Paul ADEPOJU

Nigerian Health Care System – A Ticking Time Bomb (2)

According to the Organogram for the New NPHCDA Agency (NPHCDA & NPI Merged) V 2.1 – Post Lokoja Workshop, the purpose of the agency that has now been merged with the National Programme on Immunization (NPI) is to ensure the development of primary healthcare system through advocacy, social mobilization, resource mobilization, community ownership, capacity building and development of effective managerial processes. However, apart from hefty monthly salaries, a visit to the agency’s South West office in Agodi GRA in Ibadan would attest to the fact that the agency’s workers still have a lot to learn about their work mandate, and are working at a sickening slow snail speed. While they are learning, the pressure of the failure of the Nigerian primary healthcare has shifted to other tiers- the secondary and tertiary health sectors.
Presently, the only evident difference in the services rendered by these two tiers are the medical trainings—undergraduate and postgraduate—offered by the tertiary health institutions, and what remains of our extensively eroded health referral system. In Ibadan for instance, both UCH (a tertiary health institution) and Adeoyo General Hospital (a secondary health facility) treat secondary wounds, deliver babies, give immunizations and vaccinations (duties of primary health centers), operate HIV clinics, carry out minor and major surgeries, and train medical and paramedical staffs. Nigeria’s emergency medical practices and wards also point to the fact that our health system is in disarray.
The entropy (degree of disturbance and disorderliness) is highest in our tertiary health facilities where patients with minor cases that are treatable with a salt-sugar solution mixture compete for medical attention with those presenting with medical conditions that could only be treated at the prestigious King Fasai Medical Center in Saudi Arabia.
It’s only in Nigeria that a 911 dial gives a number-not-in-use response. Our various governments claim to have procured ambulances, yet no citizen knows how to contact them when in dire need. It’s therefore an expected aftermath that Nigeria, despite its enormous oil wealth, has one of the highest emergency mortality rates in world history. Even Mozambique and Tanzania fair better than the self acclaimed giant of Africa!
No thanks to the lackadaisical attitudes of those at the top, these shortcomings, as bad as they are, are nothing when compared with associated dangers of the numerous accesses that are now available to terrorists, and anyone with harmful intentions.
According to the Atlanta based US’ Centers for Disease Control and Prevention (CDC), a bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. The agents used are ubiquitous and are widely found in nature, but could be transformed to increase their viability and ability to cause disease (e.g. botulinum toxin), drug resistant (e.g. XDR-TB), or to increase their ability to be spread into the environment (e.g. anthrax). Air, water and food are common routes of spread.
Any terrorist with scores to settle with the Nigerian government or a desperate politician who can pay a medical scientist may produce biological agents that are extremely difficult to detect.
Globally, bioterrorism is fast becoming an attractive weapon because biological agents are relatively easy and inexpensive to obtain or produce. They can be easily disseminated, and can cause widespread fear and panic beyond the actual physical damage they can cause. Politicians too are gradually seeing bioterrorism as a potential tool in ensuring victory at the polls. This has been used in God’s own country—the USA.
According to a Wikipedia article, in 1984, followers of the Bhagwan Shree Rajneesh attempted to control a local election by incapacitating the local population. This was done by infecting salad bars in eleven restaurants, produce in grocery stores, doorknobs, and other public domains with Salmonella typhimurium bacteria in the city of The Dalles, Oregon. The attack infected 751 people with severe food poisoning.
In Nigeria where dangerous arms proliferation goes unabated, weaponization and dissemination of agents like small pox, anthrax, botulinum toxin, bubonic plague, and several others are but a piece of cake. The fatality of such would be as a result of our popular synonyms- executive nonchalance, cantankerous corruption, poor planning and very late response.
Biosurveillance, early detection and rapid response are the keys to combating bioterrorism. These involve a close cooperation among doctors, medical laboratory scientists, epidemiologists, security agencies, and a working healthcare system. With political agitations and confrontations coming from all fronts, it is not a white elephant project for Nigerian government to start putting its health house in order to prevent sacrificing the lives of innocent Nigerians on the altar of peculiar ignorance, professional inertia and political insanity.
As a matter of urgency, governments at all levels should remove the health sector from their political reach and allow the health system to be run by the experts. The experts should also collaborate with the brilliant minds at the ivory tower to fortify our health boundaries against adverse medical invasions and importation of foreign diseases as experienced with the report, few years ago, of Asian avian influenza in Lagos and other states of the federation.
A complete overhaul of the Nigerian healthcare workforce is long overdue as the system is presently footing the bills of numerous ghost workers and wrong workers. The government needs to sort this out to ensure that our medical facilities are manned by qualified and experienced professionals that would ensure the good health of the sick patients and patient healthy citizens.
Since our traditional health practitioners are quite numerous and currently enjoy the patronage and trust of a large proportion of the sick population, the Nigerian Ministry of Health needs to incorporate the alternative health practitioners as primary healthcare providers, and closely monitor their activities and not act, like NAFDAC numbers, as an official rubber stamp for all shady activities and esoteric procedures.
There is also the need for the National Primary Healthcare Development Agency (NPHCDA) to go back to its situation rooms and drawing boards after awakening from its perpetual slumber. The nation is in dire need of a rejuvenating and reinvigorating programme that would revitalize our sick primary healthcare and equip our local clinics with required facilities and resources (human and otherwise) to regain the long lost confidence of grassroots’ healthcare seekers.
The age long professional bias in the Nigerian health system is another clog in the wheel of the progress of the sector. The administration at all levels should be unfaltering, just and fair in ensuring that this is permanently removed, and compel health professionals to see contemporaries as colleagues, and not competitors or enemies.
The NHIS’ current shape is shameful hence an understudy of the UK’s NHS and US’ Medicaid is suggested as this would enable Nigerian health insurance policy formulators to have an idea of how national health insurance should be operated with the interest of care seekers, and not care providers, at heart. If Guilder and other beer brands could get to every corner of the nation, health insurance policies should.
There is an urgent need for meaningful health campaigns aimed at informing and attracting citizens to government health facilities. At government hospitals, healthcare seekers should be treated with courtesy, confidentiality and mutual respect that are accorded law abiding citizens of the nation by the Nigerian Constitution.
The frequent sojourns of Nigerian leaders abroad in search of quality treatment for minor ailments connote more doom for our already disarrayed health sector than a bioterrorist’s anthrax threat hence such travels should be stopped. If government officials are satisfied with, and could boast of the quality of healthcare they’ve put in place at our various health institutions, they should be confident enough to fell asleep under the influence of anesthesia in our hospitals without any doubt on their minds.
Whichever way we choose to progress, let’s have it on the back of our minds that time is fast running out. Sooner or later, the only thing that would be safe is our last breath because the next, might actually be the last.

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