Nigeria’s government has continued to receive knocks for failing to maximise the opportunities presented by the coronavirus (Covid-19) pandemic to improve the country’s dilapidated health care system, with renewed concerns that the sector will remain in its different levels of rot, especially as the airspace has been reopened for politicians to resume their medical tourism.
It is estimated that Nigeria loses about $1billion to medical tourism yearly, which causes a huge burden on the nation’s fledgling economy. This is due to poor service delivery, poor funding, unavailability of human capital, poor infrastructure, absence of specialist services, among other flaws.
According to the World Health Organisation (WHO), Nigeria is currently ranked 187 out of 190 countries in the health index.
These concerns come at a time the Federal Government announced that it spent some N30,540,563,571.09 in last 4 months out of the N36.3 billion public funds and donations. The Accountant General of the Federation who disclosed the spending said the Presidential Task Force on Covid-19 spent N22 billion, 36 states spent N7 billion for the deployment of assets in support of Covid-19 operations and Nigerian Police spent N500 million on personal protective equipment.
The Coalition against Covid-19 (CACOVID), anchored by the Central Bank of Nigeria in conjunction with the private sector also donated over N30billion to government, as at June 2020.
Also, an official at the NCDC disclosed that the centre received the highest funding ever, to the tune of N5bn from government. Chikwe Ihekweazu, director-general of the centre had said that government will respond to the pandemic while also building a resilient health system.
Seven months into the pandemic, government at all levels have been tongue-lashed for doing nothing to improve the state of Primary, secondary and Tertiary levels of care in terms of infrastructure, human personnel, basic amenities, among others and the wave of the pandemic is already going down in the country.
The welfare of medical professionals, one of the factors fuelling medical brain drain has continued to be a struggle. On September 7, the Nigerian Association of Resident Doctors (NARD) again began a nationwide strike over Federal Government’s failure to honour demands including the implementation of residency funding, Covid-19 allowance, payment of hazard allowance and the outstanding salary shortfall of 2014, 2015, and 2016.
Osagie Ehanire, minister of health, who, during the pandemic frowned at the dilapidated state of Primary Health Care (PHC), facilities which he described at the crux of health care delivery, said government would remodel and rebrand the health care centres to ensure they carryout 24-hour operations.
But, not a single PHC was rehabilitated or remodelled on account of the Covid-19 pandemic, the PHCs were not even useful throughout the pandemic as a number of them were under lock and key as discovered by BusinessDay.
Experts say Nigerian authorities missed a critical opportunity to incorporate the pillar of every health care system- the primary health care centres.
“I am disappointed and angry, I felt Covid-19 provided the best opportunity for our leaders to finally fix our health care sector, because they were victims too, having been locked up and seeing the advantage of a good health system, but nothing was done, the situation seems hopeless”, Senator Iroegbu, publisher, Global Sentinel, cried.
“All government was doing was to convert buildings into isolation centres, what they were praying is for the pandemic to be over so that they can go, some of them were even smuggled out despite the lockdown. If our leaders don’t get it right now, when will they?” he queried.
Iroegbu also observed that government does not care about Nigerian health sector because they do not patronise it, including the Aso Clinic which receives funding to the tune of billions of naira.
The outbreak of the coronavirus (Covid-19) pandemic further exposed the huge deficit in quality healthcare facilities across the country. It also presented ample opportunity for Nigeria to close the gap by investing in the healthcare sector, and even collaborating where necessary, to upgrade existing facilities or install modern ones.
The sad reality is that N22.16 billion, which represents 72 percent of the huge sum, was expended on procurement of things needed for the fight, feeding of patients and treatment, instead of establishing local medical material manufacturing companies, or installing life-saving, ultramodern diagnostic machines and other needed facilities to save the country from losing money to medical tourism again.
Some people argue that some part of the money should have been used to establish at least a personal protective equipment (PPE) factory, ventilator assembly plant, grants to local pharmaceutical companies for clinical trials of possible vaccines for the virus, importation of ultramodern medical facilities for treatments, among others.
But none of these possibilities were considered by the Presidential Task Force on Covid-19 chaired by Boss Mustapha, secretary to the government of the Federation. The task force is taking glory in flattening the pandemic curve and improving recovery rate; feats, which many Nigerians ascribe to the weather condition and divine intervention.
Within the five months the Nigerian airports were shut down in a bid to contain the spread of Covid-19, Nigerians, who used to access health care in other countries, could not do so.
Travel agents and experts have observed that people looking for medical care for various ailments constitute a huge percentage of those who are travelling or those booking tickets to travel outside the country, one week after the airports re-opened.
Susan Akporiaye, president, of the National Association of Nigeria Travel Agencies, (NANTA), told BDSUNDAY that Nigerians are still travelling and that many Nigerians travel for medical reasons.
Akporiaye explained that because of the rise in Covid-19 cases in the United States and Canada, Nigerians are now going to Turkey and Dubia for their medicals.
“We have been having some of our clients book tickets to go to Dubia and Turkey for medical reasons. Medical tourism is quite cheap in Turkey,” she said.
Roland Aigbovo president, National Association of Resident Doctors, FCT, said the resumption of international flights will only result in further decay of the health care sector as government has not shown any seriousness in fixing its health care facilities.
According to him, the Nigerian authorities were only forced to make pledges on using lessons from the pandemic to fix the health sector, because there were no flights for them to seek alternative care.
“Now that international flight has opened, at any point in time, they will jet out of the country; let us just forget the idea that they will do something because they will not. Imagine something as minute as hazard allowance, which is the right of health care workers, doctors have to go on strike, what does that tell you?” he said with a lot of concern.
Aigbovo stressed that in the area of health infrastructure, workforce and welfare of personnel at all levels of care, government has done nothing and will do nothing.
“All they do is to churn information through the media claiming they have done this or that; they think Nigerians are fools. Pay a visit to hospitals; nothing has been done throughout the pandemic. As long as I am concerned, PHCs is non-existent, whatever they say is just wishy-washy!” he said.
Aigbovo recalled that president Muhammadu Buhari had during the early months of his first tenure, travelled to the UK, where he spent months seeking medical care, but regrets that four years down the line, the president is unable to replicate the state of care he enjoyed outside the country, in his own country, not even at the State House Clinic in the Aso Villa.
On August 8, 2020, Aisha Buhari, the First Lady, reportedly travelled to Dubai, using evacuation flight for medical attention over a pain she was experiencing in her neck.
Considering the huge sum expended so far on the fight against Covid-19, Ohaka Ajurue, a medical consultant at Federal Medical Centre, Abakiliki, Ebonyi State, noted that with the N31billion, Nigeria could have built at least five world class hospitals that are well-equipped to provide quality healthcare service and also stop medical tourism abroad.
“In India, where many Nigerians are now thronging for medical tourism, it takes less than $5 million to build a standard cancer hospital, but we have that money in private accounts, in bullion vans and in underground tanks, yet no one can fund a cancer hospital here. They prefer jetting out, and making mockery of our medical professionals here,” he lamented.
Ganiu Ojolanre, a medical equipment supplier, descried that while Nigeria has been romancing China in recent time, the country would have used that opportunity to partner China in establishing medical equipment manufacturing plants here, which could become hub for the West African region deliveries.
“We have money to establish companies that can manufacture some medical equipment and materials here, but we have failed to do so over the years because of corruption and lack of will power. Our billionaire philanthropists are not helping too, instead of building world class health facilities and donate to the people, they prefer to donate to political parties to safeguard their interests,” Ojolanre said.
He noted further that China and India, which have invested heavily in healthcare, medical business and equipment manufacturing, are among countries that are reaping from the fallout of Covid-19 today.
According to People’s Daily, an English publication in China, “China has exported medical supplies with total worth of 10.2 billion yuan since March 1, 2020 and these include test kits, masks, and ventilators”. The news publication went further to list quantities per product supplied as follows, 3.86 billion masks, 37.52 million protective suits, 2.41 million infrared thermometers, 16 000 ventilators, 2.84 million test kits, 8.41 million googles.
A significant part of the medical kits and material donations from the World Health Organisation (WHO) are supplied from China.
In the same vein, James Akanni, a medical laboratory technician and laboratory owner, decried that the Covid-19 fund was not well-spent, considering the number of quality laboratories a quarter of the money would have established across the country, which would improve diagnosis, treatment, save money and lives.
“It is very expensive to establish world class laboratories, especially procuring ultramodern diagnostic machines and maintain them. The likes of Clinx, Afriglobal, among others are huge private sector investments in healthcare. Government should have encouraged more private sector participation in quality healthcare delivery by giving them part of the Covid-19 fund as loan to establish more facilities. The money has finished now and we are back to square one,” Akanni decried.
But Martins Okopi, a public affairs analyst, insisted that Nigerians are not surprised the way the Covid-19 money was spent, describing it as another round of national cake for those who are closer to the corridors of power.
“Governors who are not working are now using Covid-19 as excuse, yet they were quick at collecting fund from the Federal Government to fight the pandemic, which they have shared already. We pray that there will not be a second wave of the pandemic because the Federal Government and private donors may not raise money again, the initial fund has been shared and not necessarily used for the fight against the pandemic. The feat achieved today in the fight is by God and not Covid-19 fund,” Okopi disclosed.
The angry Okopi also disclosed that N31billion would have started the foundation of a new city in Nigeria, built two good schools in 10 states, built 10 quality hospitals in 10 cities, and even a refinery to curb the huge foreign exchange expended on importation of fuel by selfish business people.
Covid-19 curve flattening, yet deadly diseases abound
While Nigeria and her agencies channeled all energies toward the fight against Covid-19, little thought was spared on diseases and infirmities that had for years claimed many lives in the country.
Tanko Sununu, chairman of the House of Representatives Committee on Health Services, recently noted that it was estimated that Nigeria loses about one billion dollars annually on medical tourism as almost 500 Nigerians go abroad monthly to seek medical intervention.
He noted that even before Covid-19, many of Nigeria’s key health interventions- on polio eradication, vaccination programmes, malaria, tuberculosis, HIV/AIDS, and maternal and child health- remained almost entirely dependent on foreign donors, with the government committing less than $10 per citizen to health under its current budget.
Sununu, a laparoscopic surgeon, wondered what Nigeria would do now since the donor countries may not be in the position to dole out money, as according to him, “every country faces its own Covid-19 nightmare.”
Likelihood of more brain drain
With the way Nigeria treated health workers during the pandemic; there is the likelihood of the country recording more brain drain this time around.
Doyin Odubanjo, public health expert, former chairman, Association of Public Health Physicians of Nigeria, Lagos State chapter, said that as international flights resume, Nigeria will get an increase in medical tourism, adding that in the last two weeks, close aides to the presidents were jetted out of the country despite the airport’s being closed.
Odubanjo explained that the elite and the political class have definitely lost interest in using the nation’s healthcare system, and the lockdown was just an inconvenience.
He said now that the borders are opened, they will definitely embark on their trips as soon as possible but not only will they embark on their trips, heath personnel will also leave the country as soon as possible because many countries in the world now have become more desperate for healthcare workers .
“Nigeria has shown the stalled health care delivery even in the midst of a pandemic. So much more than before, we will have an exodus of healthcare workers and the exodus of people on medical tourism.
“The Nigerian government has not really shown any serious commitment in making the health sector better unlike some other countries has shown despite the Covid-19 .We try to copy a few things at the surface level.
“The government has not paid proper attention for health workers’ welfare and remuneration which are all things that shouldn’t be adjusted for the Covid-19 period but it calls for attention to address these challenges permanently so that the entire situation of migrations will be brought to an end rather.
“However we did not do it and we are seeing the Nigeria Medical Association (NMA) going on strike in all states of this country in the last five months. It has only shown us that we have not learnt any lessons and our healthcare system is not going to get better but rather because worse,” Odubanjo explained.
Innocent Ujah, president, Nigeria Medical Association (NMA), told BDSUNDAY that the opening of the border will not stop or reduce medical tourism in Nigeria, people can travel to any country to have their treatment but the only issue is that government monies should not be spent.
“Travel for treatment is a right of an individual but the cost should not be borne by the government. Except of course, it is necessary and that will come where there is a medical board that evaluates the need when the services are not available in this country, this happens in other places.
“Some people move from America to India because they feel that the cost of treatment is cheaper. I think that the people have the right to move to wherever they want to move.
“There will be an increase in medical tourism; that is the mobility of international travel. I think that there’s nothing wrong with that. We are all concerned about the use of government funding for what is avoidable, and that can be treated in Nigeria,” Ujah said.
The Nigerian Guild of Medical Directors also shared similar concerns that the rot in the Nigerian health care system will remain as government failed to use the opportunity of the pandemic to overhaul the sector.
The president of the Guild, Olufemi Emmanuel Babalola lamented that no fundamental change was brought to bear during the heat of the pandemic; rather what was seen was a fire brigade approach in tackling the pandemic.
Babalola said even the achievement touted by government in terms of revamping diagnostic and laboratory capacity falls below what other countries in Africa have been able to achieve.
“The guild of medical directors is not optimistic that things will change, things will return to business as usual for political elite, because they are not concerned about the welfare of the people. Even during the pandemic, some of them were travelling to seek medical care, despite the official travel ban.
Barth Ufoegbunam, Anchor, WAP TV Health Matta (TV Health Talk Show) also noted that what government achieved during the pandemic was hardly enough and just a drop in the ocean for a population of over 200 million Nigerians.
“Unfortunately, the rave has died down, the energy has also died down at all levels of government,” Ufoegbunam said.
He however, noted that during the pandemic, government started from the scratch in building capacity to respond to the pandemic, such as ramping up test laboratories from five to over 70 across the country. He also said, some of the equipment will stay for many years to come.
To this end, Ufoegbunam stressed that it was important for government to find a way to sustain the achievement it was forced to make.
Olujimi Oyetomi, director, Public Relations, Ministry of Health, however, argued that the Federal Government is engaging with state governments to ensure that the lessons from the pandemic do not go to waste.
Oyetomi claimed that government has already begun addressing the infrastructure at the Tertiary level of Care across the country by increasing bed spaces, number of medical consultants and has increased the special hazard allowance for health care workers.
He added that at the secondary level, government is making a conscious effort to ensure that each LGA has a general hospital, while talks are ongoing with state governments to remodel and revamp PHCs.
Olayinka Oladimeji, an official at the National Primary Health Care Development Agency (NPHCDA), also said plans were underway to upgrade primary health care centres, but added that lack of resources in the face of dwindling government revenue is a challenge
In the same vein, Chinwe Ochu, head of Prevention Programmes and Knowledge Management Department at NCDC, said the centre has seen progress in the aspect of investment for health security in the last six months.
This, she said, has enabled the centre scale-up national diagnostic infrastructure, strengthen supply chain, improve the use of technology for data collection and strengthen the implementation of Infection, Prevention and Control measures among healthcare workers and in health facilities.
“We have also seen increased mobilisation of the private sector with big private sector conglomerates organising themselves as CACOVID (Coalition Against COVID-19) to support Nigerian government’s response efforts,” she said.
“We recognise the need to build long-term capacity, not only for NCDC as Nigeria’s National Public Health Institution (NPHI), but also for other agencies with similar responsibilities in the prevention, detection and control of infectious disease outbreaks.
“We are still not where we want to be, but we will keep pushing to utilise the lessons learnt during this crisis to build back better for the future”, Ochu added.
A lesson for Nigeria
The NMA president explained that Covid-19 pandemic should be a lesson for not just Nigeria, but for all countries of the world, because Covid-19 helped expose the weak health system in Nigeria.
He suggested that a lesson that Nigeria can learn from the pandemic is to be able to document the weaknesses and then plan how it can intervene to improve the healthcare quality and provide facilities and training capacity development for health workers, doctors.
“If we were able to sit down, document facts, share experiences, and learn lessons, then I believe that the government should be able to intervene and plan to improve the facilities, the deplorable facilities in many of these hospitals.
“Before Covid-19 pandemic, we had three or four PCRs in this country but today, I think we’re getting close to 60 and that is a national response to the pandemic.
“So that even if the pandemic is flattened and begin to decrease, these equipment will continue to be used by Nigerians not just for Covid-19 but for other infectious diseases, such as testing of the Human papilloma virus for cancer of the cervix and some other tests that have been done.
So it will not be a waste and we believe that that has brought a positive effect in terms of the availability of the PCR machines,” Ujah noted.
