Overhauling our healthcare system: An open letter to Mr. President

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By Gbolahan Diyaolu

FIRST and foremost, I congratulate you for the decisive action on the closure of the country on time. For the tremendous efforts by the authorities to trace, isolate and quarantine the first carrier of COVID-19 to Nigeria. Very few people understood the urgency at hand.

Look no further than the once-great United States of America, where confederacy of dunces are in charge, and science is discarded. The consequences of inaction speak volumes. Furthermore, kudos to the continuous efforts to keep us safe in the face of economic challenges that loom while we navigate our way out of this pandemic.

The job is not done, Mr. President. Your leadership is paramount in leading us out of this pandemic and setting Nigeria on a path that will dwarf the great Marshall Plan. We are relatively a young republic, on the verge of becoming a developing country with great untapped potentials. To remove potentials from our situation, the time is now.

It was Albert Einstein who defined insanity as doing the same thing over and over again and expecting different results. As the saying goes, the chicken has come home to roost.  COVID-19 infection has exposed the incoherent and abhorrent healthcare system or lack thereof in our nation. Our inability to think “Nation First” may lead to the demise of this great nation, the “Giant of Africa.”

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Can anyone sincerely tell me that we have a Nigerian solution to this COVID-19 infection? We spent billions of dollars of our hard earned foreign reserves on medical tourism on a yearly basis. The result is out. We flunked with flying colors. COVID-19 pandemic is ravaging through our nation. We are left with ill-equipped and dilapidated hospitals, most of which are not fit to be called hospitals. They are death traps for all intents and purposes. This country had lost great minds to the atrocities of our current healthcare system. I say enough is enough.

A once great institution in the seventies, the Lagos University Teaching Hospital, LUTH, is reduced to an eyesore. None of the so-called elite will be caught dead in any of the so-called Federal Medical Centres. How lucky of a nation are we? Let me count the ways. Please, for a second, imagine, if faced with similar situation, ‘a la New York or Italy? God forbid bad thing. This nation will be on the verge of extinction. According to published reports, we cannot even adequately attend to you Mr. President, to your basic medical needs at the clinic at Aso Rock. Why? Because it is inadequately stocked.

Not only in terms of medications but personnel and basic diagnostic equipment are difficult to find. It is non sequitur to know the clinic’s yearly budget. It is the symbolism of what obtains that matters. This is an eye-opener. This is the time to systematically abolish medical tourism and invest all that wasted money here at home. I’ve always been taught that charity begins at home. Mr. President, you need to wake up and smell the coffee. You need to set this nation on a path that will be irreversible in terms of health, roads, housing and power infrastructure.

After one month of isolation, still in the throes of this pandemic, what is the plan forward? What is the quintessential Nigerian solution? There is one irrefutable fact: this virus behaves differently in this environment. I can only presume that the Nigeria Centre for Disease Control, NCDC, has our scientists not only playing armchair quarter backing, but collecting data to figure a way out of this pandemic. Please, spare the information coming from the Western world. The usefulness is only as a guide. The solution is within our walls. The only way out of this predicament is to test, isolate, treat, trace. I repeat we need the quintessential Nigerian solution. I am aware of all the chatters around you. This decision is yours and yours only.

I hope it is obvious to all, that we are devoid of a healthcare system, but what we do have is a “death care” system. Can you believe it costs an average of about N1.5 million to bury a loved one in Nigeria? The “death care” industry is a multi-billion naira institution and thriving. This is a conservative estimate my dear brethren. My dear Mr. President, this is your time. This is the time your leadership is called upon. There comes once, in a lifetime that bold and decisive action is needed. Your war on corruption is commendable but you need a long-lasting legacy that will put you on the proverbial Mount Rushmore. Your name will be synonymous with the likes of Franklin Delano Roosevelt and Nelson Mandela.

This is the time Mr. President. This is the time to revamp and establish a Universal Healthcare System in Nigeria. A single-payer system for the masses. A system designed by Nigerians and for Nigerians. It is okay to borrow ideas from other countries but it has to have Nigerian flavour to it. This will not and does not eliminate the current system but will force it to be more accountable, efficient and bring it to the 21st century standard. All Nigerians deserve to have a good and affordable healthcare. It is a fundamental human right. I cannot but remember George Orwell in Animal Farm: ”weak or strong, clever or simple we are all brothers.” We have the expertise to handle anything and everything imaginable, but we lack infrastructures and collective will, as a nation, to put everything together to make it work.

Time to think “nation first”, Mr. President. Ironically, most of the physicians you spent millions to visit abroad are Nigerians. That is shameful. Before everybody goes berserk let me tell you that the status quo is inhumane and unsustainable. All Nigerians deserve to walk into any hospital, regardless of social and economical status, and be treated like a human being without being asked to produce a pound of flesh before being attended to. Government is a tool to be used for the betterment of the masses, to continue to be “our brother’s keeper.”  Time is now, that anyone from any class, in this great nation of ours should be able to call an ambulance and the response time should be in minutes not in hours!
The government should not be in the business of educating our children, neither should it be in the business of operating hospitals.

Secondly, where is it written that only physicians should be health ministers or health commissioners? Historically, except trained in management, physicians do not make good administrators. Government should be in the business of creating a conducive environment for businesses to grow, especially in education and healthcare. Government should set standards and conduct oversights. Let the private sector take up the mantle to lead us out of this 19th century notion that government is the solution for everything.

Let competition reign. Capitalism should not be a dirty word but capitalism without rules and enforceable laws can be catastrophic. There are many ways to accomplish reorganisation of our healthcare system, but this space is not enough to enunciate the necessary steps and to debate the merits. One critical prerequisite for a successful transition is education. As someone once said: “Criticism without solution is merely an inflation of the critic’s ego.” Be that may, here are some suggestions your people can ponder, Mr. President.

Privatisation is the key word. It can be a mixture of public private partnership where the private sector owned the majority shares and the government support comes in form of tax incentives and regulations. It must not be a give away, ‘a la PHCN.’ There must be a good inventory of all federally-owned hospitals and bid proposals should be invited for them. The role of Ministry of Health will change to one of setting standards, monitoring, creation and expansion of health payment codes, ICPC.

Private sector hospitals

These codes are to be used in payment of services and products provided to patients. The Ministry of Health will be charged with setting treatment standards and adherence to those standards. A comprehensive and interactive IT system is a must. All medical records shall be electronics. All existing private sector hospitals shall be allowed to participate in this scheme. This is just a start. I’m very sure Nigeria has better minds to figure out the intricacies to make it work with the quintessential “Nigerian Factors.”

I can hear lots of economists, skeptics and pundits out there asking questions. Who and how do you pay for this? This is very simple. This is basic mathematics. The product of any number and zero is zero. Translation: status quo is deadly. But the economic impact of this single act alone is incalculable. This single act may be the beginning of retainership of our intellectuals to voluntary repatriation of our lost experts. This may be our own industrial revolution. This will not happen overnight and I am not under any illusion it will be easy nor fully implemented on your watch. A journey of a thousand miles begins but with a step.

Your inaction will be a disservice to this great nation.
When the next generation asked you of your stewardship, let it be said that you left this nation better than you met it. Moreover the current state of healthcare is unsustainable. The measure of a great country comes from the welfare and health of her people not by personal wealth of individuals. Remember, no country falls without, countries falls within. The great Soviet Union fell without a single bullet being fired.

*Dr. Diyaolu is former Adjunct Professor of Clinical Practice at Massachusetts College of Pharmacy University.

Vanguard

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