By Owei Lakemfa
BILL Gates, the American with a trophy as one of the World’s richest men, came visiting Nigeria last week. He publicly visited the Presidential Villa twice; first to meet President Bola Ahmed Tinubu; the second, to meet Vice President Kashim Shettima Mustapha and our governors who came before him with begging bowls for health aid.
Despite Nigeria being one country, each governor had a separate health agenda and request, all expecting the former husband of Melinda French to grant their wishes. Although the Bill and Melinda Gates Foundation has a $50 billion endowment, out of which $7 billion has been earmarked for polio eradication, how do the governors and the federal government expect Gates to grant their separate requests, more so as Nigeria is just one of 196 countries in the world? If we must beg Gates for health handouts, why can’t it be consolidated, or should we also have lined up the 774 local government chairmen before him?
I reflected that it would have cost us a fortune to gather the governors and their entourage in Abuja given the fact that most would have flown down while those coming by road would have burnt fuel at N500 per litre. Such money, if spent on healthcare, would have helped.
A day before the meeting, Gates had indicted Nigerian political leaders for poor investment in the nation’s health sector. He said government spends only $10 (N6,900) per Nigerian on healthcare annually compared to $31 in sub-Saharan Africa. He admonished that: “Leaders need to make a much bigger financial commitment, focusing most on improving primary health systems. Making sure clinics are well-staffed and supplied, making sure children get the vaccines they need.”
What Gates was saying is that the primary challenge is not in begging for assistance, but what is Nigeria doing with the healthcare system? Part of the answer was given a day before the June 22, 2023 Gates-Nigerian Governors meeting when some 400 health practitioners met under the umbrella of the Nigeria Union of Allied Health Professionals (NUAHP). The theme, ‘Alarming Brain Drain in Nigeria’s Health Sector: Need for Emergency Rescue’, summarised the state of our healthcare.
Former Ondo State governor, Olusegun Rahman Mimiko, a medical doctor, had introduced a medical revolution ‘Abiye’ in the state; building and equipping emergency medical facilities within five weeks and striving for zero fatalities during childbirth. To achieve this, his administration had made a cost of taking care of a woman from conception to delivery and how to meet it.
In his analysis why governments are not making much of a headway in healthcare delivery, Mimiko said: “It is not the bricks and mortar that matter; it is the delivery. We spend so much on non-functional structures.”
He posited that no nation develops until it takes the health of its citizens serious and that life expectancy reflects the development of every country.
Mimiko, a two-term governor and former federal minister for Housing and Urban Development, argued that health is a major investment and any government that is not making serious investment in health is not serious.
In arguing that subsidising the healthcare of the citizenry should be a basic commitment of any government, he said the United States which is the father of capitalism takes healthcare so serious that the sector is the biggest employer while in Britain, the National Health Service (NHS) is a second religion. He said many never realise how poor they are until they are required to produce money for healthcare.
In making a case for the urgent equipment of health facilities and treatment of health practitioners as a special cadre, Mimiko warned that if the current rate of migration is not checked in the next five years, Nigerians may be at the mercy of traditional doctors.
On the professional harvesting of Nigerian health practitioners by foreign countries, Mimiko posited that there should be bilateral agreements such that if the United Kingdom (UK) wants 1,000 nurses from Nigeria, it should contribute to producing another 1,000 Nigerian nurses.
In agreeing with Mimiko, Comrade Festus Osifo, the president of the Trade Union Congress of Nigeria (TUC), said if health practitioners are not provided the conducive atmosphere, any bill brought to the National Assembly to stop them from migrating would be dead on arrival.
Dr Godswill Chikwendu Okara, the registrar, West African College of Medical Laboratory Science, in his forensic analysis submitted that health professionals are leaving the country in droves due to mass unemployment, poor salaries and work conditions, mass poverty, religious, communal and political crises. He said between April 1, 2022 and this March, over 3,300 Nigerian nurses and midwives trained in the country were licenced to practise in the UK, while by March 31, 2023, 10,639 of them were practising in UK alone.
Dr Okara’s solutions include a guaranteed peaceful environment, improved economy, access to competitive and fair-paying jobs, better cost of living, strategic talent management, proper funding of tertiary education and allocation of more resources to education generally.
NUAHP President, Dr Obinna Ogbona, said COVID-19 was the “most traumatic, challenging and calamitous period of monumental proportion (as it) claimed the lives of some health workers and infected several others who were carrying out their duties to save lives in various hospital facilities and isolation centres in the country”. He regretted that the brain drain is depriving the country of the best talents to provide healthcare needs.
Former Minister of State for Environment and current Emir of Nasarawa, Ibrahim Usman Jibril, said most strikes, including in the health sector, are due to the poor implementation of collective agreements, adding that in the first place, some agreements entered into by the government are not realistic. The health practitioners, he said, must develop team spirit to be able to serve the people.
Begging Gates or other donors will not fundamentally improve our health system; in any case, such funds can easily be frittered away. First, like Gates advocated, the system must be funded rather than have left over bones thrown at it. Secondly, we must return to the First Republic system of preventive medicine; the period we had active health inspectors fumigating gutters and checking the environment we lived. Back to those days when incinerators were provided in various areas rather than now when in most parts, refuse is not cleared.
The country also has to return to the building and promotion of the primary healthcare system as was under Professor Olikoye Ransome-Kuti when he was Health Minister. Our leaders also need to discourage medical tourism by developing a health system that would be good enough to treat them as was the case in the First Republic. These are some of the gates to adequate healthcare in Nigeria.