Beyond the headship of hospitals
By Femi Bankole
I READ the article by Mr. Afolabi Ebi entitled " Headship of hospitals: The issues at stake" (The Guardian, September 29), with great interest and I must agree with him that healthcare and the system that provides it is too important to be left to the 'practitioners' alone, indeed the 'recipients' must also be involved. I agree also that the rot in our healthcare is too obvious and needs urgent redress, however I disagree with some of his assertions and conclusions, hence this rejoinder.
The fact that the average Nigerian spends more on health than his counterparts in other African nations is more a reflection of the priority of our government than anything else. Nigeria has consistently under-budgeted for its healthcare over the past two decades. The World Health Organisations (WHO) recommends that a minimum of five per cent of the total budget of a nation be reserved for the health of its citizens, the Nigerian government has consistently budgeted less than three per cent.
In other nations this is not the case; the health of the citizenry is seen as priority and receives not just financial but political support. The end result is that the citizens end up paying more for what could have been provided on a large scale at a cheaper rate. That the lot of the healthcare professional is better in other African nations is evidenced by the exodus of skilled doctors, nurses and medical lab scientist to these nations not to mention the legion of Nigerians in hospitals in America and Europe.
However, the issue raised in Mr. Ebi's article goes beyond the realm of financial gain to the proper administration of resources and the provision of an environment conducive for research, learning and training. While Mr. Ebi may feel that the claims of a stifling civil service bureaucracy are over-rated, it is instructive to note that all the examples given by him were of people who in the private sector have excelled in management. Why hasn't a Fola Adeola risen from the ranks of the Nigerian civil service? The answer is obvious to even the casual onlooker, not only is initiative discouraged and unrewarded, it is intentionally squelched. Those at the head of most of our health institutions or directorates are not there because of any merit or even experience, rather they are chosen based on serious lobbying regardless of past performance. When the post of the Chief Medical Director of an institution like UCH, LUTH or the so-called 'National Hospital' is left for grabs to the heaviest lobbyist, the results become apparent for all to endure.
If our healthcare system is to rise once again to its former glory, several measures will need to be put in place. First, government must adequately fund the system, rather than paying lip service to the issue of a health insurance scheme. Secondly, government must establish and enforce minimum standards that should obtain in the delivery of healthcare in all health institutions throughout the nation whether private or public. Thirdly the government must now empower the various institutions and their heads such that the retrogressive influence of the Ministry of Health (as it is presently constituted) is removed.
The ministry is to enforce standards not serve as a contract supervisor/agency. Fourthly, the role of the public must now be emphasised as the 'end users' of whatever services the hospitals are rendering. The Nigerian public must become vocal as to the type and quality of healthcare they desire. Rather than seek solace in 'exclusive' private hospitals/rescue centres, wealthy and influential Nigerians must take the government to task over the quality of healthcare in the country and insist on change.
Finally, the role of the "hospital head" must no longer be seen as a 'winner takes all' opportunity, a good hospital administrator is one who provides needed resources for the staff to perform their duty, whether cleaning the corridors or performing surgery. When performance standards are set before employing such a person and when these same standards are used to assess continuity in service maybe then we can make sense out of such tags as 'the best CMD' in the country.
In conclusion, I look forward to a time when a 'Fola Adeola' will be allowed to run a public/government hospital in our dear country. Indeed this may explain why Prof. Roger Makanjuola is held in such high esteem by those of us that had the privilege of working under him, he was a man ahead of his time who despite the odds beat the system. My prayer is that more people like him will be given the opportunity to make the changes necessary to move our healthcare system out of the rot it presently occupies.
- Dr. Bankole is a medical practitioner in Lagos.
