By Victor Anya
Honourable Commissioner for Health, Lagos State, Prof. Akin Abayomi has said that the state didn’t abandon other health challenges for corona virus. He stated this during the Lagos State Health Summit organized by Private Medical Practitioners, Lagos State Branch under the umbrella of the Association of General and Private Medical Practitioners of Nigeria held at Sheraton Hotel and Towers, Ikeja on Thursday, March 12, 2020. Speaking on the theme: Repositioning Healthcare Delivery In Lagos State: A Synergy Between Government And Private Sector, he said that why the state was confronting the corona virus challenge frontally, other health challenges like Lassa fever, typhoid, malaria, yellow fever etc were never neglected. Prof. Abayomi said as the state was doing everything within its power to overcome the new corona virus that was ravaging the world, the state was equally giving adequate attention to other health challenges hence there was no mortality associated with other health challenges within the state.
Prof. Abayomi therefore advised participants at the event not to send a wrong message out that other health challenges were neglected for the corona virus in Lagos State like it was during the Ebola virus outbreak where hospitals were shutdown against people who had other diseases in Liberia, Sierra Leon and Guinea. He said the neglect of other health challenges like typhoid, malaria, Lassa fever, yellow fever etc while there was absolute concentration of attention in combating the Ebola virus led to the death of multiple innocent Liberians, Sierra Leoneans and Guineans. He stated that Lagos State didn’t want to experience the negative effects of what Liberia, Sierra Leon and Guinea experienced during the outbreaks of the Ebola virus hence the state took adequate measures to fight the corona virus along with other health challenges, saying this was why there were no recorded casualties since the outbreak of the deadly corona virus.
The Honourable Commissioner of Health also gave detailed accounts of how the Italian index case who imported the corona virus into the country was monitored, trailed to Ogun State and brought back to Lagos State because of the better health facilities in the state. He added that the index case was quarantined and that he was responding to treatment positively. He further said that the people the index case had contacts with were all identified and also quarantined in Ogun State hence the spread of the virus was contained to a very large extent.
Speaking further, Prof. Abayomi said that the Lagos State Government recognized the important role private medical practitioners play in the health sector in the state hence he had always attended all their programmes. According to Prof. Abayomi, more than 70% of healthcare services in the state are being rendered by private medical practitioners. He said the main role of government was not in service delivering but to provide governance, regulation and policies in the health sector in line with international standards and benchmark. He added that it was the duty of government to create the enabling environment for the private sector to thrive and that this would prevent brain drain in the state and compelled the best brains to stay back and work here.
Speaking in the same vein, Prof. Abayomi said that the Lagos State GDP was in excess of ₦40 trillion and that the private sector was actually driving the economy of the state saying that the private medical practitioners was driving the healthcare sector in a ration of 40-1. He added that 77% of assisted ventilator capacity in the state belonged to private medical practitioners. The Commissioner of Health made it clear that as Lagos State was confronting the corona virus, majority of the ventilators in the state belonged to private medical practitioners. He called for the continuous supports of the private medical practitioners in the state so that the healthcare sector could be improved and remained active.
One of the facilitators, Prof. Akin Osibogun who spoke on this topic: Between Strategic Plans, Healthcare Services in Nigeria: Policies and Implementation or Education: Wellness of a Nation, began his presentation by saying that health could be measured by the volume of diseases, disability, discomfort, dissatisfaction and the number of deaths in a country within a period of time. He said the National Health Act was enacted in 2014 and that the Act defined the responsibilities of the three tiers of government in the provision of healthcare in the country. According to Prof. Osibogun, the National Health Act empowered the local, state and federal governments to provide quality healthcare services to the citizens while ensuring their safety. He stated that Nigeria has the largest health resources in Africa only equal to Egypt and South Africa while Sub-Sahara African average of 15 doctors and 72 nurses per 100,000 populations compared to 30 doctors to 100 respectively for Nigeria (WHO 2006). He added that physician density in Europe and USA average 3000 per 100,000 populations.
Prof. Osibogun mentioned the challenges in the health sector in Nigeria to include: inadequate human resources managers in the health sector; shortage of health professionals; inter-professional rivalry due to unclear job description; poor financing in the public health-leading to poor supplies, drugs and equipment; 80% of health budget goes to salary and allowances; poor power supply, water supply, bad roads-all affecting health services negatively.
He explained that the way roads are built in Nigeria also affects the healthcare sector saying that if the roads are built to accommodate the use of bicycles as they are in the Netherlands; this will promote physical exercises as riding bicycles usually helps to curb many communicable diseases and also prevents cardiovascular diseases, diabetes, tuberculoses, cancer etc. He noted that inappropriate application of resources affects the health sector saying that there is waste of resources in the healthcare sector in Nigeria than it is in Senegal and Ghana. According to Prof. Osibogun Senegal spends less than Nigeria on healthcare but that the infant mortality rate in Senegal is half of that of Nigeria while Ghana spends $83 per capital on health, Nigeria spends $85 per capital on health but the infant mortality rate in Nigeria is 75 per 1000 while infant mortality rate in Ghana is 57 per 1000. He further said that Europe spends about $4,000-$5,000 per capital, USA spends about $8,500 per capital while Nigeria spends $85-$90 per capital and that it is obvious that the more money that is spent on health, a better health service would be achieved as more drugs and equipment would be bought.
He noted that the kind of policies in the health sector is usually determined by the political ideology in that country saying that the countries that practice social democracy in the 19th century like Sweden, Norway, Denmark and Austria also have the best healthcare services in the world. He stated that the countries mentioned above allow their women to work and such working class women contribute to their family health and financing. Countries led by political parties with Christian Social Democratic Ideology in most of the 19th century like Belgium and Netherlands which had Christian values, considered the women’s place was in the home, prevented them from working and they didn’t have the financial power to support their family health, he said. Countries that have liberal democracy like America, United Kingdom and Canada also have some of the best healthcare services in the world he added. Countries that were ruled by dictatorships like Spain, Portugal and Greece had the worst health policies in Europe he pointed out.
Prof. Osibogun revealed that the health status of a people was not determined only by the health sector but by a group of factors such genetics, human biology, sins of our fathers, the things we inherited from our parents like sickle cell anemia, diabetes, cancer of the breast and our lifestyle. He asked the following rhetorical questions: do we keep 20 boyfriends or 20 girlfriends? Do we smoke or drink too much alcohol? Do we eat beans that was cooked since last week or cooked this morning? Do we drink dirty water or portable water? He added that the kind of environment we live in will also determine our health status saying that if 30 people live in a room, it is much easier to spread diseases among them.
He noted that early detection of a disease would help to fight such a disease as he made reference to late Mrs. Nancy Reggan who had breast cancer in 1982 but lived above 30 years before she died because her breast cancer was detected earlier and the lump was cut from her breast leading to her timely healing. He stated that the survival rate of breast cancer in Nigeria is just five years because breast cancer cases are not usually detected earlier enough for them to be given adequate before fatality sets in. Likewise, he mentioned late President Ronald Reggan of America who was shot on his chest but was able to live above 30 years before he died because there are good healthcare systems in America.
The expert of public health and epidemiology stated the threats to healthcare services in the country to include: bad roads that lead to multiple road accidents which cause many deaths; violence like terrorism and insurgency as a cause of many deaths; outbreaks of viruses such as Lassa virus and the new deadly corona virus-all stand as threats to healthcare as they cause numerous deaths across the globe.
It was not all gloom, as Prof. Osibogun mentioned some opportunities in the health sector to include: investments in healthcare by elected officials as a way of providing the dividends of democracy to the people; private individuals investments in the healthcare sector; public private partnership was viable in the health sector; provision of high quality healthcare will elicit the support of the electorate for their representatives.
Talking about how the healthcare sector can be strengthened, Prof. Osibogun said there was need to urgently implement the National Health Act as he called for the setting up of National Hospitals Commission; the need to revamp the National Agency for Public Healthcare Development to help the health sector; to increase public financing in the healthcare to include the poor; attract private sector participation in the health sector.
Speaking on the cost-effective intervention in the healthcare sector, he emphasized preventive healthcare to curative healthcare saying it was much cheaper to prevent diseases than to treat diseases. He mentioned preventive measures to include: regular immunization; health education and healthy lifestyles such as a few people living in a house; eating healthy foods; keeping one sex partner; having workable health policies and taking timely actions etc.
Speaking on the topic: Understanding Financing Healthcare Services, Policies in Nigeria: Policies or Education, Dr. Leke Oshunniyi, said the National Health Insurance Scheme started on the floor of the Association of General and Private Medical Practitioners of Nigeria (AGPMPN) in 1986 under the leadership of Dr. Doyin Okupe. He noted that six of the pioneering members of the health insurance scheme were owned by members of AGMPN. He said that the scheme was not a compulsory scheme and that many people didn’t believe that it would work. He stated that doctors find it very difficult to access loans from banks because they don’t have boards of directors to oversee their hospitals.
He said doctors take decisions alone without inputs from anybody which according to him was a bad corporate governance process saying that no bank would give loan to an organization that doesn’t have open and transparent accounting system. Dr. Oshunniyi said if private medical practitioners want loans from the government or banks, they should provide relevant documents in a manner that would convince government officials to approve their loans requests. He noted that the health budget for each Nigerian for a year was a mere $1 and that for this reason private medical practitioners were playing a vital role in the health sector that would prompt government to approve their loan requests.