Enabulele: Nigeria loses $1b annually to medical tourism

Dr Osahon Enabulele, a former president, Nigerian Medical Association (NMA) and now Vice President, Commonwealth Medical Association (CMA), spoke to ALEMMA-OZIORUVA ALIU in Benin City on Nigeria’s distressed healthcare.

What can be done for Nigeria to have a well-planed health system?
I think the first point is that we need to have health conscious leaders, who understand the place of health in development and the nexus between health, economic prosperity and development. They must also be committed to massive investment in the health of the people. That is the first point. Nigerians need to appreciate that unless and until you have people who are health conscious, who understand the importance of investing massively in local health care, our health care delivery will not improve. So, the first thing is to see how we can truly elect people who understand the place of health in development and who understand the need to upgrade the standard of healthcare in our country, to even use it as a source of revenue generation because health is one big player in terms of generating resources for any country.

Today, India like we all know because of the upgrade in their health care system, especially in primary healthcare sector, is receiving more than 50 per cent of the world medical tourism. This is because they understand the place of health in generating resources. So, Nigerians first need to have that level of appreciation that even in electing our leaders, we must concretely be sure that we are electing people who believe in our health, believing that health is wealth and that health is one area that can drive economic prosperity for the country and even development.

What can the National Health Act do?
The National Health Act is one Act that was deemed necessary for our country to address a lot of the problems challenging Nigeria’s health system. First is the issue of standardising our healthcare services. The National Health Act clearly is an opportunity for us to see how we can regulate, standardise and upgrade the quality of health care in our country, through the prescription of certificate of standard for people who are to practice or set up health facilities or even bring in health technologies. They will be given certificates of standard to ensure that they meet up with the minimum quality requirement and standards.

The Act is an opportunity to invest massively in the health sector. Section 11, which has been most celebrated, talks about providing one per cent of the Consolidated Revenue Fund of the country as a basic healthcare provision fund to finance largely the primary health care in terms of facilities, because over 70 per cent of our problems are at the primary healthcare level. Right now, the primary healthcare system is virtually dead. So, the first point in building a robust national health system, is to build that level of healthcare closest to the people, while also hoping that through some level of commitment and technical support by the Federal Government, state health facilities can be upgraded, and the Federal Government takes care of its tertiary health institutions. If you don’t have standard health facilities at the lowest level, you are just going to be wasting your time because the healthcare system can never be strong, because all those at the primary level will be gravitating towards the secondary and tertiary health facilities, over-burdening them, and so the issue of sustenance of those facilities becomes questionable.

I think that is something that Nigerians must begin to clamour for. We did not fight for the National health Act just because we wanted to have a piece of legislation, but it was for the reason of ensuring that we create investment in the health sector to provide for pregnant women, children under five, the elderly, who for reasons based on natural events do not have that much access to healthcare. So, in the absence of social security in our country, the best way to go is to see how we can provide some resources to make provisions for these people to access healthcare. The Act talks about research, it is an Act that is meant to direct the focus of government in driving a robust health care system, but we are two years down the line. The Act came into existence on October 31st 2014, but government has not played its part largely in terms of implementing its own obligations as provided for in Section 11, which fortunately is now attracting the attention of the legislators. So, we hope that the legislators will do the needful to upscale the budgetary provisions for the health sector.

Another issue is how government allocates resources to healthcare and monitors those that manage resources that are channelled into the healthcare system. Over the years, we have been clamouring an up-scaling of the budgetary provision for health and one of the reasons why some of us were interested in some promises made before the emergence of President Muhammadu Buhari, was the commitment to a provision of 15 per cent of the national budget for health. That was part of their manifesto and everybody applauded because since 2001 at a summit of African leaders held in Abuja, there was a resolve by all of them that a minimum of 15 per cent of the national budget will be provided for health. But in the last five years, the average Nigeria has been able to provide is around 5.64 per cent and even in this 2017 budget, we are talking about something less than five per cent was proposed. Until we have political commitment to the health sector, Nigeria will continue to struggle with a fractured, a flagging and an unsustainable healthcare system. Some persons including me were not very happy last year when Mr President, in spite of the prescription in the National Health Act still went abroad for health services. We thought that was a slap on the Act as provided for in Section 46, which says that no public office holder in Nigeria will be allowed to go outside the country to procure health services unless it has been deemed necessary through a medical board approved by the Minister of Health. So, revitalising the health sector is going to take a lot of harnessing of a multiplicity of factors to be able to ensure that we start on a journey of sustained improvement in our healthcare sector. The universal healthcare coverage of Nigeria is hovering over only five per cent.

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