Public finance should not be spent on medical tourism— Pate

Dr. Muhammad Ali Pate is an ex-Minister of State for Health. He previously served as the Chief Executive of the National Primary Health Care Development Agency (NPHCDA). He recently spoke on various issues plaguing the country’s health care system. NKECHI ONYEDIKA-UGOEZE reports.

It has been said that Nigeria loses billions of dollars yearly to medical tourism. How do we reverse this trend?
Medical tourism is a global phenomenon, but in our case, it is one of those key areas we have not addressed, even though there has been some improvement in the private sector recently. What is wrong is using public finance to pay for an individual to get medical care abroad, when ordinary citizens cannot get good medical care in the country. Public finance should not be used on medical tourism, because it is inequitable. Every Nigerian life is the same. Rather, we should invest in medical services in the country, so that everybody has access to quality health services.

The health sector in the country has a public side. But do you know that most health facilities in the country are privately owned? There are more privately owned facilities than public ones. However, the private health sector has been highly fragmented. Players there have not been able to come together or get the resources to grow to the level of developed countries. When people go on medical tourism, they don’t go to government hospitals, but private ones.

So, the challenge is: How do we make our private health sector work, so that the money taken abroad gets invested here? That is the economy aspect. The last administration focused on providing an enabling environment for the private health sector. There was the first private sector summit held in Lagos, where we looked at the policy and regulatory constraints. After we left government, with some external partners, we identified an ecosystem that could be created. Unfortunately, that got stopped, but I understand the Federal Capital Territory (FCT) wants to revisit the matter. We need to create the environment for those that can do the job here.

How can primary healthcare be used to achieve Universal Health Coverage (UHC)?
Primary healthcare is the foundation for achieving universal access to healthcare; both the basic and even the most sophisticated ones. The building block for it includes not only the infrastructure in terms of availability, but also the people— human resources.

When we were in government, the Midwives Services Scheme (MSS), the community health workers, the village health workers and the communities were important elements. The primary healthcare system has to be people centred. It should be designed for the people, taking into account their needs and ensuring that they have a say in holding officials accountable at the front lines.

Also, we have to invest in Universal health coverage. Mere talking about it will not make it happen. Now, we have the basic health services fund. If the fund is released and properly used, it will make a lot of impact on Nigeria’s progress towards Universal health coverage, even though the fund needed is far more than what is available. It is also important to formalise the health insurance programme, such that a wider pull is brought to bear on financing health service. This will reduce the risk of families and individuals from catastrophic health expenditure, which is an avenue that will grow the private and even help the public sector. 

There should be health sector regulation and standard setting to ensure there is minimum standard that ought to be provided by practitioners and providers. We have to also attend to the quality of healthcare itself. That is another avenue to even grow the private sector, as well as help the public sector. Universal health coverage is not going to be achieved by expanded access, which alone cannot improve people’s health. Health issues affect almost everybody, and yet our political leaders have not paid needed attention to improving the sector. Other countries have done it and we also can do it.

As we tackle the UHC agenda and building the PHC, we also have to ensure that core capacities in the public health system are built, as well as promote research to better understand within our localities the pattern of diseases and do the needful in that regard. The Ebola outbreak in West Africa in 2014 was a sad, but important event we should learn from. During that period, about 10,000 people died. Nigeria was lucky to have in place the infrastructure that helped in curbing the danger posed by the epidemic. However, in other countries, we found that investment in public health preparedness, in terms of surveillance and capacity to respond was not there, and so they got overwhelmed.

Public health is not only a matter of health; it is also a matter of national security, because if an epidemic occurs, it can undermine the state’s ability to function properly. The Nigeria Centre for Disease control was lucky to have a good leader that enables the country to respond effectively during disease outbreak. However, we still need to build a more effective surveillance mechanism to contain any disease that may spring up in future. The established public health institutions are to build a generation of visionary leaders that will be innovative, generate evidence and also influence both policy and practice of public health.

What is your view on the resurgence of polio virus in Borno two years ago after all the efforts?
Ten years ago, Nigeria was almost a barrier in the global polio eradication. You remember there was a World Health Organisation (WHO) resolution that specifically condemned Nigeria, because at that time, almost 27 states had polio. Every week, there were cases of children paralysed by polio. We were the last in the continent and were exporting virus to other parts of the world.

The late President Umaru Musa Yar’Adua tackled it and a lot of efforts went into it. We played our role as the National Primary Health Care Development Agency then.President Goodluck Jonathan continued with the effort and he promised he would not hand-over polio to his successor. He fulfilled this promise, because the last Type 3 polio in the whole world was in November 2012. Since then, there has been no remaining Type 3 polio. The only remaining one was Type 1 Wild Polio Virus. Nigeria was able to interrupt the virus, although the security situation in Borno limited the ability of the programme and those who followed us to reach some children in security challenged areas. So, that led to some reversal, but was localised to some areas in Borno State.

So, from when we had 27 states to where we had just one state, I think Nigeria has made a remarkable turnaround and has broken the back of polio in the country, and by implication in Africa. Since the reversal two years ago, I know that this government has tried to build on what was done by the previous administration, in terms of continual improvement of surveillance and the quality of the programme, even though the security challenge in Borno has not allowed all children to be reached. However, in the last two years, no child has become paralysed by WPV.

I know that over time, an independent certification body will have to verify if this is true. And if it is, then one year from now, Nigeria stands the chance of being considered to have eradicated polio.It has been a tough slug, but we don’t have to judge the entire country by just one state that is not completely out of the woods.Closely connected to polio is the issue of routine immunization, which is important to guard against reversal in the future, if polio is completely eradicated.

In the last few years, Nigeria has been able to introduce new vaccines. If we raised immunisation to a certain level, children in Nigeria should not have widespread measles epidemic, because such diseases are vaccine preventable. I am hoping that the resources will be provided and government will continue to prioritise immunisation of Nigerian children from vaccine preventable diseases, because that is the most cost effective public health intervention. If we cannot immunise our children against simple diseases, then handling the highly complicated ones will be tough.