Published On: Mon, May 14th, 2018

Nigeria is in a mess and the medical sector in shambles – Dr. Omole

Dr. Wale Omole is a medical practitioner who believes in the ideals of the late environmentalist and human rights crusader, Dr. Tai Solarin and that is why he named his hospital at Mushin Olosa in Lagos after the late human Rights crusader Dr. Tai Solarin and his wife. He is a man who has been very vocal about governance and health-related issues in the country. He has spoken against Nigerian leaders and rich men goings abroad for medical treatment when they ought to have fully equipped the hospitals in Nigeria to the standard of where they go for medical treatment.

Dr Wale Omole

In this explosive interview with Olusesan Laoye, he spoke about the health insurance scheme which he said has been in shambles and want it reviewed or scraped if no proper review would yield a better result. He also spoke about the political situation in the country which he says would hinder the progress and development of democracy in Nigeria if care is not taken it. Below are excerpts.

The Senate has called on President Muhamadu Buhari to declare a state of emergency in the health sector in view of the decay in infrastructure and lack of adequate facilities in Nigerian hospitals. As a medical practitioner, what is your take on this?

As far as I am concerned the call was in order, but the call ought to have been made much earlier since the president himself completely lost hope in the country’s health sector and had to go outside the country for medical treatment. He could not have taken the risk and stay in Nigeria during his critical health condition; he knew that there are well trained and seasoned medical practitioners in Nigeria but they don’t have the good and sound equipment to work.

Aside this, the infrastructures in the country’s hospitals are horrible. I want to ask how many of our rich people – ministers, governors, senators – do patronize Nigerian hospitals for an even common medical checkup. So if the senators now overnight realize how shameful it is for our President and some of them to be going outside the country, like London, Germany Dubai and even India for treatment, I think the call was made at the right time and it is a good omen for the nation.

The Senate should do everything to follow this up and be committed to ensuring that the Federal government improves our health facilities.

Again if the governors in the States feel the same way, then a new dawn is on the way to transform our health industry to a similar standard to the ones they patronize outside Nigeria. In fact, one would have thought that the first assignment of President Buhari when he returned from England where he went for medical treatment was to immediately embark on the transformation of our health sector. I hope that the president is not waiting again to be sick before he thinks of improving the health system in Nigeria.

It is also sad that successive governments in Nigeria have failed in the era of health provision for the people. Those in government always use health as a statement of campaign following which they would abandon the people and embezzle funds even those provided for health. Rather than earmark sufficient allocation to the health sector, they prefer to give more money to security at the expense of health. Even when the military wants to take over from civilian they always use lack of good health delivery as a strong point to justify their coup d’état.

I could remember that in 1984 when Gen. Buhari toppled the government of President Shehu Shagari, he said in his inaugural speech that ‘our hospitals have been reduced to mere consulting rooms’’. It was sad to note that when he eventually got the power, they did not change the situation in our health sector. The story in the nation’s health sector has been the same and declaring a state of emergency in our health sector is welcome and well justified.

Although the present government should not take the total blame for the decay in the health sector, but since he too was a former head of state, and he is now at the helms of affairs, he should take responsibility for the decay. The only way that could exonerate him is for him to start initiating ways of great reform in our health sector. He must urgently do something or else, the whole world would come to Nigeria to see how we kill ourselves daily and if that should be the case it will be too bad for the country.

There is a serious controversy on the Health Insurance scheme and the huge amount of over N351 billion so far paid the HMO’s without result. The Minister of health too is said not to be satisfied with the situation of things in this respect. What is the way out of this scheme?  

As far as I am concerned, the health Insurance scheme has failed. All the stakeholders except some benefiting HMO’s have lost hope in the scheme. So many factors are responsible for the failure. The scheme is not benefiting all the healthcare stakeholders like the Doctors, the pharmacists, laboratory scientists, nurses, and radiographers. Perhaps less than 5% of these professionals are happy with the scheme. The patients are not getting proper treatment through the scheme despite the fact that this is a patient’s fund scheme. The patients do not get value for their money.

The N351billion is claimed to have been spent so far to the HMO’s. This amount is only on papers and no one is sure whether the whole money got to the HMO’s. From findings, it was discovered that not all HMO’s benefitted from the acclaimed fund. The amount which the health providers and other stakeholders get should be verified to know whether they actually benefited. To be honest with you, I don’t think that laboratory scientists or radiographers in Nigeria put together did benefit up to N15billion out of the N351bfund.

To get to the root of the matter, I would suggest that international auditors be brought to trace the fund and how it was spent, I am sure that Nigerians would be amazed that those who are to be beneficiaries are not and they would be shocked as well when the true beneficiaries are revealed. The minister of health is right to say that they have not seen an appreciable improvement in the scheme in view of the amount said to have been spent so far.

Honestly, if a trillion had been sunk into the health insurance scheme in the last five years, the story would be the same, especially in the era in Nigeria where animals eat currencies. What has caused the problem the country is facing concerning the health insurance issue is the fact that the foundation laid for the scheme was faulty. There was no proper training for the providers and the public. It is not fashioned along a definite scheme. The scheme may be similar but very much different in operations in USA, England and Australia.

Our problem is picking up a good idea from these nations and come over to Nigeria to implement same. What goes under are never taken along. The situation in each country differs, the society and the conditions under which the scheme operates also differs in the nations where it is applicable. So many mistakes are made and to be honest with you the countries where some of these schemes are copied do make mistakes as well but they know how they rectify whatever lapses found. This is not the case in Nigeria; we always capitalize on any available lapses to take advantage of the situation and the people because of selfish interests. A mistake in England becomes a new style in Nigeria. This should not happen again. Nigeria has come of age.

In my own opinion, the scheme has failed; this is evident in the fact that many companies are pulling out because they don’t get value for their money or contribution. Also, many Hospitals are pulling out for losses they are incurring; individuals too are disappointed while many enrollees’ are prepared to pay to in order to get better treatment services. The healthcare providers are getting poorer because the cost of running health care is getting higher on daily basis. The capital received does not cover half of the treatment giving to patients.

This is obvious because the scheme is targeted at the poor who cannot even feed well but fall sick often and come to the hospital regularly. Some enrollees when they come to the s hospital for treatment believes that everything has been taken cared of with the money provided and they come to the hospital believing that everything they need has been paid for. They come with frivolous complaints. If they come to the hospitals today, they would come again the next week and when you ask them that they were here last week they will tell you that they were in the hospital to collect treatment because their money has been deducted and they have made their contributions.

The scheme is killing the business for the doctors. Many hospitals cannot pay the salaries of their workers. The doctors have to be paid, Laboratory scientists and other workers too because they must be at work since the HMO patients would come. The money collected as capitation cannot pay the salaries of all these professionals. Many private HMOS offer ridiculous capitation to Doctors. We have a situation where one HMO was offering N200 per enrollee. If he gives you 50 enrollees and offers N200 each how much does that amount to. A single patient would take treatment far above the amount offered. What then is going to be the gain of the doctor, yet they would make the doctors to sign some ridiculous clauses.

In fact, the person that paid N200 per enrollee lost so many doctors who had to pull out of the scheme because it was realized that HMOS took millions of naira yet he offered ridiculous amount to doctors. Many hospitals run the scheme at loss. Some HMOs would not allow their cost for authorization code at critical stage when the lives of patient are at stake and the doctors only use their intelligence to take care of the patient, only to be insulted by HMO officers who come round to cut down the providers bill after putting so much in saving the lives of the patients in critical situations.

Their argument for doing this was that the authorization code was not taken and that they would not pay. This often resulted in long arguments. Even if the doctor failed to present the bill on times because he was busy attending to patients they would ignore him saying that the bill was not presented on time. These are the ordeal of doctors and what they are going through.

The most pathetic aspect of the whole thing is that in the night when they rush down a patient who needs urgent attention and when they are called the HMOS would not pick your call when you want to inform them that you have an emergency and the doctor would not want to risk the lives of the patients, he would use his discretion to treat the patient and after doing that the HMOS would start telling stories when they are to pay for the services rendered. All these are killing the scheme and there is no way the scheme could survive if these continue.

In fact, the doctors don’t know the work being done by the HMOS, who are made to supervise them. What the HMOS care about is collect millions and give stipends to the doctors who do the job. The scheme is now bound to die a natural death and in order to save it, the government must readdress the issue and if not they should allow the doctors to treat patients and take money directly from them rather than involving a third party.

Nigeria is in a mess and the country’s medical issue is in shambles. It is sad that many doctors who actually work cannot afford to buy Tokunbo cars but ironically go and check the cars being used by these HMOS you will be amazed that they ride state of the art cars with the huge amount of money collected. Who is working and who is enjoying it shows that Monkey works and Baboon is eating. Honestly, the cheating and the ways the scheme is now being operated must come to an end.

Recently stakeholders in the health sector came together to express their concern over the way Nigerians abuse drugs and failure to follow doctors’ prescriptions. What do you think is largely responsible for this and how could it be curbed?

I believed that with good regulation drug abuse could be curbed. The issue also requires the seriousness of government. The kind of regulation required would restrict sales of drugs to specific facilities. The sale should not be by anyone who could open shop by the roadside. In developed countries like the United States of America, United Kingdome and others only established companies are giving the permission to sells drugs. In those places, it is not easy for just anybody to open a shop and start selling drugs. That is why they find it very easy to regulate the sales and fight abuse of drugs.

In Nigeria, prescribed drugs are sold in open markets, such as Tetracycline, Ampicillin and other Antibiotic.  Some hypertensive drugs too, are being sold on the streets by every Tom, Dick and Harry. It is now a fashion for people to carry drugs in containers and hawk them around while you see others displaying all kinds of drugs on buses, motor parks and odd places. It is very sad that it is only in Nigeria that all these are happening despite the fact that we have a body that controls sales of drugs. These people have even turned themselves to doctors, and because Nigerians are very gullible they approach them for treatment.

The government has to regulate itself by the kind of licenses issued out. One may ask what is the patent license giving out which even allows illiterates to sell all kinds of drugs. These people sell medicines in their shops and on the streets because they have the patent license to sell drugs.  You cannot imagine that these days, drugs are prescribed by native doctors. The situation is so bad in Nigeria today that traditional medicine attendances call themselves doctors, and someone who has worked in the hospital as a cleaner, or attendant after retirement are also bold to prescribe and write medication for people.

So if we are talking about drug abuse, the abuse is everywhere. The bottom line is that the public has too much access to a drug that is one of the causes of the abuse. The public access to drugs means that they can buy what they want. This cannot happen in the advanced nation. Over there, before you can use any drug it must be prescribed by a physician who is the only person that has the right of prescription. This even has to do with a prescription form which can be crosschecked anywhere. But this is not the case in Nigeria.

Honestly, the government has a big role to play in that. The doctor’s job is to prescribe while the pharmacy is to dispense. Let the Laboratory scientist carry out a test and stop prescribing medication. The law has specified the functions of everybody and they should all limit their functions to what the law says. By the time that all of them limit their functions to what they have to do, drug abuse would be eradicated.

Let us now look at the issue of security; it is like the federal government is still not capable of handling the situation especially the issue of Boko Haram and the invasion of the Fulani herdsmen spreading everywhere. Some people want the IGP sacked because of his actions. What is your take on this?

I may not support the call that the IGP should have been punished. We all know the peculiarity of this country and then the president himself is not unaware of the situation in the country. I am sure that the way he gave the order to the Chief of Army Staff in 2015, that he should relocate to Maiduguri to fight the insurgency was different from the way he gave the IGP the order. The president should realize that the IGP occupies a different position different from what the Military occupies. He is the overall security officer in the country. He has so much on his table.

There are so many things happening in the country especially when it comes to crime. Criminals are celebrating everywhere in the country, killers, kidnappers are everywhere; the roads are bad and most of our roads are not safe and armed robbery takes place on daily basis in all our roads; the Boko Haram and the herdsmen on rampages every day, while we also have the communal crisis. It is not logical for him to pack all his things to stay in one particular place. If he did that what about what is happening In Katsina, Yobe, Nasarawa, Balyesa, Imo, Oyo, Osun Sokoto and other places in the country.

To me I don’t think the IGP disobeyed the President intentionally but because he has enormous duties here and there. The IGP is fighting so many wars unlike the Chief of Army staff. The IGP is occupying a very hot seat. The job may somehow be similar but the orientations and training are different.  A military man is trained to fight in the bush while the job of the police is civil and to maintain law and order in the society.  To me, I don’t want the President to feel that the IGP disobeyed him. Let us come to think of it, the president knew that the IGP would not in any way disobey him.

The issue of Boko Haram is still a big concern for everybody in the country, we have heard so many stories and information concerning the operation of the Military; how they have told us that they have conquered them and even their leaders have been arrested, so to now hear that there are some strongholds of the insurgents where the Military cannot penetrate gives room for concern. The question to be asked is, are the Military not sincere, are they dishing out wrong information or are we just boasting to tell the whole world that we are capable of handling the situation, whereas the Boko Haram are still very much with us?

What they have demonstrated with the Dapchi girls was to show us that they are still very much alive. In that kind of situation, what can the IGP do as such we cannot put much blame on him. He is the one going after corrupt people and ensuring that the entire nation is secured and this same IGP is daily losing his officers.

It is now time for the National Security Council to fashion out a new strategy in solving the security problems in Nigeria. They have to sit down to find out what is really the problem with the security of the country. If it has to do with the personnel or equipment they are using they should come out with concrete solutions.

With the people not still happy with the security situation in the country and with the clamour all over for state police do you think state police is feasible and is it what Nigeria needs now that some states are even setting up vigilante or community watch which looks like state police in solving their security and other crime-related problems?

As far as I am concerned, there is nothing wrong with setting up state police. One of the problems we have in Nigeria and why crimes are not tackled at the grassroots is because there is one unitary police. The police are only being controlled by only the IGP. With the situation in the country now, there is nothing bad if there is the state, local government and the Metropolitan police. In the USA and other European countries, this is what they operate.

As far as I am concerned I will not even mind if we have regional police. You know that Nigeria now has six geopolitical zones and the country’s police could be fashioned along that line. The police have to be decentralized if Nigeria must move forward. As for the Military, it must remain one but the police must be centralized. You see the centralized IGP cannot cope; we need to have several of them in different areas.

As a person who believes in the ideals of late Dr Tai Solarin and you know that if he were alive today, he would have carried placards to protest, even if it means a one-man protest as he used to do, about what is actually happening at the National Assembly; what is your take on the imbroglio between the National Assembly and the Presidency and as well as the infighting at the Assembly?

I think all of them are selfish and they are thinking about themselves alone. Honestly, the problems confronting the country today are caused by the politicians who think of their selfish interests without any considerations for the poor masses who voted for them. There is nothing to write home about concerning their services to the people. To some of us, the imbroglio between the two is understood. The fact of the matter is that the President feels that if certain elections are carried out first, the bandwagon effect would follow and the legislature feels that if a particular election is carried out first, and it does not favour their aspirations they may not return back to the house.

I think what should be done is for them to come together and work out what is best for the country and not their selfish interests otherwise they would ruin democracy and eventually demoralize the electorate. The way they are behaving shows that they want to kill the democratic future of Nigeria. The legislators and those in government should work out a standard way of doing things; they are the ones representing the country and they are the ones as well being looked unto by the entire world as leaders and representatives of the people, so whatever they do would always serve as a reflection of what is happening to Nigeria and this is why they must not do anything that would tarnish the image of Nigeria.

 

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