Many government-owned hospitals and care centres are either in dilapidated state or poorly equipped. This, has pushed Nigerians to seek medical intervention abroad, thus spending so much on medical tourism, while maternal and infant mortality ratio remains high. Rasheed Abassi, medical director of Heritage Men’s Clinic, speaks to Anthonia Obokoh on why the new administration should focus on healthcare delivery and capping interest rates for a healthy competition in the nation’s health sector. Excerpts:
During economic crunch, social services like healthcare also suffer neglect; what can or should be done to mitigate this?
Neglect is the key word from your question; during economic crunch, it is important to prioritize social services like healthcare. The economic crunch is not unique to Africa or to Nigeria for that matter. Great countries go through economic downturns. The key is not a reaction, but taking proactive measures.
For instance, in the United States of America, no matter how bad the economic downturn is, the government has made Defense and its Budget a priority. Hence nothing happens to the budget. No cut and no misappropriation. So, what we need in our country is value- added priority. When you value something and you prioritise it, then you protect it and you are proactive about keeping it sustained.
The government should prioritise the Healthcare sector by displaying value added actions, Budgetary allocations should not be just for this administration, it should be enshrined in our legislative agenda that each year, certain percentage of our budget should go towards Healthcare, and these allocations should be dynamic and not static.
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There should also be allocation for Technology upgrades, population shifts and utilisation preferences based on Data acquired via Medical Intelligence. This administration has the unique advantage of laying the foundation for what a robust Healthcare industry should be like moving forward.
We need a new direction. Data from Medical Intelligence can, and should guide us. Other countries show what they priotitise by what the budgetary allocation is: NATO countries allocate 2.8 percent of each member nation GDP to defense; Nigeria needs something similar or in the frame work for the Healthcare industry. The sooner the better, Nigeria currently spends an excess of $2bn on Medical Tourism. That is simply not sustainable.
What would it take for our PHCs to run 24 hours uninterrupted services like it is the case in advanced economies?
We currently have about 30,000 Primary health Centres across the country. And by my last check, only 20 percent are functional and operational. So, we have 24,000 health centres not working. We need to evaluate this and find out what exactly is the root cause of such. We cannot be thinking of 24 hours when the facility is not even operational. But if your bigger concern is how can we get to the point of providing 24-hour access Healthcare to our fellow citizens, then: Healthcare Delivery is something that should be well thought-out, not only for the present generation but also for the future.
This is why I advocated for the appointment of a good Administrator and not just a Medical Doctor. I am glad the President has appointed an excellent Physician with the added benefit of great administrative skills. Healthcare delivery cannot and should not be left to the government alone. We need private and free market enterprise to join and be invited.
The government using its leverage should make a priority, the healthcare industry investment-friendly.
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With Nigerians spending in excess of $2bn on medical tourism, No Nigerian buys Dollars to go abroad for Primary care. Almost all the $2bn is spent on specialised care: kidney disease, cancer care, cardiac care, orthopedic care, Spine and Neuro care. So, why can’t the government step in and provide tax incentives to the private sector to encourage investment into specialised care.
The government can and should use its legislative powers to offer tax right-offs and tax-breaks to Nigerians willing to invest in specialised care.
Our Banks are currently asking private investors to come and take loans with interest rates in the high 27 percent range, and yet we offer tax exempt status to Churches and Mosques Who are we kidding? It’s all about priorities.
Looking at the new scenario of a new government, what should be the focus of the Minister of Health?
We have a non-existent health delivery system, with over 30,000 primary healthcare centres, only 20 percent being functional all over the nation. That is supposed to be one of the bedrocks of the government. The healthcare system is predicated on primary, secondary, and tertiary healthcare. Unfortunately, the federal government is only focusing on the tertiary sector. They are looking at the teaching hospitals, but they need to do more than that.
Our medical education is non-existent. Nigerian doctors who established Saudi Arabia never came back. They established the Saudi Arabian healthcare system and created a vacuum here. We are not producing qualified Doctors. Brain drain has heightened. Our medical schools don’t produce good professors anymore. This is an opportunity for the new government. And one of the things they can do is start afresh and brings in private-sector players. We need investment-friendly initiatives, like good interest rates, for establishing health sector facilities.
For instance, my clinic is trying to expand; I have a 15-member clinic. The banks are ready to lend us some, but they are asking for a 27 percent interest rate. That is not sustainable.
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If the Federal government thinks healthcare is a priority, they need to show us in terms of budgetary allocation for health. I think they have done well because they chose a good administrator. If the Federal government can invite businessmen in the health sector, by capping the interest rate and making us tax-exempt for a few years. The largest employer is the medical system, so we can employ more people. The taxpayers will foot the bill.
I advocate for medical intelligence because, as of today, we don’t know how many doctors we have, or how many doctors have relocated. We don’t have enough healthcare facilities for our people. If we invest in medical intelligence, it’ll be data-driven. Our preparedness for the next outbreak depends on the amount and quality of medical intelligence.
You’ve touched on salient points. Which is the most crucial of them, and which will start the chain reaction in the health sector. The accessibility and production of healthcare facilities. Nigeria exports $2.5n annually in medical tourism, and none of the dollars goes to primary healthcare. We need to make this environment greener for specialists. When you cap interest rates, you bring specialists and primary care doctors home. Nigeria will be able to compete in the free market system with investments in data. Data is the new gold, and medical intelligence will open up Nigeria’s Healthcare sector.
The Nigerian health sector is bedeviled by a lot of ills. How do we navigate the stark reality of these times?
With Covid- 19, we dodged a big bullet. But the reality on the ground is we are really far behind when it comes to healthcare, infrastructure development and even the other variables. There has been mass exodus of Nigerian doctors. Even the United States of America doesn’t have enough doctors, not to talk of Nigeria where our population actually exceeds the ratio of Nigerian doctors to patients it’s overwhelming. I think the government needs to provide a business-friendly environment private investment to augment what the government is doing or not doing. Once private investment comes in, the free market will help healthcare industry develop rapidly. Nigerian doctors living abroad are willing to come home and invest here, but the interest rates of Nigerian banks are ridiculous. The government needs to set up targeted healthcare funds and cap interest rates so the sector can grow.
Are people even aware of Nigeria’s health insurance policy?
It’s non-existent. If we have medical intelligence, we will know who is privately insured, and how many need to be on government insurance. We don’t have the data, and so that’s why people are at the mercy of non-existent HMOs.
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What is your assessment of our current framework of health insurance policy?
In the United States, it’s a hybrid situation where employment-based insurances provide employed staff of private companies with insurances. If you are in a low socio-economic level, the government comes in with what is called Medicaid. There is Medicaid and Medicare.
Medicare you get as a result of your length of years of working whether private or as a civil servant. Medicaid as the world implies a government is caring for you for whatever reasons. You find yourself in that trench; disability, medical condition. All dialysis patients in the United States are paid for by the government. Whether you can afford it or not, it’s under Medicaid. We need a hybrid system in Nigeria, because the government alone cannot fund it.
