Oyetokunbo Ibidapo-Obe is a medical doctor, working as an Assistant Professor of Family Medicine at the University of Texas Medical Branch in Galveston, Texas. Her postgraduate training includes three years of family medicine residency and one year of surgical obstetrics fellowship. She is also a qualified telemedicine physician and expert. In this interview with ZEBULON AGOMUO, Editor, Ibidapo-Obe spoke on the challenges of the health sector and practitioners in Nigeria; the cause of brain drain; what must be done to improve the sector and retain medical practitioners; the benefits of telemedicine to every country, among other issues. Excerpts:
For years now, there seems to be utter neglect of the health sector by successive governments and administrations. Nothing much has happened except the lip service they pay to the sector. What is your opinion on the issue?
I do appreciate that there are lots of challenges facing the healthcare sector in Nigeria. In the same vein, I believe collaboration between the private sector and the government can find a solution to all of these problems. I think it is important to focus on the practical steps we can take to improve the system rather than push the blame back and forth. There are many aspects where we need to work together as a nation to make our nation greater. For example, one of the issues with the health sector is the lack of infrastructure. We have heard of patients having to buy diesel for the generator when they are to have surgeries in Federal teaching hospitals. I have seen patients having to run around to buy basic things like cotton wool, methylated spirit, and gloves. So, lack of infrastructure is a major thing. I think if we have a semi-overhaul of the entire system, it will be easy to set the healthcare sector on the right track. To be honest, some of the problems we are having are easy to fix. We just need to have our minds in the same place.
The primary, secondary and tertiary healthcare systems in Nigeria appear not to be functional in the real sense of the word. The various authorities that should be alive to their responsibility are not doing so. What could be done to get these systems to work well?
While many challenges affect the different levels of the healthcare system, I believe we can work together to proffer practical solutions. Prior to my leaving Nigeria, I do know that healthcare workers, particularly in the primary healthcare centres (PHCs) are working. Unfortunately, they can only work with what they have. This takes me back to setting up infrastructures that allow everyone to deliver safe and effective healthcare services. This goes back to the little things again. There has to be a partnership with all the stakeholders to be able to improve the system that we find ourselves in. These little things include having power, a backup generator, and running water. Some of these primary healthcare centres work with almost nothing and the fact that they can still provide healthcare services to their users is a testimony of how resilient Nigerians are.
The public-private participation (PPP) that has worked in other climes is not thriving here. What we see is a situation where facilities established under this arrangement are beyond the affordability of most Nigerians. Even the intervention of the Health Management Organisations (HMOs) is not working well here. From your experience in how these things work abroad, what prescriptions would you give in this regard?
Whilst private-public partnerships can be very effective in certain situations in other climes, I believe that it is very important to recognise that every context is unique. In Nigeria, we need to consider what the specific challenges are to develop practical solutions that work within our own context. One of the things that stands out to me in this situation is awareness and knowledge. Health Management Organisation (HMO) schemes came up and people were forced to use them. The big question is, Do they really understand the purpose? When there is a lack of knowledge, things don’t really become successful. At the time they chose to switch to the HMO scheme, it would have been best to make a lot of noise about it so people know how it works fully. For instance, in the US, my employer pays for my health insurance 100percent while I pay for my copay, which is the little amount of money that my family pays for healthcare services they access. The HMOs, in my own opinion, were introduced to help improve the healthcare system so more people can afford healthcare services. This in itself is a form of partnership. However, if people do not understand its workings, it is not going to work. People need to be aware of the facilities available and their rights as both employees. Also, there could be different tiers of HMOs to further decentralise access to healthcare services.
In the US, we have the Preferred Provider Options (PPOs) and the HMOs. The things you get on an HMO are basic while you have access to more healthcare services for those on the PPOs because you pay more. The differences are, however, majorly in the medication coverage. I, therefore, believe that creating awareness and having input from stakeholders across all levels of the healthcare ecosystem will help create an inclusive healthcare structure.
Health budgets over the years in Nigeria have failed to address the myriad of challenges in the sector even though there has been incremental improvement in the figures every other year. For instance, in 2021 it was N547bn; in 2022 it was N826.9bn; in 2023 it is now N1.17bn yet it fell below the African Union commitment in Abuja in 2007 that every member state must allocate at least 15percent. Now, what concern do you have for Nigeria in the next 10 years, judging by the sorry state of healthcare in the country?
What worries me the most is that there might be a total collapse of the system which will impact everybody. However, my main concern is about the common man who cannot raise funds to access healthcare services outside the shores of the country. If the system collapses and it is only the privately-owned hospitals that are functioning, people will be dying on the streets because they would not be able to afford it. So, the big question remains, What happens to the common man? Meanwhile, as broken down as the system appears, I am still optimistic that we can find practical solutions that work for this context. We can always work together to explore innovative financial models. There have to be investments in infrastructure and technology. We also need help from well-meaning Nigerians and the government to make healthcare more accessible for the majority of Nigerians. This is important because the ripple effects of a collapsed healthcare system will negatively impact both the rich and the poor in equal measure. If we begin to face the issue as everybody’s problem, then we are one step closer to the solution.
It is estimated that over 20,000 Nigerians travel abroad every year for medical care. This only does not engender capital flight, it also shows the trust deficit in facilities in the country; how may the Nigerian government begin to check this foreign exchange haemorrhage?
As I said earlier, we have to overhaul the system. I strongly believe that doing a systemic overhaul would be one of the first steps. If you ask the common man if he falls sick and he has money to go abroad, would he or she go? The answer is going to be yes, definitely. This is because the basic infrastructures are not working. Unfortunately, where it works, it is not trusted. On the contrary, I still believe today that Nigeria still has one of the most brilliant minds. Medical school education, under the kind of conditions that we learnt, requires you to be brilliant. I have seen medical education here in the US and in Nigeria. They have everything they need to be successful. They are seeing what the issues are. They also have access to the resources to learn it well. For instance, in Nigerian medical schools, you will be given scenarios of what to do when a patient has an issue and how to treat them. But the reality is that these tests are not available to Nigerian medical students as they do not even know what the machine looks like. The funny part is that Nigerian medical students will only rely on reading their textbooks extensively and they get to know it to the point where they are able to use the equipment confidently when they get to see it. This shows the kind of brilliant minds we have in Nigeria, but we do not have the infrastructure. We need to support our doctors to help care for us.
Another sore point is the brain drain being witnessed among health practitioners. This is occasioned by poor remuneration, poor working conditions and equipment. Where actually did we get it wrong or in your own reading where the rain begins to beat us?
Long ago while I was in secondary school, my dad, Late Prof. Oyewusi Ibidapo Obe, was the chairman of the first-ever brain drain committee in Nigeria which was set up by the Babangida regime. This shows that the issue of brain drain has been around for a very long time and I think it is a global phenomenon as it affects diverse sectors across countries, not just the health sector in Nigeria. While it might be challenging to compete with the salaries and benefits offered by other countries. I do believe that there are steps that can be taken to improve the working conditions, including the welfare of healthcare workers in Nigeria. I strongly believe that any healthcare worker – doctors, nurses, pharmacists, etc – did not go into that profession purely because of money. We all have some desire to alleviate pains, cure diseases, and generally do good for humanity. So, if we are able to structure our healthcare system by taking into consideration that medical practitioners are sacrificing their time and financial freedom to just take care of the people that need care, then I do not think there would be an exodus nationwide. As much as we want to cure people, we also need money to do it. If I have three hungry children at home or they are sent back home from school because I have not been able to pay their fees, I will not be happy to go to work and you would not be getting the best of me as a physician. That is why when you go to some of these public hospitals, you will see the doctors yelling at their patients at times due to frustration. Doctors work hard all the time to deliver the best healthcare services. You do not want to make any mistakes and you will also want to keep abreast with the advances going on in medicine. As such, I think worrying about finances should be low on a physician’s list of worries. This is why physicians in well-developed countries are well-paid. If you take away the financial stress from me, you will get the best from me because I know my salary is going to come at the end of the month and that covers everything I need. All of these issues can be resolved by striking mutually-beneficial partnerships with the concerned stakeholders and also by providing adequate training, equipment, and infrastructure. All of this will incentivise healthcare professionals to remain in Nigeria.
There are aspects of medicare that are not developed in Nigeria- telemedicine and others. How can these be developed and what benefits does Nigeria stand to gain by developing these?
Telemedicine has the potential to greatly impact and improve access to healthcare delivery in Nigeria, especially in rural areas. First of all, a physician who lives in the city will most likely not want to travel to the middle of nowhere to work. Every country in the world has some form of difficulty in getting healthcare access and delivery to rural areas. To develop this aspect of medical care, the government can work with medical companies and non-governmental organisations to establish the necessary infrastructure and technology. By doing so, healthcare providers can remotely access their patients.
I could be in Abuja and I would be able to connect with a patient in a remote location. It is important to note that there are things you cannot do via telemedicine in the case of an emergency. Telemedicine affords you the ability to contact the patient in order to guide them on the next things to do. To me, telemedicine is a plus for every country in all situations. It improves healthcare outcomes and also reduces healthcare costs. For a person who is not technology literate, a virtual messaging system or a text message service could be deployed to enable them to reach the services of a medical practitioner. With the advent of AI, chatbots could be developed to give people the basic healthcare-related information they need. This shows that there are endless possibilities.
There are major concerns about the influx of substandard drugs and food products which has led to various illnesses across the country. How do you think Nigeria could salvage this situation to reduce the influx of substandard food items, drugs, and cosmetic products?
To combat the importation and distribution of substandard products, I believe that the Nigerian government should focus on strengthening its regulatory agencies that are responsible for monitoring and ensuring quality standards are met. One of such agency is the National Agency for Food and Drug Administration and Control (NAFDAC) and I do know that they generally do a good job. I have had the opportunity to interact with them in the past. Again, people are sometimes limited by the availability of infrastructure to work to their capacity. Strengthening these agencies would be very helpful and this can be done by increasing the funding for these agencies as well as enhancing their outputs by providing them with capacity-building training. Additionally, public awareness campaigns should be applied to salvage this situation. This is because if you are trying to create awareness about a potential social crisis, you have to go out loud to create all the needed awareness. I also think there should be a deliberate effort to crack down on those producing, importing, and distributing harmful food and drug products. I believe we have the capacity as a nation to crack down on all of these people to get rid of this menace. We should start levying heavy fines on those engaging in this act. This will make it less attractive to people in order to improve the overall well-being of Nigerians. I would suggest we adopt criminal penalties for those involved in the sales and distribution of substandard medications.
You recently founded the Oyetokunbo Ibidap-Obe’s Medical Student Summit, what’s the rationale behind it and what do you hope to achieve with it?
The Oyetokunbo Ibidapo-Obe Medical Student Summit was born out of what I perceived as a need for guidance for Nigerian medical students. I attended the College of Medicine University of Lagos (CMUL) for my medical school and I had the privilege to come to the United States for further training. I have pretty much trained in Nigeria and in the US. Right now, I am an Assistant Professor, meaning I work in an academic setting. I train future doctors and young doctors as well.
When I compare the experience I had as a medical student in Nigeria to the experience medical students here have in the US, I realise that there are a lot of opportunities for improvement for medical students in Nigeria. One of which is creating awareness and helping them know that these are what they can do to position themselves ten years down the road. For example, when I have research papers, I pull in medical students. They do a lot of my research, fact-finding, and literature search. In the end, we get to successfully publish the paper and they have a publication in their name which also enhances their CVs.
Drawing from my experiences, I realised that the opportunity is there but the knowledge is not there because no one ever opened our eyes to it. My aim and a lot of my classmates in Nigeria was just to survive medical school but it is way more than that.
My annual summit is focused on creating awareness for both medical and dental students so they have access to the information they need in order to think ahead. Succinctly, my core aim is to help medical students strategize on how to position themselves for success both locally and internationally.
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