On teaching hospitals and partnerships
THE parlous state of Nigeria’s healthcare sector is easily measured by Nigerians’ lack of confidence in it as those with the wherewithal now prefer to travel overseas for medical treatment of even minor ailments. This is a tragedy that needs not befall a nation.
And that Nigeria loses a huge amount of money to countries like India, United States, United Kingdom and many others in the course of medical tourism is a shame that must end.
But while most of Nigerian hospitals’ non-viability can be contemplated or debated, the rot in the teaching hospitals of the nation’s universities cannot be excused. Indeed, the least expectation is that they would remain the centres of medical excellence where training, research and health-care delivery would be first class. Unfortunately, this is not the case. Over the years, lack of funds has made research impossible, training shoddy and medicare disastrous. Often, medical personnel abandon their patients as they embark on strikes over remuneration, making even the teaching hospitals nothing more than death chambers.
In a bid to make these teaching hospitals perform optimally again, the administration of former President Olusegun Obasanjo awarded contracts for resuscitating some of them. The government envisaged that such a development would transform selected teaching hospitals in different parts of the country into centres of medical excellence. But unfortunately, this project was thwarted by corruption and neglect. Where the funds were not diverted, the medical equipment bought has been abandoned to waste away.
Which is why in a bid to make these teaching hospitals perform optimally, a new regime of reforms, bordering on private sector participation in their management which is being proposed, deserves a dispassionate appraisal. Some of the teaching hospitals under consideration are the Lagos University Teaching Hospital (LUTH); the University of Nigeria Teaching Hospital (UNTH), Enugu; University College Hospital (UCH), Ibadan; and Ahmadu Bello University Teaching Hospital (ABUTH), Zaria in a proposed “National Policy on Incentivising Healthcare Investments,” drafted by the Federal Ministry of Health. The plan entails bringing in private investors to partner the government to improve the services of the teaching hospitals. The proposal, naturally, has elicited diverse reactions. While health workers under the aegis of the Joint Health Sector Unions (JOHESU) are opposed to what they consider a plan to “sell” the teaching hospitals, medical doctors are fully in support of the scheme.
Understandably, the divergence of opinion has been necessitated by the importance of the health sector to the citizens. Health is one of the essential services in the social sector that a good government should provide. This is why in most advanced countries, the health of the citizens is given top priority. For instance, in Britain, though more than 90 per cent of the population subscribed to the National Health Service (NHS), medical treatment to a certain level is offered free for the citizens. Also, in the United States, while most employers pay for their workers’ health insurance, the poor get free health insurance paid for by the government through Medicaid and there are other kinds of medical assistance to the elderly, veterans as well as federal and state employees.
There is the understandable apprehension that once the private sector is allowed to invest in the Nigerian teaching hospitals, profiteering would make it impossible for poor citizens to have access to affordable health care. Moreover, there is the fear that as in past privatisation schemes, only a handful of people would muster the financial resources to buy over the hospitals, thereby creating a situation in which the national family heirloom is ceded to a few privileged, even criminal, few. Thus for those opposed to the involvement of the private sector, the best approach the government should adopt is to make the hospitals work without the private sector’s intervention. They would want the government to inject more funds into them and provide the necessary facilities that would make medical personnel and other workers perform excellently.
But a major plank of the argument in support of the new proposal is that the private sector can be involved in the development and equipping of the hospitals without the government and the people losing the ownership of these health institutions. For one, the government would not relinquish all its ownership. More importantly, universities would still remain the effective regulatory body to oversee the activities of the reformed and, hopefully, better managed hospitals.
To avoid a few people buying over the teaching hospitals in the proposed reform, the government should create a partnership scheme in which the people of Nigeria and even the workers in the hospitals are co-owners. This it can do by encouraging them through unions, communities, local councils and states to invest in the hospitals. In other words, the government may have to introduce the concept of catchment areas in the course of seeking investments in the hospitals in which priority would be given to stakeholders in the areas where the hospitals are located. Indeed, the government’s proposal appropriately anticipates that investments in the health sector would be “through strategic partnerships across all levels of government (federal, state and local), the private sector, development partners, donor organisations as well as development finance institutions and other financial institutions.”
As a measure of its control over the hospitals and a way of making health-care accessible to the citizens, the government could even intervene in cases affecting a community or the whole country. To further enable the majority of Nigerians have access to these health services, the government should ensure that there is a viable health insurance scheme in the country. What exists today as a health insurance is not working as it is either too expensive, far beyond the reach of the majority of the people or the poor are not even aware of it. And for the citizens to be engaged in this health scheme, they must be gainfully employed.
Those who invest in the hospitals would ensure accountability by appointing their own directors or merit-based conditions and a sense of accountability and responsibility would cascade down from the directors to the health personnel like doctors and nurses and other categories of workers in the teaching hospitals.
If many years of poor performance of the teaching hospitals compel the government to bring in private capital to develop them, it is a worthy experiment, as long as the duty of government to the people in providing affordable tertiary health care is not lost sight of. Infusion of patient capital, broad-based in sourcing, and the enthronement of sound management may be a new effort. But it is one worth trying to save the teaching hospitals.