Mobolaji Oladoyin Odubanjo, executive secretary, Nigerian Academy of Science, Lagos, Nigeria, has held this post since July 2011. A peadiatrist, by training, Odubanjo is also the chairman, Association of Public Health Physicians, APHPN, Lagos Chapter.
In this interview with Olu Ojewale, general editor, Realnews magazine, Odubanjo paints a vivid picture of what the Nigerian health facilities have become and why Nigerians prefer to go abroad for simple surgeries that can be carried out in the country.
Realnews: What do you think of the state of health facilities in Nigeria?
Odubanjo: I think the signs are there for everybody to see that it is not good at all. Anybody saying otherwise just wants to deny the obvious. Number one, are we happy with what we have to go through to access health services? Are we happy about what we find there? I can say virtually everyone I know of complains about the kind of health service they are getting. So, that’s one sign. A more object are the signs of the mortality and morbidity that we have; those statistics that give us the picture of how many under-five children die per year; How many pregnant women die from pregnancy related-death annually; our life expectancy. All of those indices say a lot about our health system particularly those first two. They help to define what our health system is like or what stage it is in. Those two don’t speak well of Nigeria at all.
Realnews: Is the problem about the institution or lack of funds to run the system?
Odubanjo: I don’t think it is funding issue. I think it is a management issue, which is how you use what you have. What you have may be not much, but how do you manage the little you have. A good example of that is Cuba. Cuba is renowned for its health system, yet Cuba is under economic sanctions from different parts of the world. It is a poor country, it is a country that has been cut off for many years, but still managed to produce a health system that works, which has kept the people alive and well. So, it is not necessarily a funding thing. Of course, funds are needed for a lot of things generally speaking, but first and foremost it is how you manage what you have.
Realnews: Which particular areas of health delivery are badly affected in this country?
Odubanjo: All of them. When you talk about the health system, which consists of infrastructure, human resource, equipment, drugs and so on, you talk about the whole areas. But the very first and key one that I always point out to management is human resource. Because if I have some money today taken away from the health system and I say I am going to start a factory, where we are going to be producing milk and I have N1billion to set up the factory. But if I don’t have the right staff or if the staff are not well trained, that project will collapse. I may have bought the best equipment from the best company in the world, but that company will still not do well if I don’t have the right people there. So, the very core of any system, to my mind, is human resource. Your human resource must be good. The workers must be motivated, have good remuneration and all of that. They must be given the right equipment to work with, given the right environment to work and then you will get good result.
Realnews: I read in the newspapers that the nation is short of nurses. How bad is the situation and what is responsible?
Odubanjo: We have shortage of virtually all health personnel. We don’t have enough personnel in the health service; that is the truth of the matter. We act, sadly, like a country that has more than enough, but we don’t have enough. We train them (health personnel) and treat them with levity. If we all sit down and look at what we have and what is recommended, we are far from it. Whether it is doctor, radiographer, nurse, name it we are far from it. In a situation where you don’t even have enough, you should keep what you have. But because we treat our health personnel shabbily we lose them to other nations. So, we have become a factory that manufactures professionals and they go elsewhere to work; not to only the United States or Britain, they also go to African countries like Ghana. We don’t have enough, yet we are losing the few that we manage to produce to other countries, which means that our shortage will never be overcome at the rate we are going. We even hope that the entire system doesn’t collapse on this account because we are grossly at disadvantage because we don’t have enough personnel.
We are here in Lagos, saying we don’t have enough. But with the available statistics, Lagos, has about 90 percent of the doctors in Nigeria. If you move out of Lagos, and move inward, especially to the North, you will discover that in a given state they don’t have more than 20 doctors. (Editor’s note: Nigeria has 36 states apart from the federal capital territory). That’s why some states, especially northern states, go out to employ doctors from outside the country. We don’t have enough doctors, we don’t have enough nurses, we don’t have enough other supporting staff as well.
Realnews: How do we solve this problem?
Odubanjo: It has to be multifariously pronged. It is like this: if I have a bucket of water and my bucket is leaking. I need to plug the leaking bucket so that I don’t lose the one that I already have because if I open a tap on it I will still not get a full bucket of water. My first step is to plug the leaking area before pouring water in. Plugging the leak will mean that we have to keep what we have. We have to find out, why they leave for other counties; we have to solve the problem of leakage. We need to talk about the remuneration; talk about the environment, welfare and all these. Can we pay more and make them comfortable?
During the time of Ebola threat, the government was ready to pay N50,000 to health workers. They had to beg people to come and work and promised to pay N50,000 a day but none of them was ever offered N50,000 a day before. The truth is that the hazard they were exposed to are the hazards they are exposed to every day. At the time the Ebola came they didn’t know that it was Ebola and some of them died of it. It is that same exposure that health workers are exposed to all the time. So, when you put all together, at the time Ebola came the government was willing to pay every health worker as much as N1 million a month. But now if a doctor asks for a million per month nobody will listen to him. In fact, what a doctor gets paid in the state hospital is about N150,000 a month and N200,000 in a federal government hospital.
Besides, we have not sat down to take stock how many doctors we have to the population and how many we need to produce to meet minimum international requirements. How many medical and nursing schools do we have? What is their capacity? How many can they produce annually and how many years will it take us to close the gap? We don’t have such plan ahead of time and we need to. If we review what we have and the study says it would take us 30 years to bridge the gap, we can say it is too long. I am saying this hypothetically. So, what we need to do, therefore, is to set up more nursing schools with production capacity of producing at least 5,000 graduate nurses per year or so. So, we can close that gap within five to 10 years or thereabout.
So, we must sit down and plan to work on our production line to and produce what we need.
Realnews: Have we overcome Ebola in this country?
Odubanjo: We have been declared Ebola free.
Realnews: I know. But is the danger no longer there that it can still happen?
Odubanjo: The danger is only there because it is still in Sierra-Leone. The country is about to be declared Ebola free. You know, Ebola did not originate from here, it started from Guinea; it got into Sierra Leone, it got to Liberia, it got to Senegal, it got to Mali, it got to the US, it got to Spain and so on. So, as long as there is still a source of Ebola, we are not safe. Until we all deal with that source, destroy it and make sure there is no more Ebola there, we are not safe here in Nigeria. But if we are able to destroy the source, only then we can all relax.
Realnews: Is there any other disease in this country that requires the kind of mobilisation we saw during the time of Ebola?
Odubanjo: Actually, we have a lot of them. It is just sad that we are not paying attention to them. In fact, Ebola has cousins like lassa fever, like dengue fever. Those are just two ailments that kill like Ebola and they are in this country. In fact, when I used to speak to people on Ebola I told them then that Ebola came to Nigeria with a diplomatic passport, but it has cousins that have Nigerian passports. They are citizens and they live here. But we are not paying attention to them. Lassa fever has a special centre because it is a ‘native of Nigeria.’ It is named after Lassa which is a place in Nigeria because that is where it was first discovered, and it kills just like Ebola. It particularly kills health workers because if you bring in a person suffering from the disease to the hospital you have to take extra precaution. That’s how some people, including health workers, get it and die. But it looks like we don’t have value for life in Nigeria that’s why we don’t think about it.
Of course, all the time we have cholera outbreak and meningitis outbreak all the time. Ebola had a reputation that made everybody to jump up. When we heard that it had killed thousands of people and in some cases it had shut down the economy, that’s why we started to take it serious. So, the moment they said Ebola in Nigeria we all said we were in trouble because of that reputation. Not that because people don’t die of epidemics in Nigeria; they do.
Realnews: What about malaria? Is it no longer a major killer in Nigeria?
Odubanjo: Oh yes, it is. But our own is to preach prevention instead of cure. That is why we encourage people to keep the environment clean and use mosquito net and so on. In medicine, prevention is cheaper than cure. Because by the time you fall sick, you will be asked to do some tests before drugs are prescribed all these cost money. By the time you know may have spent more than N3,000 in treating malaria.
Realnews: A lot of Nigerians go abroad for health services probably because they cannot get the kind of experts needed to handle their cases. What is your take?
Odubanjo: Actually in terms of expertise, I would say that is not our problem at all. We have very good health workers. They are largely incapacitated because of the environment in which they function. So, very often if you find people want to go abroad, it is not necessarily because nobody can handle their case here. Maybe someone who can handle the case is across the street, but he doesn’t have the equipment, he doesn’t have the drugs, he doesn’t have the support staff to be able to do it as well as the man who is outside the country. That is why a lot of people go abroad. I know someone who has a health issue that requires surgery and said he would not do it in this country. He said: ‘I have to go to a place that I know that there will be no power outage.’ I also know someone who has a leg fracture. There are so many competent hands that can take care of her, but she doesn’t want to do it here. Well, most members of her family are abroad anyway. Besides, she said she would need somebody to fetch water to take care of her in hospital here, she would need people around her to send on errand, to bring her food. If we have adequate infrastructure, drugs and equipment and all of that, you would be shocked by the kind of health services you would see in this country. We can handle almost every kind of health challenges here in Nigeria.
Realnews: Do you know how much Nigerians spend annually on health abroad?
Odubanjo: Hmmm… actually I was reading somewhere where somebody was saying N30 billion or $30 million. But when you look at that being taken out of the country annually the money helps to oil another economy instead of Nigeria.
Realnews: How much do you think should our budget should be for the year to put the situation right?
Odubanjo: This is a tough question. I don’t think the minister of health will be able to answer the question. There are many things to look at and I don’t think we have the required statistics to help us solve the problems yet. Like I talked about human resource, we don’t know how much will be required to pay every category of workers of health service from primary, secondary and tertiary levels. There are different levels to go through before you can achieve the required standards. Then, you talk of basic equipment and infrastructure.
Realnews: If you are asked to draw up an agenda for the new administration, what would be your recommendations?
Odubanjo: Human resources should be the first priority. To stop the leakage in our health service, we have to look at the kind of remuneration and welfare package that are being offered and make them more competitive than they are now.
Secondly, we have to look at the orientation and programme. Over the time we have some people with bad attitude; that has been killing the system. If we don’t have the right attitude we will not have a good system, so we have to look at this area and retrain our health workers.
Now you have to come down to reorganising the system. By this I mean the situation whereby everybody has to go to general hospital or teaching hospital for small ailment should be discouraged. For instance, if I have simple malaria I should be able to walk to the primary health sector near my house and have it taken care of. I shouldn’t go and sit down in the general hospital and overload the work there because of treating malaria. That’s ridiculous. But it would happen if our health care centres are allowed to be habited by chicken and goats without any proper equipment, cotton wools, drugs and others to provide service to the public. After a while nobody goes there anymore. So, we have to equip our health centres and provide trained health workers to encourage people to use them.
We need to re-organise our referral system. And be able to refer patients to appropriate referral hospitals whether to general hospital or the teaching hospital.
In the case of emergencies, the system should work in such a way to use ambulances to transfer patients immediately to either general hospitals or teaching hospitals.
Then our budgeting, we should have sensible rationale approach to it. Sometimes when there is a budget, the National Assembly can say strike out this one or that one thereby hurting the health care delivery. This should not be allowed to happen anymore.
*This interview is in collaboration with Ouestaf News and with support from Osiwa
• Official statistics show that Nigeria has one doctor to every 6,400 patients whereas WHO recommends one doctor to every 600 patients.
• Since the inception of the Medical and Dental Council of Nigeria, MDCN, there have been 65, 000 registered medical doctors in the country, but currently about 25, 000 medical doctors are practicing in the country.
• Nigerian medical schools produce between 2,500 and 4,000 graduates every year.
• To meet the WHO benchmark, Nigeria needs to have 283,333 doctors, to cater for its population of about 170 million. This means that the country needs 283,308 additional doctors at present.
— Jul 6, 2015 @ 01:00 GMT