‘Nigeria needs to address work issues to prevent doctors’ migration’

Francis Faduyile is the president of Nigerian Medical Association (NMA). Faduyile tells OBOKOH ANTHONIA in this interview what Nigeria can do to deepen its universal health coverage and how the country can stop the high migration rate of doctors. Excerpts:

How can you describe Nigeria’s health sector?

The Nigeria health sector is still in a terrible state, the country lacks political will to commit to developing sector. Nigeria has weak healthcare structures and the workers are disoriented. There is disorderliness in the sector, which all boils down to an inability to have a framework or guideline that monitors each of the various health bodies within the system in the country. The Federal Government must be able to do what is needful including increasing the budgetary allocation to health sector and also make sure that the country pursues the universal health coverage act judiciously.   

As the new president of NMA, what are your prospects for the sector and the association?

As the president of the Nigerian Medical Association, my goal is to bring back sanity into the system. We want to see how all professionals can work as a team and in close ranks to move the sector forward. However, we are going to call other workers within the health system for us to sit down and chat a way forward for the sector.

We are as well going to see that the hospitals are working and to develop our activities to make sure that things are done normally in the hospitals across the country. Also, we want to see that the welfare of our doctors is taking care off, ensure proper training and remuneration in the system. These are the things that NMA wants to achieve in the health of Nigeria.

How can health insurance penetration be deepened to meet universal health coverage standard?

There are two things I think can be done. The government needs to show more interest in the national health insurance scheme. Firstly, the national health act says that one per cent of consolidated revenue fund should be put into the national health act in which 50 per cent will go into national health insurance scheme and the other 50 per cent will go for primary health care development.

Today, the enrolee’s are so few, and it is just about Federal Governments staffs alone, we do not have other members. The national health insurance scheme needs enough funding as well as more enrolees. Once this is done, I am sure that the national health insurance will help advance in achieving the universal health coverage.

However, apart from these, we know that health is in the concurrent list; and we expect all the state governments to have their own individual health insurance scheme. For example, Lagos state is having one, Delta has come and by the time we have more of these states having their own health insurance, it will also help in achieving universal health coverage. There is also a need to deepen the health coverage of enrolees. We want to invite private facilitations in such a way that it is truly deregulated. Then it means that these private institutions can have their own enrolees that they can now take care of health of people where ever they are. If the Federal Government, state government and the private sector gets involved, it will help in achieving the universal health coverage.

On the recent approval of one percent consolidated revenue, it is one of the greatest things that happened in the health sector and it will help strengthen the system. Once the fund are allocated to the key bodies,  we now see that we have money, then the necessary equipment, machineries and drugs in the hospitals will be purchased and we can treat people and these will have a lot of benefit to Nigerians. So, I believe the one per cent is a welcome development, it is one of the best things that have happened to Nigeria in recent past.

Secondly, to deepen health insurance in Nigeria, the key problems of the sector is at the level of the primary healthcare centres where about 70 per cent of Nigerians lives and there is a need for the government to hasten up their plans for the centre. We know the primary healthcare centres as the first point of contact for health care, which is into a lot of prevention of many of the disease stage that will cause more complications at the secondary as well as the tertiary institution.

However, on the side of the budgetary allocation, it is sad that the percentage amount allocated to health in this year’s budget 2018 is abysmally low which is about 3.5 per cent whereas we expect that we have nothing less than 15per cent and once you do not have enough funding for health, you see a lot of buildings that are dilapidated, a lot of things that are totally in the state of disrepair. All these things are what the money is expected to take care of and if we do not have this machinery in place, we will not have the optimal management that is needed to take care of patients. For instance, the issue of care for cancer patients. It is difficult because today the government has no policy on the care of cancer patient. So we want the government to do everything possible to increase the amount budgeted for health in Nigeria.

What is your perspective on the doctor to patient ratio in Nigeria?

Well, we expected that we have a doctor to patient’s ratio of maybe 1-500,000 thousand but what we are having is abysmally low, maybe 1- 2million or 1- 2.5million and the doctor patient ratio is terrible.

However, most of the few doctors that are graduating are getting out of this country because we do not have placement of doctors and we do not have good working setting. We also have issues with our working place and it is really sad. Despite the fact that Nigeria is training medical profession to the barest minimum, many of our graduates are leaving to other developed countries. These fresh graduates leaving the country believe they will be better appreciated in other countries and better remunerated out there. So the doctor’s – patient’s ratio is terribly low and we have a lot to do in this regard.  This is one of the reasons why we have a lot of characters as in quacks within the medical profession and a lot of Nigerians are dying in the hands of these quacks.

The country need to find a way to regain the doctors, because the list of doctors that are leaving keeps increasing and are highly skilled. The government needs to create spaces so we can take care of our people and also needs to improve in health institutions so that it can take more specialists who can also train doctors.

What are the main challenges in getting more doctors to stay back in Nigeria?

The challenges are numerous, but we are more concern with the work environment, placement of employment as well as appreciation, even though the economy situation is terrible. One of the major things that start the frustration of these very young doctors is that immediately they finish medical school, they do not have placement to do house job.

Some of these doctors upward of six months, one year are still looking for house job placement and some close to two years. Many of them are unemployed or under employed and it is because we do not have spaces for house jobs.

Also, many of them are frustrated, they struggle to write examination to become specialists, the amount spent on exam is very expensive and the success rate is very poor and even if you pass, you may not have placement. All these things are things that are militating against doctors wanting to stay. Meanwhile, they go for class and for USLMA ,they pass the exams, they get placement and starts work almost immediately and this are some of the things making doctors to leave, we need  improve our work environment , we need to improve funding so that the doctors can remain in the country.

Most doctors will work for say five years before they can buy things that can make their life successful. We have many similar doctors who cannot afford to have vehicle or not to talk of paying a house rent at a good place and  they know that if they transit to other places, they will be better off within a very short period of time.

So the challenges of poor remuneration, work environment and the need to improve the spaces for activities so we can have more spaces to get our doctors and also improve the economy status of the country, all these things will comminute to make doctors to stay.

Finally, on the side of doctors, we need to do a lot orientation to let them see that the government has spent a huge amount on them to train as doctors and they need to give back to the society.

With public official constantly going aboard for medical care, is there hope that the situation will get better in Nigeria?

The country is paying lip service with health; it cannot get better once the sector is not well funded. The country is yet to agree with the Abuja declaration, which says that at least 15 per cent must be budgeted for health from the annual budget. It was just once in 2001 that Nigeria had gone beyond 5 per cent. These are some of the things militating against us being able to create a better health care system for Nigeria. Nigerian doctors are doing well, we have some Nigerian doctors who have some private clinics and they are doing very well.

In fulfilment to better Nigeria’s healthcare, all hands must continue to be on the deck.