The National President, Association of General and Private Medical Practitioners of Nigeria (AGPMPN), Dr. Iyke Odo, who is also the owner of Meridian Hospital in Port Harcourt, Rivers State, in this interview with Mike Odiegwu, reflects on the challenges of healthcare delivery in Nigeria and their solutions. Odo, whose association is marking 100 years of existence says the government has yet to play its expected role in repositioning the sector.
WHAT are the roles of private medical practitioners in the country’s healthcare?
The role of private medical practitioners in any health economy is to partner, to collaborate, to support and to augment the efforts of government to provide adequate, effective, functional, accessible, qualitative and affordable healthcare delivery system to the country; so that every citizen or resident has access as at when due.
What is your impression about healthcare delivery in Nigeria?
The system is sub-optimal. It is not performing effectively. It is not adequate or comprehensive in its performance and to a very large extent, the system is weak, unable to meet the needs of the average Nigerian; and it is compromised and struggling. We can do far better.
Most people also blame doctors, who work in public hospitals but own private hospitals for the rot. Does your association allow such doctors as members?
It is not about my association. It is about the law. It is about the provisions of the law and the demands of the regulatory body. In the country like anywhere else, we have two categories of healthcare workers. The public healthcare workers are the employees of the government and they don’t own hospitals; and then you have the private sector doctors who are private hospital owners. However, there is this group in the middle you can call the amphibious doctors. They are partly private and partly public.
Nobody works in government hospitals and goes there to sleep for 24 hours. Every doctor has a schedule. After your schedule, you are at liberty what to do with your time. That is why some of them work genuinely and legitimately for government and also do what we call part time in private hospitals. It is allowed. It is legal and it is legitimate. But the law is also careful to say that if you are a government employee, you should also not at the same time own your hospital. You can own your hospital by proxy.
It is wrong and unethical, improper and unprofessional for you to take undue advantage of your position in a public hospital to exploit and undermine the system. If your patient walks up to you in a public hospital, you should understand that the patient saw private hospital before coming to the public place. So, for you to refer him to the private hospital is wrong and unethical and the law and our association frown at it.
What is the relationship between private doctors in Nigeria and the government?
The relationship is not very progressive. It is not very supportive and it is not very rewarding. The government in other climes provides a very conducive economic, social and political environment for private hospitals like other economic investors to survive. The government takes very deliberate and special interest in supporting and encouraging private medical and health sector participation because of the significance, relevance and exclusivity of healthcare to life. In developed climes, healthcare is taken as special and government invests very heavily in it. The government provides basic and simple loans, reduced taxation, import duty waivers and reduced utility tariff. The efforts are aimed at reducing the cost at which healthcare facilities provide their services.
But that is not the case in our country. The very ugly and very pathetic experience of the Nigerian private doctor is that the government appears to have looked away and sees us like any other investor. But it is not exactly so. Healthcare is categorised as social service. We are social workers because sometimes we get paid and sometimes we are not paid. So, the government comes in to buffer, to augment, to assist and take part of this shock from the system by the efforts they make to subsidise, give waivers and grants. Currently, the private health is struggling to save to buy all needed equipment and materials. That is why the system is weak and unable to meet international and global competitiveness.
How functional is the health insurance in Nigeria?
Our health insurance experience can only be described as a distraction. It is an apology and a story in reversed gear. After more than 16 years of introducing it, Nigerians are still suffering because more than 90 per cent still do not have a health insurance cover. And those that have it are not enjoying the full benefit because it is about a different unique healthcare financing system that makes people no longer pay for their medical treatment out of pocket. People are meant to pay in advance minimal, basic regular frequent contribution called premium into a consolidated account whether they are sick or not.
But less than 10 per cent of Nigerians are contributing, and so the money being contributed is very little to sustain the system. And that is why many are outside that net. Those inside the net appear trapped because they are not getting the best that they should have. But for a country like Nigeria, great and mighty, we should have no reason why our health system should not work except for the old reason of lack of good leadership, lack of transparency, lack of coordination and lack of unity because if health insurance works, it is the game changer. It is the solution, the cure and the gateway and the greatest opportunity to promote quality, affordable and equitable healthcare where everybody is happy.
What are the major challenges of private medical practitioners in the country?
I run a private facility. Eighty percent of the time, my hospital is powered by generators. Over 40 per cent of our earnings goes into power supply. We spend over N4million every month on power. It is a major headache. The cost of fund is too high. Normally because we are a social welfare industry, we are supposed to be given a rebate, concession, subsidy, waivers. If as a hospital, I need a bank loan, I should get the lowest interest rate. But in Nigeria, there is no difference.
We are clamouring that the government should establish a health bank like we have the Bank of Industry, be dedicated to developing the health sector. Government business is not business. The business of government is taxation and before the government can embark on taxation, it has to provide the enabling environment for businessmen to do their business. We have come to a point where we feel that government sees us as competitors. They are suspicious of their private sector players rather than treat them as collaborators and partners.
The truth is that the private sector of Nigeria is the highest employer of labour, the highest owner of infrastructures. In medical, we are the highest providers of healthcare in Nigeria. We provide over 70 per cent of the healthcare services to Nigeria by extension over 70 per cent of employees in the health sector are in the private sector. So, the government ought to encourage us.
We also have security challenges. Hospitals today are raided by people. In the hospital, our business is about birth and death. So, when people die in a hospital, it shouldn’t be seen as unusual. It should be perceived as unusual if somebody dies in a mosque, a church and supermarket and not in a hospital. So, if somebody dies in a hospital, they should not descend on the doctors, the hospital and the workers. The question should be, ‘did they do their work well?’ If you are not satisfied, there are processes and procedures in the system through which you can obtain your justice.
How bad is the brain drain in the medical sector?
Medical brain drain is the next cancer that is going to run down this country. Nigerian doctors, optometric and radiographers; everybody is leaving. In my own facility alone, last year, seven nurses left my facility for London; five radiographers left my facility last year. This year alone, two radiographers have left, three doctors have left and four nurses have left. Three are about to leave. They are all moving into Europe. Those, who have not left are at various degrees of preparing their documents. The media must do more to raise the awareness on this. It is far more than people know. A time will come when there will be no nurses to employ in this country and no doctors to do the job. Already we are saying that if you keep all the doctors we have in Nigeria, the population you will have is not up to 30 percent of what we need; and yet more than half have left, reducing our capacity. Why are they leaving? We have a catalogue of problems. One is poor remuneration. The Nigerian doctor is about the poorest paid in Africa.
The conditions of living are uncomfortable. We are not secured. People want to live anywhere else outside this country to save their heads. Most hospitals don’t have the infrastructures. Technology has taken over the industry and the equipment is very expensive, especially at the current exchange rate. Many hospitals are folding up. Nigerians are in for a raw time. Government should stop politicising issues of the doctors condition of service. Anywhere in the world, the doctor is the highest paid individual. They are most respected and the most protected. Brain drain is real and a time bomb waiting to explode if nothing is done.
Is there any hope for the Nigerian health system?
There is always hope. But we need to understand how such hope can be converted to reality. Hope is fantasy but it can be translated to reality by looking inwards. The number one component is to stand the health system on the shoulder of the private sector. The future of the Nigerian healthcare system is the private sector of Nigeria. Only the private sector can deliver the system as they have done in America, in UK and India. The government should provide affordable loan, good taxation system, healthy environment, power supply and infrastructures. Nigerian doctors are the best anywhere you find them. We are waiting for that day when the government will call the private doctors and ask them, ‘what shall we do to make Nigeria, the global medical tourism destination? If government calls for such partnership transparently and is willing to advance it, it will not take two years Nigerian doctor abroad will all begin to buy their ticket to return back home.
Your association is 100 years. What does it mean to you and all the private doctors in the country?
It means a lot. I feel excited as a person and as president that my association is celebrating its centenary. It is the same way my colleagues feel. It is remarkable and a landmark. It is historic and a great milestone. We know that 100 years is not a common experience and looking inwards, we have asked ourselves, ‘At 100 years, what have we been able to achieve for our country?’ We have decided that our celebration will not go unnoticed. We have chosen to reflect within this session the healthcare delivery system of Nigeria. Remember that my association is everywhere in this country and we take care of everybody; and because we are everywhere, we understand more than any other group the challenges of the healthcare sector. Nigerians are not living well. Nigerians are living a stressed and compromised life. We are also aware that maternal and child health in Nigeria is very poor. So, as part of our activities, we have decided to engage the private sector in dialogue on health so that the private sector, which is the highest provider of health and the highest consumer of healthcare can come together from all the various discipline on the 12th of August at the International Conference Centre, Abuja, to have dialogue from which we will produce a blueprint to support the government’s efforts as to how best our healthcare delivery system can be run. We want to also launch a N10bn-intervention fund in health to support maternal and child care believing that over the next five years, we will save one million mothers and their children. The agenda is ‘Save One Million Nigerians Initiative’. We have also discovered that one of the reasons health insurance is not working is that most Nigerians are ignorant of what it is. We have accepted to take up the challenge of communicating to Nigerians starting from our consulting rooms to tell them what health insurance is.
