August, 2012

Following the recent strike action embarked upon by doctors under the employ of the Lagos State government to press for the full implementation of the Consolidated Medical Salary Structure (CONMESS), almost 800 doctors were sacked, with the state government insisting that the strike was illegal. However, following the intervention by various stakeholders, the doctors were recalled and the strike was called off.
In this exclusive interview with SAIDAT ALAUSA, the Chairman of the Lagos branch of the Medical Guild Association, Dr Olumuyiwa Odusote spoke extensively on what informed the action by the doctors, the challenges of the health sector and what the government could do to correct the anomalies in the system. Excerpts:

Reason for Strike action
Many people had thought that before now, there were no issues and that everything was fine. Although we have gone back to work, everything is still not okay because the real issue that took us to the battlefront has not been addressed. Like I said earlier it is not about building structures alone, the welfare package of health practitioners needs to be improved. That is what we are asking the state government to do for us. We need to take care of our own needs so that we can concentrate more on the job. The general belief is that doctors don’t go on strike because they say it is wrong. Doctors are human and every human being has his or her needs.
For example, if am on surgery now and something bites my leg if there is nobody to remove it for me I will have to stop the surgery to attend to it. It is true they (doctors) save lives, but who will save theirs? Recently, doctors in America went on strike because there was a change in their pension scheme in which they will have to pay more. They did not close the hospital down, but they were not attending to people except emergencies. So it is everywhere.
Challenges in the health sector
The challenges are multiple. One of the major challenges we have is in being focused in our efforts towards improving the healthcare system in the state vis-a-vis improving the health indices which is among the poorest in the world. One of the things we want to do is to get our members to be in such a position where they can give their best. And to achieve this is not easy, particularly when the state government is running a policy that is at variance to what we believe in.
The Lagos state government has been building infrastructure and putting some structures in place, even though at a slow pace. But our concern has got nothing to do with that, because as the saying goes, slow and steady wins the race. As long as they are steady, we are in support. But where we really have a problem is when government does this at the detriment of manpower development.
We believe that government should not only improve infrastructure, but should also improve the welfare of manpower that is going to run the infrastructure. A disgruntled, unsatisfied worker will not be able to produce results. The American government and some other government in the world come as far as Africa to look for manpower to man their already highly equipped hospitals. So, we believe Lagos state government should take a cue from that and begin to do more than just build
Infrastructures.
Why Nigerians have lost faith in the health care system
One of the major reasons why this is so is because manpower development has been largely ignored by both the federal and state governments. It does not even exist at the local government level. If you are not developing, there is every tendency for you to decline. Take the medical practice for example. A physician continues to study to learn and to improve himself until he retires from active service. It is not a case of I have graduated, so that is the end of my learning process no. By the time you graduate, you get your license to more education. A doctor cannot afford to stop being educated; the books that were used by medical students who graduated five years ago are not the same books that are still being used in medical school today, because there has been an improvement, there have been changes, changes in causes of illnesses and new discoveries.
Some 20 years ago, ulcer used to be treated systematically and then surgery. Now, we treat ulcer with drugs and then the patient gets cured without any operation. This is has a result of advancement. A doctor cannot remain stagnant and expect to perform in today’s medical field. So there is need to for continuous education.
At the federal level, there is supposed to be a compulsory oversea training attachment for resident doctors, just before they graduate. But the reality is that, Government has been paying lip service to this overseas training. They have refused to release money for it and these are things that are critical to the development of healthcare system. The same thing is happening in the state, a lot of development has been ignored and then people just pay lip service to healthcare development. You cannot develop healthcare system without developing the manpower and this also includes other health workers that are also assisting them.
On the way forward for an improved health system in Nigeria
The healthcare system can be improved in the country when our political office holders come to terms with reality. The reality is that our hospitals are inadequate in number, they are in adequate in the quality of facilities and they are under manned. The number of doctors to a patients is very high in today’s Nigeria. The ration is probably 1 (doctor) to about 20,000 people as opposed to the recommended 1 to about 5,000 or so, in terms of a developing country as ours. When you have about 20,000 people sharing only one doctor, how is that doctor going to cope? How are the people going to get the services? So that is a major problem.
There is need for an increase and one of the reasons we have not been able to meet up is that, even though medical schools are increasing, a lot of doctors are leaving the country every day. Almost half of the doctors that graduate every year leave the country. This is because the welfare package in the country is below expectation and there are no opportunities where you can improve yourself. It is only those who have special commitment to the nation and people that will ignore the beautiful incentives that are out there and choose to stay back to contribute to the country.
So, those who choose to do so must be encouraged by regular review of the welfare packages. When you see your colleagues who went out and after five years are ten times better than you, is not encouraging. Though the government is trying to bring back the doctors in the Diaspora, but what are they going to come back to? The system in the country is so bad, the security is terrible, power system is a failure, road network is dilapidated, even our air travel now is becoming a risk.
There are many factors that are going to prevent somebody from outside the country, who has tasted the other side of the medical practice, to want to come back to Nigeria. For those of us who have decided to stay, we need to improve the system and that is why the Nigeria Medical Association thought of the issue of the consolidated medical salary structure, which is the minimum wage for all doctors. All doctors should have a better package and this is a minimum, which would encourage them to stay back, knowing that they can meet up with some basic needs of their family.
If a doctor is busy chasing money, there is no way he can concentrate on improving the service. The welfare of health practitioners should be taken care of, so that in turn, they would now take care of the health of the society. A society like America pays its doctors very well. This is because they know the importance of the services they are getting from them and they know the only way they can keep these people from going out or trying to look for money themselves is to ensure that they meet their needs. They don’t have anything to distract them and they face the research purpose squarely. That is why they keep getting improvement, that is why they keep having breakthroughs in research every year. But that is not available in this country because our basic pre-occupation is, how do I feed, send my children to school, pay my house rent, get water and power my generators? These are our basic thoughts. So, we cannot concentrate on how we can improve the society.
There is no law governing the health system in Nigeria. The national health bill has not been passed, rather there is an attempt to try and bury it. The government does not want any law that would make it accountable to the law. Right now, health services in the country are at the mercy of whoever is in power. They can decide to do it anyhow and nobody will hold them to it because there is no law.
For instance, if we have a law in Nigeria that says 90 per cent of the total budget must go to health and a government fails to comply, then we can hold them accountable for a breach of the law and be able to take them to court. This can be done through the national health bill. The bill needs to be signed, stating who provide what kind of services, how is those services are going to be funded and who pays for what.
On the National Health Scheme
The National Health Insurance is one of the ways to finance the health sector. The health sector is a capital intensive, medicare all over the world is expensive. For instance, if you want to buy an X-ray machine, it is going to cost you about five million naira. You can imagine when it needs service or breaks down and you need to change it. So we have to transfer this cost to somebody.
There are also many other things that cost millions of naira. If you want to have a standard hospital, somebody has to bear the cost and that is where the national health insurance scheme comes in. For us to get modern equipment, instruments and new drugs, which are costlier that the older ones, somebody must pay for it. That is the only way we can make progress because it is too expensive for the government to fund alone and also too much for an individual to bear. That is why group finance comes in.
The national health insurance scheme gathers money from everybody, bit by bit and then use it to treat those who fall ill, because not everybody that partakes in the scheme will fall ill at the same time. In fact, it is estimated that that not more than 10 or at most 13 per cent of those who participate every month will have to visit hospital and most of them will go for minor illness like malaria and so on. Those who really need big money to take care of them are those that have cancer and those who need to go through surgery are less than 10 per cent of the population.
So if they are going to need N100,000 to treat somebody now, and then you have 10,000 contributing one thousand naira each, they will contribute what that person will need and they will still have change. And when it gets to their own turn, there is money available for their own treatment too. That is what the National Health Insurance Scheme is all about.
Are the General Hospitals well equipped to treat critical health issues?
Yes, the facilities are improving, but like I said earlier on, it is not the building that treat people, it is the quality of the personnel. You can improve the building, improve the equipment but you will not get an improved output so there is need to improve the quality of personnel by increasing their welfare and their training. There is still a lot that needs to be done in the area of training. For example, for critical illnesses, there is only one critical cure unit in the whole of Lagos state hospitals and that is the one in LASUTH and it is privatized. For anybody to be admitted, that person needs to deposit N250,000. With that, you cannot meet the needs of majority of the people. Somebody who is dying that needs something critical to be done within an hour or so may not survive and then, they say you must pay that amount or you will not enter the place.
Activities of the Medical Guild, Lagos
The Medical Guild is the association of all Lagos state employed doctors. It comprises of consultants who are specialists in general hospitals, medical officers who are not specialists, resident doctors who take care of training in teaching hospitals and of course, the consultants in teaching hospitals who are also lecturers in the medical school. It is an affiliate of Nigeria Medical Association Lagos.