Healthcare system in the eye of the storm

The world woke up a few months ago to the news of an uncommon virus epidemic in Wuhan, China. Like most such epidemics around the world in time, it was initially not a major news item and not a matter to worry about. That growing epidemic was later to be executively dismissed as “Chinese Virus” and ignored.

Now everything has changed. What began as a little fire at some corner has in no time engulfed the world. The world is running from what it cannot see and drifting to where it is not assured of any measure of safety. As it were, no one is safe and no nation is free. For once, the world is faced with an enemy that is fighting every nation at the same time and none seems to understand it and none seems to be prepared. It is an invisible enemy that has disappointed the strongest healthcare systems and humbled the most powerful nations of the world.

Suddenly, the president of America realises that for once, he might not be the strongest element in the world. A virus is, even if for one month, has locked down nations and kept the world standing still. Yes, today, we have a vicious pandemic that defies regular definition. The world has been locked down into one massive prison in which every nation is engulfed in its own struggle for survival and several have been overwhelmed. In this global war, no nation seems courageous enough to claim strength or advantage and each is watching as its neighbor crumbles. So much battle is being done and despite the progressively worsening data of both new infections and daily mortalities, there is ample sign that the world may not have seen the worst yet.

Response to and management of the COVID-19 pandemic has suddenly become the world’s undocumented tool for measuring the level of preparedness and capacity of the healthcare systems of nations in this time. It has revealed some as dynamic, strategic, systematic, sensitive and adequately responsive. On the other hand, it has exposed others as undefined, unstructured, arbitrary, reactive and weak.

As a nation, we may have been grandstanding; we may have been telling ourselves lies; we may have been engaged in systematic self-deceit and the state of our healthcare system may have passed unnoticed at certain quarters over the years. It may also have been routine and normal and commonplace for our leaders and other privileged Nigerians to readily jet out of the country at will for medical treatment for the slightest indications and so, never bothered to develop our healthcare system. If nothing else has changed, the hide and seek debate about the dilapidated and exceedingly weak healthcare system of Nigeria has been put to rest. Our healthcare system is down and in need of resuscitation.

We are now caught up in the web of our self-created network of misplaced priorities in setting national goals. With the lockdown, the embargo on international flights and closure of the borders, citizens have been confined to their countries and are being compelled to look inwards. Some are seeing what they have never seen and realizing what they never knew about their healthcare systems. To many, including Nigeria, the findings are baffling. They are shocking and now we wish that it never happened.

For the first time in decades, Nigerians, big and small are constrained to seek medical treatment at home. Our healthcare system has been rediscovered. It has been shown to be a huge caricature of reality. We have been seen to be generally weak in ordinary times and specifically, unprepared and incapable of the appropriate response to the demands of a daredevil pandemic such as Covid-19 if aggressively challenged by it as has been seen in some parts of the world. Desperate efforts are now being made on the spur of the moment to try to bridge the gap preparatory to positioning for the fight against this pandemic that has shown itself to be faster in spreading and bringing down its victims than the most advanced systems have been able to contain. Now, we realize that the years of the locusts are many and the damage is done, colossal. Today is still early to begin. Indeed, today becomes the earliest time after the past, as no other time can be better than now. We must however not allow ourselves to make the same mistakes of yesterday and expect a different result.

That well over 40% of Nigerian doctors and other healthcare workers have deserted the country into the diaspora for greener pastures and many more are on the verge of leaving is no longer news. That Nigeria spends an average of one billion dollar (approximately N370 billion) annually on medical treatment abroad has lived with us for many years and this figure has progressively risen as our healthcare system has strayed on the path of increasing deterioration. The situation in our healthcare system is a red alert. It is a national emergency demanding urgent intervention. It may have taken an unusual circumstance such as the lockdown syndrome of the coronavirus pandemic to unravel this cold fact but it matters more to Nigerian healthcare workers and Nigerians in general that this hard reality has been not only publicly exposed but admitted into the upper room of our national conversation. The old colloquial definition has shifted from; health is wealth, to health is life. Life loses value without health. Life is worth what health offers it. We can buy all other things but not life, for the value of life is worth more than money can buy.

This is the guiding principle of successful nations whose realization of and commitment to this eternal truth endears them to decisions and actions that place a maximum premium on the lives of their citizens. No nation of the world develops or becomes developed without first developing its healthcare system. A healthcare system is developed when it is functional, affordable, qualitative, accessible and equitable. None also has succeeded in building its desired healthcare system without primarily encouraging and developing its private health sector. Finally, no nation has and can achieve this without a healthcare system that is driven by a functional health insurance scheme strategically conceived and implemented to guarantee Universal Health Coverage. A good health system holds government accountable for the health of every citizen and holds every citizen responsible for his own health by building and sustaining appropriate health-seeking behaviour that is supportive and responsive to a friendly and inclusive healthcare financing system. Such a health system has very high value for the life of the people and unmistaken respect and gratitude for healthcare workers.
 
In the face of the pandemic, the cost of personal protective equipment in the country has risen by more than 500% and gone beyond the reach of the average doctor or healthcare provider. Face masks and disposable gloves have been taken over by the general public and clinics and hospitals lack these basic needs at this time. Many thanks however to the magnanimity of benevolent individuals and organizations both local and international who have graciously donated and continue to donate huge cash and materials towards the support for the fight against the pandemic. A judicious and equitable distribution of these relief and support items to all concerned will restore not just hope but trust in the system as well as motivate all stakeholders to the desired action. Events and the seasons of the times shape the world.

Today, the world over, preventing and protecting the people from the scourge of COVID-19 infection is dominating every conversation and every policy directive of governments. The world now, therefore, has one season cutting across all nations in the same time denominator and it is the season of healthcare. The top item on the agenda of governments and managers and leaders everywhere is healthcare. By the law of competitive advantage, we are in a big market of divergent specialities and specializations but convergent in a network of integrations. During the season of sports, sports experts take charge. The legality of man and society is the preoccupation of the lawyers. The Imams drive the mosques and the affairs of the Vatican lie in the hands of the Pope. Professionalism settles the doubts about the boundaries of life.
 
In this season of health and wellness, it is the season for healthcare professionals to take charge. Nobody understands the terrain as they do. No one has their experience and nobody else does the job that they do. In this season, the rest of the country should look up to them partnering and collaborating with technocrats and administrators to direct the war on the COVID-19 pandemic as it affects Nigerians and Nigeria. I have no grouse about the present composition of the Presidential Taskforce on the pandemic. Each person there represents a Nigerian community and has a positive role immediate or remote to play to aid their work. But I have all the problems with the absence from that body, the representation of the organized leadership of the healthcare professionals, the frontline soldiers who understand firsthand the anatomy and physiology of disease patterns and their remedy. It surprises me as it does well-meaning Nigerians. The Nigerian Medical Association (NMA), the umbrella association of doctors in Nigeria is not on that taskforce. If we agree and preach it, and it is indeed true that the private health sector accounts for over 70% of the healthcare needs of Nigerians, it presupposes that 70% of the experience and competence resides in them. Amongst the doctors, the Association of General and Private Medical Practitioners of Nigeria (AGPMPN), the oldest medical association and the largest private medical association in Nigeria represents this group of doctors. The leadership of this body ought to be part of that body to yield its wealth of experience to the planning and execution of the management strategies necessary to combat the enemy.
To be continued tomorrow
Dr Iyke Odo wrote from Port Harcourt