Nigeria’s health system must be fixed for all citizens access quality health care

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Prof. Innocent A. O. Ujah who is the current President of the Nigerian Medical Association (NMA), a consultant obstetrician and gynecological surgeon and the Vice-Chancellor of the Federal University of Health Sciences, Oturkpo, Benue State was interviewed by Chukwuma Muanya of the Nigerian Guardian newspaper ahead of the Association’s yearly general conference and delegates meeting held from May 15 to 22, 2022 in Port Harcourt.

In the interview, Professor Ujah proffers solutions on how best to tackle health emergencies, particularly with the increasing incidents of emerging and re-emerging diseases, which have continued to ravage developing countries like Nigeria.

Q: The issue of medical brain drain and medical tourism is increasing in the country as more Nigerian-trained doctors travel abroad to the United States (U.S.), Saudi Arabia, United Kingdom (U.K.) etc. in search of greener pasture. What are the latest figures? What are the main reasons for this? How could these be remedied?

A: The current momentum is emigration to developed countries, where the conditions of services and remuneration are far better than in Nigeria. There is the “pull” factor and the “push” factor. The pull factors include good remuneration, security and safety of lives and property, and a conducive work environment with better and up-to-date equipment to work with. Good schools for our children, steady and uninterrupted energy supply and excellent infrastructures like communications and transportation. The push factors include increasing and escalating insecurity through Boko Haram, banditry, kidnappings and abductions, the supposed Indigenous People of Biafra (IPOB) menace in the south East; poor take-home pay, thoroughly dilapidating and obsolete medical equipment, inter-professional rivalry and very poor public utilities/infrastructure like electricity, poor water supply, recurring strikes by Academic Staff of Union of Universities, Polytechnics and Colleges of Education leading to months of the closure of universities, thereby interrupting academic activities in Nigeria’s public universities.

Q: Is the NMA not concerned that Mr. President and other government officials/politicians still go abroad for medical treatment?

NMA is certainly very concerned and it is therefore not sleeping over it. NMA has stated times without number that the nation’s health system must be fixed so that the rich and the poor would access quality health care in Nigeria. NMA has severally kicked against government officials going abroad for medical treatment with public funds. However, anyone using his/her personal fund has the fundamental human right to seek healthcare anywhere in the world. In response to the unbridled brain drain, NMA on 4 April 2022, organized the first NMA lecture series with the title: “Brain drain and medical tourism: the twin evil in Nigeria’s health system” with impressive output and which we believe will certainly impact positively on the Federal Government’s policy on brain drain and medical tourism. It has now resulted in a national health emergency for strategic and appropriate intervention. The national and sub-national governments must act very quickly; otherwise, it will become too late and difficult to reverse this national health tragedy. We intend to continue the conversation at the 62nd yearly general conference and delegates meeting of the NMA scheduled for May 15 to 22 in Port Harcourt, Rivers State.

Q: What is the theme of the Conference?

A:  “Current emergencies in building a resilient health system for Nigeria: Situation analysis and solutions with sub-themes”.

Q: What informed the theme?

A: The theme is informed by the weak and poor response to national health emergencies as witnessed from the containment of Lassa fever, Cholera, Ebola and now the COVID-19 pandemic. It is therefore imperative that scientists and leaders of the health team brainstorm on how best to tackle health emergencies, particularly with the increasing incidents of emerging and re-emerging diseases which have continued to ravage the developing countries like Nigeria, with huge losses of the population to death and infirmity.

Q: How far with the issue with Nigeria Universities Commission (NUC), universities, PhD holders and medical doctors?

A: Two regulatory bodies of equal jurisdictions – the National Universities Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN) superintend over medical education in Nigeria. The Fellowship of the various Postgraduate Medical colleges is the highest known postgraduate medical qualification anywhere in the world but then the highest degree in the university is PhD. The contention is the inability of some staff in NUC to come to terms with the peculiarities of medical education as fail to realize that the acquisition of a PhD by a medical doctor without the Fellowship can never qualify such a doctor to be a consultant and teach clinical medicine. PhD is not recognized in clinical medicine and therefore the fellowship of national postgraduate medical college was uniquely designed to accommodate both professional as well as academic medical training. I, therefore, advise the NUC to come to terms with the peculiarities of the profession of medicine. I am surprised that the authorities of NCU have failed to realize that if PhD were required in medicine, over 90 per cent of doctors would obtain the PhD within three years without at all being immodest because doctors are among the very highly cerebral human beings that are trained in many components in human endeavour. We need to continue to educate the “troubleshooters” in NUC to come to terms with medicine as a peculiar profession or discipline.

Q: What are your recommendations on how to fix healthcare in Nigeria?

The health system in Nigeria is riddled with very many issues and no one person can suggest how to effectively fix healthcare (primary, secondary and tertiary health systems) in Nigeria. Perhaps, the health reform committee under the leadership of His Excellency, Professor Yemi Osinbajo, the country’s Vice-President, would probably find the solution on how to fix the deplorable health system in Nigeria and improve the health indices. 

Q: If you were elected the next President of Nigeria, what would you do to fix the poor health indices recorded by the country?

A: I know I will not be elected as Nigeria’s President but if by miracle (an illusion), I am elected Nigeria’s President, I will first fix Nigeria’s economy, health and education. These are drivers of development with a strategic focus on human capital development as soon as it is possible.

Q: As the outgoing President of NMA, what were the challenges, low points and achievements?

A: My administration came to office during the COVID 19 pandemic with lockdown being commonplace. My manifesto predicated my administration to be based on high-level advocacy, constructive engagement, diplomacy and consultation and building bridges across professional divides for smooth health care delivery to Nigerians. As a person, I do not give in to lamentation and therefore, despite several challenges, we moved on to see how to improve our health care system including the condition of service and remuneration of our members.

Q: Would you say you met your targets? If yes how? If not, why?

A: I have assessed my performance in the past two years as NMA President, and without being seen to blow my trumpet, I will give myself 75 per cent (which is a distinction), even though, nobody sees himself/herself except by the use of a mirror. I have gone through all the items in my manifesto and I am left with very few items to accomplish, including reducing quackery in the medical profession (50 per cent), implementing doctor’s stamps (40 per cent), Fellowship/PhD (55 per cent). The high point is effective high-level advocacy and constructive engagement (100 per cent), gender mainstreaming among female doctors (100 per cent) in participation in NMA activities, completion of negotiation and segregation of hazard allowance (clinical and non-clinical) among health workers (100 per cent) and closing the inter-professional rivalry gap among members of the National Association of Nigerian Nurses and Midwives, NANNM (70 per cent). This is the first time the history of NMA is being written and it is my administration that commissioned the project and will be presented/launched at the AGM/ADM in Port Harcourt on 19 May 2022; institution of the maiden yearly NMA Lecture series held on 4 April 2022, with the topic, ‘Brain Drain and Medical Tourism: the twin evil in Nigeria’s health system’ was a huge impactful success. The commencement of the construction of NMA House is another area in my administration where I broke the jinx by the renovation of the NMA national secretariat, Abuja, for the first time since its acquisition in 2008. Media engagement has been robust and superlative through which platform NMA informs and educates Nigerians on health-related issues. On the whole, the confidence-building mechanism among the governments and the Nigerian public increased the visibility, profile and relevance of the NMA and medical profession in the national and international arena, with the election of the President of the World Medical Association of one of our members as the highest point in the achievement of my administration. During this period, the relationship between the MDCN and NMA was excellent with due respect and understanding established between the two bodies. I appreciate my senior colleague and Chairman of the Council, Prof. Abba Waziri, who gave me unprecedented regard as his president. I participated fully in the activities of MDCN, including the Medical and Dental Practitioners Disciplinary Tribunal (MDPDT), during which some erring medical doctors were convicted for infamous conduct. On the whole, it was a worthwhile experience and I am happy that I have led my professional association for this period with impactful outcomes. A lot remains to be done as the administration is a continuum, but I feel fulfilled.

Q: Who is Innocent Ujah?

A: Ujah was born on November 6, 1954 and hails from Aidogodo-Okpoga, Okpokwu, Benue State. He studied medicine at Ahmadu Bello University (ABU), Zaria and graduated in June 1978. He started working as a lecturer and consultant at the University of Jos and Jos University Teaching Hospital in 1988. He became a professor in 2001. In April 2010,  Dr. Goodluck Jonathan appointed Ujah as the Director-General of the Nigerian Institute of Medical Research (NIMR) Yaba, Lagos. He was appointed as the pioneer Vice-Chancellor of the Federal University of Medical Science, Oturkpo by Muhammadu Buhari on 12 May 2020. He was elected as the President of NMA in a virtual election on 30 May 2020, succeeding Dr. Francis Faduyile.

Q: How far with the implementation of universal health coverage?

A: Well, you know universal health coverage is saying that nobody that needs health should be deprived of that service for lack of money or lack of access and also the fact that there should be the availability of health. So Nigeria under the national health insurance scheme is trying to reposition itself to respond to universal health coverage by using even the community health insurance programme and the rest. So it’s a formative period but the direction is that we want as much as possible for all Nigerians to buy into the national health insurance scheme because that’s the one that subsides, that’s the one that will last, and that will provide accessibility, availability and quality service to our people. 

Q: There is this belief, should I say criticism, by people that most of our research institutes are not doing well in terms of churning out discoveries. They say that research institutes are not doing as expected, in terms of producing cures or breakthroughs and so on. How true is this?

A: Yes, I had said that wherever you want results, you must invest and research is capital intensive. There are no two ways about that and Nigerians are quick to ask what your breakthroughs are. What they do not ask is: “what are the investments given to you?” So in a way, with even the limited resource that we have, we are able to do a lot of things. For instance, you know when the Ebola virus disease came out, very few countries gave us a chance. They thought Nigerians were going to be wiped out, but we used Nigerians with the support of other partners and with the political commitment of Mr. President then and the Ministry of Health and you found out what happened. We started discussing the issue of Ebola before it came because once it came to Sierra Leone and Liberia, we knew it was a question of time, because of the trans-border movement and therefore we started training, we started seminars and when it came, the emergency treatment centre. So I think that what is needed is that Nigerians must appreciate the value of research, and if they know that research is important, then they must invest in research. I think that Nigeria should look at that very seriously and I have also advocated for a special fund for health research. We call it National Health Research Fund and it should be put aside for scientists to access for health research because if we do that you find out a lot of breakthroughs would come out.

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