Hospitals as undertakers? Saving a dying health sector -By Ayo Olukotun

Filed under: National Issues |

Ayo Olukotun

Over 90 per cent of deaths in our hospitals are due to the attitude of doctors and other health workers” — Thomas Agan, Chief Medical Director, University of Calabar Teaching Hospital, The PUNCH, Wednesday, September 20, 2017.

Had the searing indictment of our hospitals and health workers by Professor Thomas Agan, Chief Medical Director of the University of Calabar Teaching Hospital, quoted above, been made by someone outside the medical profession, it would have been passed off as either sensational exaggeration or arrant nonsense. But right there you have it, staring at you from the newspapers of Wednesday, September 20, 2017. Way back in the 1980s, one of our Generals dismissed the hospitals as little more than consulting clinics. A little over three decades later, however, an elite practitioner raises the alarm that they are on the verge of graduating into undertakers, whereby unlucky patients are sent to their graves.

After reading Agan’s troubling remark, I thought a second opinion might be in order. So, I called up Professor Friday Okonofua, Vice Chancellor of the University of Medical Sciences, Ondo. To my chagrin, Okonofua validated Agan’s astonishing take, and went on to warn that the death bed circumstances of our hospitals are fast careering out of control and require an urgent redress. According to him, it is not just the attitude of medical workers that is frightening, but also their gaping incompetence, traceable to the decay in residency training and other programmes which churn out doctors by routine, rather than by merit.

Obviously, the combination of an “I don’t care attitude” and incompetence is a most lethal one, decidedly so in a profession where the human agency is critical to the survival chances of patients. However, let us throw up the question, why is a poor or derelict attitude, such a disabling problem in our hospitals? One possible answer, a general one, is to see this as part of the remiss work ethos in the Nigerian public sector. Recall the Yoruba proverb “A ki sise oba lagun, akatakata la n sise ijoba” (We do not sweat when we are doing government work, you do government work in fits and starts). In the case of health workers, this pervasive culture of indolence in the public sector has been compounded, in recent times, by truculent dialogues and upheavals arising from deterioration in the conditions of service of doctors.

Indeed, industrial strikes have become routine, and just on Wednesday, the Joint Health Sector Union declared another “indefinite national strike”.

Part of the decline of scholarship in this country is that hardly anyone does any serious research anymore. In earlier years, you could see young men and women administering questionnaires to workers seeking to measure job satisfaction and morale. You hardly see them anymore, suggesting that much of our national life is the equivalent of the philosopher’s unexamined life. To bring the point home, what attitude do you expect from disgruntled medical personnel, in and out of strikes, who view the subversion of his negligent employers as a situational response informed by contingent ethics. In this connection, recall the war chant of the university teachers’ strikes of the 1990s: “My employer is a comedian. He pays me starvation wages”. So, it is idiotic to give someone enormous, life-saving responsibilities, and deny them salaries, pay them at intervals, and give them rusty malfunctioning tools to work with. Before going ahead with the narrative, I characteristically ask the reader to indulge the digression of a short take.

A spirited national conversation trails recent military activities in South- Eastern Nigeria, and the proscription of the Indigenous People of Biafra. It would appear that the whereabouts of Mazi Nnamdi Kanu, leader of IPOB and some members of his family are unknown. For this columnist, one of the curious aspects of the discussion is the silence of many civil society activists and constitutional lawyers about the human rights issues involved in the repeated use of the military to achieve short term ends. Of course, no one takes anything away from the fact that government, must live up to its core assignment of maintaining law and order, and Kanu, given his irresponsible utterances, was a sitting duck for a law and order campaign.

That said, it matters the way national security is achieved, considering that even illegal actions can be cited as precedents or as play books for leaders with varying intentions. In this respect, it is of interest that Operation Python Dance, and its linguistic cousin, Operation Crocodile Smile, names whose linguistic resonances howl for deconstruction, are now being extended to the South-West, presumably to tackle crimes such as kidnaping and robbery. So far, nobody has explained satisfactorily, why the police or joint patrols of the police and the military cannot successfully address these challenges. This apart, officialdom is taciturn about whether the Kanu phenomenon, admittedly lousy and violent, is a reminder of unresolved issues concerning the national question, and the cry for restructuring, which this government has so far sidestepped. To sum up the raging apprehensions, let us recall the famous words of Martin Niemoller: “First, they came for the socialists, and I did not speak out because I was not a socialist; then, they came for the trade unionists, and I did not speak out, because I was not a trade unionist… then, they came for me, and there was no one left to speak for me.”

To return to the initial discussion of our comatose health sector, it should be pointed out that we cannot change the desolate narrative of our hospitals without changing the budgetary architecture of a failing health sector. Browse the allocations to the health sector by the Federal Government in the last two years, and you come up with 3.73 per cent of total budget in 2016 and 4.15 per cent of budget in 2017; both figures fall far short of the 15 per cent of budget spending recommended by several international organisations, and already achieved in some African countries. Contrast our paltry health budgeting to countries like Germany, which allocates almost 20 per cent of total budget to health, as well as the United States, 20.7 per cent and China, 12.6 per cent, and you begin to get the true picture. To be sure, enhanced financial allocation must be matched, in a sector not known for probity, by rigorous oversight to ensure that money budgeted reaches the end-users. We cannot run away, however, from the fact that meaningful reform ought to proceed from improved funding.

That is not all. There are incredible human resource gaps in our hospitals. A sampler; Zamfara State, according to the Minister of Health, Professor Isaac Adewole, has only 23 doctors serving 24 hospitals (The PUNCH, September 21, 2017). Nationally, we have one doctor to 4,000 Nigerians, while the World Health Organisation’s recommended ratio is one doctor to 600 patients. Furthermore, as Prof Niyi Akinnaso argued in his insightful “African leaders and medical tourism” (The PUNCH, August 16, 2017), there is a need for the re-kitting and overhaul of equipment in our hospitals.

In sum, a national emergency should be declared in our health sector, with a view to bringing it back from the life support to which it has been consigned. But first, we must get the doctors to return to work.

 

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