22view­point Buhari and the ques­tion of med­i­cal tourism

The Punch - - MY NEWS.COM - Ni­ran Ade­dokun

WHile pon­der­ing over head­lines high­light­ing the Pres­i­dent, Ma­jor Gen­eral Muham­madu Buhari (redt.)’s com­ment on Nige­ri­ans spend­ing so much to at­tend hos­pi­tals abroad, i ar­rived at two con­clu­sions of which one is likely.

The first is that the Min­is­ter of Sci­ence and Tech­nol­ogy, Dr Og­bon­naya Onu, who rep­re­sented Buhari at thealex ek­wueme Fed­eral Univer­sity Teach­ing Hos­pi­tal, Abaka­liki event, may just have been so­lil­o­quis­ing.

He may have nursed the thought and wished to speak to his prin­ci­pal about the same for a while. But given the level of syco­phancy that at­tends au­thor­ity and the dire con­se­quences of dar­ing to speak to power in Nige­ria (most fright­en­ing of which is los­ing the pub­lic of­fice that may have be­come a life­line to the of­fice holder and a horde of peo­ple around him), the idea of moot­ing the dis­cour­age­ment of med­i­cal tourism to the Pres­i­dent would have been per­ished. That is as soon as Onu or any other pub­lic of­fi­cer con­tem­plat­ing such is re­minded that no other pub­lic of­fi­cial had ex­ploited this in­dul­gence as Buhari.

This is so be­cause, he, it was, who spent three months out of the coun­try for med­i­cal rea­sons that the cit­i­zenry has yet un­clear about. He, it is who jets out on trips said to be short hol­i­days or pri­vate vis­its to the United King­dom, where every­one knows his doc­tors might be. it is his wife, Aisha, who re­cently stayed back in the UK for med­i­cal rea­sons af­ter her an­nual hol­i­day. This fam­ily sure takes a lion’s share of the coun­try’s bur­den on this front, but this is a ter­rain where you see or speak no evil.

So, even if any gov­ern­ment of­fi­cial had some brain­wave about the dam­age that med­i­cal tourism does to Nige­ria, men­tion­ing it to the Pres­i­dent is com­pa­ra­ble to de­lib­er­ately throw­ing one­self into a lion’s den. But pub­lic events present per­fect cov­ers that may even not be no­ticed by the Pres­i­dent, es­pe­cially as Onu stands in no ad­min­is­tra­tive po­si­tion to pur­sue what is clearly a no­ble in­tent.

The other pos­si­bil­ity is that Buhari truly thinks that med­i­cal tourism should end in Nige­ria. He, how­ever, may not re­alise that he has got more work to­wards achiev­ing this than any other Nige­rian. lead­ers some­times imag­ine that speak­ing about their vi­sions is enough in­cen­tive for be­havioural change, but trans­for­ma­tional lead­er­ship is more about the ju­di­cious use of op­por­tu­ni­ties to show pos­i­tive ac­tions and ex­am­ples.

That is not to say that Buhari or Onu, (whomever of the two owns the idea), is wrong in this as­pi­ra­tion. it in­deed is the way to go for a coun­try com­mit­ted to the di­ver­si­fi­ca­tion of its econ­omy and sav­ing up for­eign ex­change. in 2016, then Min­is­ter of State for Health, Dr Osagie ehanire, told us that the coun­try spent over $1bn an­nu­ally on treat­ment abroad. Such money, if spent here, could do a lot for the econ­omy.

How­ever, chang­ing this can­not be through mere pon­tif­i­ca­tion by gov­ern­ment of­fi­cials. In fact, the state­ment cred­ited to the Pres­i­dent at Abaka­liki truly says noth­ing. Hear it: “Nige­ri­ans have suf­fered so much go­ing abroad for med­i­cal treat­ment. This is not good for us and it must stop be­cause we can’t af­ford it again…”

So, which Nige­ri­ans have suf­fered? True, we want to stop it, but how? And then, the lamest part of the state­ment is the: “We can’t af­ford it again.” One is forced to ask, who are those that can­not af­ford it? is it the coun­try, which is un­able to take care of its peo­ple? even more up­set­ting is the fact that we re­duce all of this to fi­nan­cial costs rather than the ef­fect of the fail­ure of the health sec­tor on the lives of millions of Nige­ri­ans. To make med­i­cal tourism a topic of dis­cus­sion is it­self an at­tempt to fur­ther alien­ate the bulk of Nige­ri­ans who can­not even in their dreams, con­tem­plate trav­el­ling abroad for any form of med­i­cals.

Just last week, news­pa­per re­ports quoted Pres­i­dent of the Nige­rian Med­i­cal As­so­ci­a­tion, Dr Fran­cis Faduy­ile, as rais­ing the alarm on the fright­en­ing state of health care de­liv­ery in the coun­try. Speak­ing at the 10th sym­po­sium of the Health Writ­ers As­so­ci­a­tion of Nige­ria, Faduy­ile said there were only 42, 000 doc­tors avail­able to treat the coun­try’s es­ti­mated 200 mil­lion peo­ple. Al­though the NMA ac­tu­ally has 77,000 reg­is­tered mem­bers, 33,000 of the num­ber have left the coun­try to prac­tise abroad. To bring the chal­lenge closer home, the NMA Pres­i­dent in­formed that the ra­tio of doc­tors in the ru­ral ar­eas is 1:22,000 peo­ple, while it is 1:10,000 or 1:12,000 peo­ple in towns and cities. When you jux­ta­pose that with the bal­anced ra­tio of 1:600 which the World Health Or­gan­i­sa­tion pre­scribed, you re­alise that Nige­ria has more prob­lems on its hands than ten­ta­tive lamen­ta­tions of Onu.

This is one other thing Faduy­ile said: The United King­dom em­ploys an av­er­age of 12 Nige­rian doc­tors ev­ery week. if Nige­ria de­cides to grad­u­ate 3,000 doc­tors ev­ery year, it will take us 25 years to meet up with the WHO es­ti­mate of one doc­tor to 600 per­sons!” Now, that is if all the 3,000 new doc­tors choose to stay back in the coun­try, a pos­si­bil­ity that does not to ex­ist.

The point here is while it is okay to aim at re­duc­ing the vol­ume of trips that Nige­ri­ans make abroad for med­i­cal rea­sons, a more crit­i­cal fac­tor should be the well-be­ing of the ma­jor­ity of the peo­ple of the coun­try. Of course, peo­ple can ar­gue that tack­ling the first, (which would def­i­nitely mean an im­prove­ment in the at­ten­tion given to the health sec­tor) could en­sure bet­ter ac­cess for the pop­u­lace, but that would be pre­sum­ing too much. The truth is that rais­ing the stan­dard of health care de­liv­ery is not the same as im­prov­ing ac­cess. if at­ten­tion is fo­cused on stop­ping med­i­cal tourism, a ma­jor­ity of Nige­ri­ans will def­i­nitely be un­able to af­ford those ser­vices.

Gov­ern­ment there­fore needs to take a holis­tic look at the health sec­tor. This must start with train­ing, em­ploy­ment and re­ten­tion of doc­tors and other health work­ers. Then, there is the ques­tion of fund­ing of pub­lic health in­sti­tu­tions. At the mo­ment, there is noth­ing in­di­cat­ing that gov­ern­ment un­der­stands that Nige­ria’s health in­dices are some of the most un­speak­able in the world. This is the sense one gets from the sum of N427.3bn al­lo­cated to the sec­tor in the 2020 bud­get. That is in a coun­try with the per­son­nel sit­u­a­tion de­scribed ear­lier. A coun­try where ma­ter­nal mor­tal­ity is put at 814/100,000 live births; where neona­tal mor­tal­ity is put at 34/1,000; where 300,000 peo­ple are said to die of malaria an­nu­ally and 102 out of 1,000 chil­dren do not live to see their fifth birth­days!

So, gov­ern­ment needs to do more than pub­lic lamen­ta­tions. A De­cem­ber 2019 NOI poll in­di­cates that only nine per cent of Nige­ri­ans are cov­ered by one form of health in­sur­ance or an­other yet solv­ing Nige­ria’s health ac­cess chal­lenge de­pends greatly on this strat­egy. One re­alises that the load of Nige­ria’s health prob­lem should not be on the Fed­eral Gov­ern­ment only, but with Nige­ria’s mis­guided fed­er­al­ism, the onus to mo­bilise the na­tion into uni­ver­sal ac­tion on the rests on the Pres­i­dent, who needs ur­gent re­jig of his own per­spec­tive.

• Twit­ter: @ni­ranade­dokun

and as­sem­bled for ac­cred­i­ta­tion with the state’s elec­tric­ity Distri­bu­tion Com­pany tak­ing the blame for the black­out. The sci­ence pro­gramme in this state univer­sity scored 85%! The ques­tion i asked my­self was: “Why did the ac­cred­i­ta­tion team not re­quest a gen­er­a­tor to check one or two of the equip­ment”?

The sug­gested scrap­ping of Post-utme tests in uni­ver­si­ties by the Min­is­ter of ed­u­ca­tion is very un­for­tu­nate as this will only en­cour­age the in­take of mis­fits and in­do­lent stu­dents who did not write the Jam­bor­gan­ised Uni­fied Ter­tiary Ma­tric­u­la­tion Ex­am­i­na­tion by them­selves. This does not how­ever pre­vent a univer­sity from con­duct­ing an oral ex­am­i­na­tion at no cost to the can­di­date in or­der to se­lect the right stu­dents for ad­mis­sion.

• In­fra­struc­ture and learn­ing re­sources:

Again, a univer­sity that is well-funded must have all the in­fra­struc­ture needed in place as well as the ap­pro­pri­ate fa­cil­i­ties for learn­ing and re­search. The ma­jor prob­lems in our uni­ver­si­ties are the is­sues of bot­tle­necks and bu­reau­cratic hur­dles that must be dealt with in or­der to get rea­son­able amount of money from the Gov­ern­ment. As the Dean of Sci­ence, Univer­sity of ibadan, be­tween 2007 and 2009, i was very ex­cited when the Fed­eral Gov­ern­ment ap­proved an ex­tended list of re­search fa­cil­i­ties from my of­fice un­der the Needs As­sess­ment and Tet­fund. As of the day of writ­ing this piece, Jan­uary 3, 2020, over 90% of the ap­proved re­search fa­cil­i­ties have yet to be de­liv­ered! The truth is that the Fed­eral Gov­ern­ment is re­ally not in­ter­ested in the pro­vi­sion of in­fra­struc­ture and learn­ing fa­cil­i­ties in the uni­ver­si­ties she has es­tab­lished. The con­tin­ued es­tab­lish­ment of new fed­eral uni­ver­si­ties in the coun­try is a clear mock­ery of ed­u­ca­tion and an at­tempt to score cheap po­lit­i­cal point at the ex­pense of the na­tion. Nige­ri­ans are very in­tel­li­gent peo­ple and must not be taken for granted by any gov­ern­ment of the day.

• Gov­er­nance and ad­min­is­tra­tion

The Gov­ern­ing Coun­cil of a univer­sity must com­prise highly ed­u­cated and ex­pe­ri­enced men and women who have a strong bur­den on the ed­u­ca­tion of their youths and con­se­quently, on the tech­no­log­i­cal eman­ci­pa­tion of this na­tion. They must not only be creative and in­no­va­tive but must have ex­cel­lent rap­port with the man­age­ment of the univer­sity in or­der to en­sure her rapid growth and de­vel­op­ment un­der their watch. Mem­bers of the Gov­ern­ing Coun­cil must also be united, coura­geous and as­sid­u­ous in the ex­e­cu­tion of their aca­demic and ad­min­is­tra­tive re­spon­si­bil­i­ties.

On the other hand, the man­age­ment team must be in­no­va­tive, re­spon­sive and have solid strate­gic plans to en­sure the up­lift of the univer­sity both in the qual­ity of the teach­ers and avail­abil­ity of teach­ing and re­search fa­cil­i­ties. The gov­ern­ment, wealthy Nige­ri­ans, phi­lan­thropists and in­dus­tries should pro­vide fi­nan­cial sup­port as an in­cen­tive to the uni­ver­si­ties.

To be con­cluded

• Prof. Odi­aka, FAS, is a for­mer Dean of Sci­ence, Univer­sity of Ibadan (2007-2009) and cur­rently Head, Depart­ment of Chem­istry, Univer­sity of Ibadan (2017-2021)

nade­[email protected]

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