

$ 51 billion and 700 doctors
In the early part of 2015, the Federal Government sought for about $51 billion (N9.4trn) to fix the healthcare in order to meet international standard by 2030.

Nigeria would also need over 700,000 additional doctors to meet the timeframe. According to a source, “Nigeria currently has roughly 14 percent of the number of doctors per capita of OECD countries. To catch up, Nigeria would need approximately 12 times as many doctors by 2030, requiring, under current training models, about $ 51 billion.”

It was gathered that this is because many emerging economies face rising occurrence of non- transmissible diseases determined by aging populations and injurious lifestyles. Budding economies have under-invested in health.

The source added, “In 2012, their Gross Domestic Product (GDP) allocation for health was on average 5.6 percent, less than half that of developed economies (12.5 percent). This has led to shortages in health infrastructure and workforce.”

Nigeria’s Bleak Universal Health Coverage

The year 2015 was when Nigeria had in 2009 set goal to achieve Universal health Coverage (UHC). The promise was to make sure that all citizens in the country enrolled into the National Health Insurance Scheme (NHIS).

But there were miserable scenarios for the Health Sector in 2014 as Budgetary Allocation failed below anticipation in the African Union’s agreed 15 per cent budgetary allocation for health.

Media reports stated, “The total vote for health in the 2014 expenditure plan of the federal government is N262.74 billion. This is about 5.6 per cent of aggregate expenditure of the national budget. This year’s provision is a further 0.82 drop from the N279.23 earmarked for the sector in 2013. More perplexing is the fact that the budget proposal allocates 76.3% to recurrent expenditure and just 23.7% to capital expenditure. What this means is that the budget is meant to just keep the country and its burgeoning bureaucracy running with nothing spectacular to show for. Experts believe that a budget focused on massive development of infrastructure would assign more to capital rather than to recurrent which covers personnel and overhead costs.”

Conclusion: Nigeria Is Yet To Follow The World

Seven years after Nigeria set the goal to meet the 2015 Universal Health Coverage target, many Nigerians are yet to tap into the enormous advantages of health insurance, experts have said.

Hence, voices are being raised incessantly in the country suggesting that health insurance should be made available to all Nigerians and not only a handful that can pay.

During its “NMA’s Physicians’ Week” recently, the Nigeria Medical Association (NMA) called on General Muhammadu Buhari to declare emergency in the health sector.

The reason is that there is a dearth of well-designed guidelines for medical practice in Nigeria, because the Medical and Dental Council of Nigeria Board was wrongly dissolved.

The NMA lobbied for the appointment of a Chief Medical Officer of the Federation to superintend and fast-track the urgency needed in the health sector.

It also called on the authorities to instantaneously start the discharge of the 2014 National Health Act. It added that there is need for a vivacious primary healthcare system in the states to enliven immunisation and healthcare.

Odimegwu Onwumere writes from Rivers State, Nigeria. ([email protected]). Tel: +2348057778358.