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Monday, August 24, 2015

Nigeria: 'Buhari Must Focus On Primary Healthcare'






INTERVIEW

With a new government in power, a UK-based gynaecologist and a visiting Professor, University of Sunderland, Prof. Rotimi Jaiyesimi, shares with journalists what he expects of the President Muhammadu Buhari's administration in the provision of primary healthcare to Nigerians. He also spoke on the disharmony among health workers.Martins Ifijeh and Rebecca Ejifoma bring excerpts:


What are you passionate about in this country?

I am a trained medical doctor who happen to practise abroad, but I have always been passionate about Nigeria's primary healthcare, so I still come home to contribute to our health sector. I write about health issues on Facebook and other social media as well.


I came in June as the Chairman of Board of one of the newest hospital in Lagos - Bright Hope Specialist Hospital, Agidingbi. I visited it two days ago, because we are now operational. I didn't tell them I was coming. I wanted to see what they were doing. So, I pretended I was a patient just to know how I was going to be received and how I was going to be treated. I was impressed at what I saw.

Now, when I look at the Nigerian health sector and the Nigerian matrix, I say no; we can do better than this. We must strengthen our healthcare to reflect how precious we value lives.

What area of the health sector have you come to fill?

I believe about 70 per cent of Nigerians require primary healthcare so as to be able to tackle issues of malaria, diarrhea and even anemia in pregnancy and this is one thing lacking here. You don't need to go to general hospitals to be treated, that's why there ought to be primary healthcare. And that one gap the Bright Hope Specialist Hospital came to fill in its little way. It is a bit similar to a novel idea in the United Kingdom, where the bigger hospitals now want to buy general practitioners so that there will be flow among primary, secondary and tertiary care.

Now, as a specialist hospital, there is also the school where you can come and talk about primary healthcare like asthma, malaria, among others. So, you can call it a primary care institution also delivering at secondary care level. When you now need higher care, we refer you. So, it is basically primary and secondary care.

Our healthcare system needs a revamp. How can it be addressed?



I will start on a positive note. Nigerians are brilliant and intelligent people. What is happening in the health sector is the absence of the political will in terms of investing in the infrastructure.

Secondly, what is happening in the health sector is that there is no framework to monitor the performance of doctors, nurses and other allied healthcare workers. You could have doctors who are on call and you don't see them. You could have surgeons who are supposed to be operating and they don't even operate for a year. And nobody within the health system holds them accountable. So, what we need is a framework to help us make sure we deliver what we promised. We will like to see this new government deliver accessible, affordable and safe care to all Nigerians. There should be proper framework for primary, secondary and tertiary care.

If you are to make changes in the health sector where will you start?

I will like to start from primary care. The primary care has to be looked at, especially in rural areas and small cities, where most Nigerians live and that is where most Nigerians die.

Nobody wants to go there and serve - doctors and nurses. Therefore, we need a very well-established, well-run and well-equipped primary healthcare system. But having a primary healthcare system to stand alone; if something goes wrong, we still need a secondary care. More so, you need like a referral pathway to secondary and from there to tertiary care.

Various past governments have created policies, but the problem we have is in the delivery of the policies. There is no accountability. People have got to be held accountable for their actions. That is what I will like to see - a framework in place and political will. We spend just about 3 per cent of our GDP on health and that is inadequate. I would recommend 10 per cent if we are serious about health issues in Nigeria

If nurses and doctors have refused to go into rural areas, where primary care is needed, how can this be tackled?

You don't need doctors. You need healthcare workers. How do you diagnose malaria? I've got high temperature. That is the commonest cause of high temperature in Nigeria. Now you do you treat malaria? You have a guideline. You have a protocol.





How can the problems be solved? We will not solve all the problems in one day. But today, for the last 12 years, Nigeria hasn't had one case of polio and that is due to what the last government did in terms of polio vaccination, immunisation.

Malaria is something that kills a lot of Nigerians. Today, however, it has been announced that a vaccine has been made available. The next thing is to get it in African countries and in Nigeria. I will commend Professor Ransome Kuti because he did a lot of work during his time.

The thing about health improvement is a step-wise improvement. It is continuous. You never get to a level and say, 'Yes, we are there! And we can no longer improve'. Building on what other successive governments have done. That is what I will like to see this government do.

Malaria drugs, vaccines and every other thing for treatment are imported, yet these are tropical diseases. Do you foresee any situation where Nigeria can produce its own drugs? If we look at research, before any drug comes into the market, it could take 15 or 20 years of animal studies before going into use.

Nigeria has a National Institute of Research which is either not well-run, or perhaps not well-funded and this is why we are getting the result we are seeing. What is being done now is that some universities are being identified as centres of excellence in its research work. University of Ibadan has an Institute for drugs and drug introduction. They are constructing a building for it. And again once that is established, drug manufacturing will be good.

Again, FIDSON Healthcare is a company I admire. I visited the company and I was impressed at what I saw, as its just like what we have in Sunderland, where I'm a visiting Professor. We have a lot of Nigerian Pharmacy students. When they are doing their PHD, they come here but because there are no supervisors, they are lost.

Now, we are forging a link between FIDSON and the University of Sunderland. FIDSON is into manufacturing. But now, it wants to go into research.

I will take hypertension as an example. Black people require diuretics' for their hypertension; whites don't. There is research going on within and outside this country with even outside Nigerians involved in the search. But underneath us the gene is what we should be looking at. It is a lot of work. But we need to come together. If we don't see ourselves as a team in this sector - doctors, nurses, midwives; everybody just looking for prominence in the profession. Without a nurse can a doctor operate? Without a patient can I be a doctor? Therefore, it is a system where everybody has to be respected for what they bring to the table.



How can we resolve the disharmony among doctors in Nigeria?

The weakest link in a chain destroys the system. There should be mutual respect among every healthcare provider because every body has something to bring to the table.

Once we all understand that we are here for the benefit of the patients and not for our own positions or hierarchy, things will work harmoniously.

For example, in the UK, pharmacists don't just stand behind the counter and dispense drugs. They come to the wards as well to know what doctors are prescribing.

Government can facilitate this. It will need a mediator, a facilitator. That is the role of the Federal Ministry of Health, a state ministry of health.

Must a medical doctor be the head of a health institution?

I do disagree to this. As far back as the 70s or 80s, when I was in University College Hospital, Ibadan, the head of the laboratory services was not a medical director. Even when some people were saying a doctor has to head a medical service, their agitation didn't stand because he man is even a PHD holder in Microbiology. Running a health institution is no longer confined to a perimetre. There should be mutual respect for what the other person can offer.

Non-communicable diseases are increasing by the day. How can it be controlled?

Two things: lifestyle - the things we eat and what we do. So, it is what goes in and how you burn it out. We are eating all these processed foods.

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