AFRICA :NEWS,CULTURE, SPORT.

Nothing aptly describes the state of the Health Sector in 2009 as the various strikes called by different groups of health workers. Among health care workers who downed tools for different reasons during the period were the Senior Staff Association of Universities,

Teaching Hospitals, Research Institutes and Associated Institutions (SSAUTHRIAH), Medical and Health Workers Union of Nigeria (MHWUN), Nigerian Union of Pharmacists, Medical Technologists and Professionals Allied to Medicine (NUPMTPAM), Nurses and Midwives Association of Nigeria, the Medical Guild, which are doctors in the employment of Lagos State Government and some state chapters of the Nigerian Medical Association (NMA). Also during the period, the national body of the NMA effectively used threats of strike to achieve the current Medical Salary Scale for the benefit of its members.

While patients who needed urgent medical attention were abandoned to their fate while the various strikes lasted, health care workers advanced different reasons for their actions.

Characteristically, the Medical Guild, which is an affiliate of the NMA, Lagos State Branch pioneered the strike in January, by calling for improved salary scale based on the Consolidated Tertiary Institution Salary Scale (CONTISS), which had been implemented by the Federal Government since 2007. Aside from the demand for CONTISS, which is supposed to enhance their salary by almost 50 per cent across the board, other demands of the Medical Guild include a better working environment, stoppage of harassment, and victimisation of the Guild’s officials by the management of the State’s Ministry of Health and the Health Service Commission.

At the Federal level, MHWUN called out its members in July to protest the non-payment of money that accrued to them from the Monetisation Policy of the Federal Government.

While the NMA, through the threat of strike struck a deal in September when the Federal Government approved the Medical Salary Scale for their members, other health care workers under the auspices of NUPMTPAM have not been lucky. Last week, they suspended a one-week strike after their negotiations with the government a was stalled over call duty allowances, motivation allowances for administrative health workers and non clinical administrative allowances for nurses operating in the Federal Ministry of Health. Having lost confidence in the Minister of Health, Prof. Babatunde Osotimehin to lead the negotiations, NUPMTPAM rose from a meeting in Jos, Plateau State last week and chose to present its grievances to the President, Umaru Yar’ Adua. NUPMTPAM’s National President , Felix Olukayode Faniran said the grievances include appropriate and commensurate salary structure, allowances and other conditions of service and a comprehensive reform of the Health Sector.

Apart from strikes, another issue that dominated the scene in the sector is the huge workload on medical practitioners and other category of health workers. In fact, this was one of the reasons that some doctors including the Medical Guild called its strike.
Commenting on this phenomenon based on a study that was release in 2009, the Chief Medical Director (CMD), Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun said health workers in Nigeria are overworked. In Europe and America, there is an average of one doctor to about 400 people unlike in Nigeria where “doctor to patient ratio now is one to 4,000,” he said. Although, he noted that the ratio is an improvement to what was obtainable years back, analysts said it imposed a significant strain on health workers, impacting negatively on the quality of services.

On their part, the patients were not amused at this development, which left them waiting hours-on-end before receiving treatment and care for urgent medical conditions.

Giving details of the study titled, Locating the Public Health: An Agenda for Health Development, Osibogun , a professor of community health said although teaching hospitals have increased from six in 1960 to 30 in 2009, resulting in improved health care delivery, “the ratio of teaching hospitals to the population improved from one to 10 million in 1960 to one to five million in 2009.”

Similarly, he said there has been an improvement in Nigerian health centres, which stand at one to 8,000. “About 50 per cent of Nigerians don’t also need to walk for more than one hour to access a health facility and it is a remarkable improvement,” he said.
Going by the findings in the study, it is clear that accessing health facility may not have posed a problem throughout the year, what remained a knotty issue is poor/nil service delivery at most of the Primary Health Care Centres (PHCs) across the nation.

At a summit on PHCin Uyo, Akwa Ibom in June, Osotimehin disclosed that 80 per cent of Nigerians access health through PHCs, which are under-funded, making most of them incapable of providing needed services at the rural and community level.

Lamenting the decay in PHCs across the nation, he said local government councils should be held responsible for all lapses in the nation’s health sector. In many of the PHCs, many relevant staff are not on ground to see patients and pharmacies are empty, warranting community people who constitute the nucleus of the patients to loose confidence in that system.

According to Osotimehin, the poor performance of the councils has resulted in the deplorable condition of the PHCs nationwide.
The Federal Government launched the PHC in 1987 as a cornerstone of the Health Policy with objectives such as accelerated health care personnel development, enhanced availability of essential drugs, implementation of Expanded Programme on Immunisation (EPI) and the promotion of health awareness. Its major aim was to bring health to the door steps of the populace through collaboration between the Federal Ministry of Health and the participating local government councils, which received grants directly from the federal government.

With the decay, which persisted in the PHCs throughout the year, a lot strain was brought to bear on both secondary and tertiary health care facilities following patient’s drifts there because that is where they were sure of getting the treatment and the care they need. What this means is that the goal of the national health policy, which is aimed at brining about a comprehensive health care system based on PHC that is protective, preventive, restorative and rehabilitative to every citizen within available resources has been defeated due mostly to corruption and illiteracy.

During the summit called to increase investment by states and local government councils towards the development of PHCs in June, the minister of health made it clear that the provision of the PHCs is non negotiable.

While calling for their restructuring, he said that energies should be directed towards the training of paramedics, traditional birth attendants and other grassroot-based health cadre personnel with a view to bridge the gap in the provision of health care services between the poor and the rich.

It is not only long waiting hours and poorly-funded PHCs that patients contended with in 2009, the cost of medical treatment increased beyond the reach of many Nigerians, raising the questions on why the National Health Insurance Scheme (NHIS), has not been expanded to accommodate more Nigerians as a strategy to change paying for health care services from out-of-pocket expenses to pooled financial resources based on insurance policy.

The NHIS, which is a health insurance put in place in May 1999 by the former President, (Rtr.) General Olusegun Obasanjo, encompasses government employees, organised private sector and the informal sector. It also covers children, including under-fives, permanently disabled persons and prison inmates.

The reality is that orthodox medical treatment is not cheap. Expensive state-of-the-art technological equipment being used in the 21 Century to facilitate diagnosis and treatment as well as modern drugs have contributed to increase health care bills, the responsibility of which was borne by individuals in Nigeria in the period.

For instance, in 2009, many patients facing communicable diseases, heart-related problems, various cancers, and others who could not pay for medications abandoned their treatment, resigning themselves to fate. Many in that category had been sent to early graves.
Against this background, the practice observed was that patients went cap-in-hand, seeking financial support for medical care.
Although, the full implementation of the NHIS will eliminate 60 to 70 per cent out-of-pocket expenditure on health by Nigerians and curb rural-urban drift, as at 2009, about five million people only have enlisted on the scheme, prompting concerned Nigerians to ask what is delaying its expansion to accommodate more people four years after the scheme was established?
Executive Secretary of the NHIS, Dr. Waziri Dogo Mohammed said national coverage of the scheme is achievable. “Government has set 2015 as target to enlist all Nigerians,” he said.

According to the Head, Media and Public Relations, NHIS, Mr. Ayo Osinlu, the NHIS has finalised the blueprint for the community-based scheme, which is the platform to accommodate over 80 per cent of Nigerians.

However, he said that there are challenges, which include funding and and the amendment of the Act, which will make it compulsory for state governments to buy into the scheme. As at 2009, Bauchi and Cross River States only have bought into the NHIS, leaving millions of poor Nigerians struggling to pay for needed health care services.

Ironically, while some wallow in poverty in the year, on the other side of the divide, rich Nigerians, top government functionaries, politicians and and power brokers sought medical treatment abroad. On that list are: President Umaru Yar’Adua who is receiving treatment for Acute Pericardiatis in a Saudi Arabian hospital, former First Lady, Mariam Babangida is reported to be receiving treatment for ovarian cancer at the UCLA’a Johnson Comprehensive Cancer Centre in Los Angeles, United States (US), and the former Governor of Yobe State, late Senator Mamman Ali who sought treatment for luckemia abroad where he succumbed to death.

Apparently, lamenting the way top Nigerians fly out of the country to receive medical treatment, Prof. Osotimehin in June disclosed that $200 million US dollars (about N32 billion) has been lost by the country in the process.

In 2009, top and rich Nigerians traveled abroad for ailments such as eye check, removing a tooth, among others, all of which can be treated locally. The minister said people go abroad for eye check up because of lack of confidence in the system.

As part of strategy to address the problem, Osotimehin called on the Presidency to help in establishing four quality health care hospitals in Nigeria that are world class and “where there will be no nonsense, where you will go and their staff will not go on strike. You will go there and you will get what you want when you want it. You will get first class service but you will have to pay.”