Paper Presentation on "Challenges of the Nigerian Health Care System"


The World Health Organization (WHO) definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity describes an intrinsic relationship between the good feeling of self and the good state of the body. It defines individual’s social responsibility of being able to live in peace and contributing to the welfare of others. In this regard, Nigerians’ state of health is compromised judging by our health indices and demographic statistics.

There are many daunting challenges to our health system at the moment. The average life expectancy of Nigerians at birth has dropped from 54 years in 2005 to 45 years in recent years despite an overall decrease in population per physician and nursing staff. Several factors, including deterioration in both structure and organization of the healthcare system, and a lack of skilled personnel, especially in the primary health care centers, have contributed to this sharp drop.

In addition, financial incapacitation, poor planning, sociocultural influence and religious bigotry have reduced access to the limited healthcare facilities by majority of the populace and influenced our life expectancy at birth. Apart from death due to diseases, accidental deaths from road traffic, insurgencies and Fulani herds’ men have become rampant in the country in recent years, involving youths who are supposed to be the prime movers of the national economy.

The Nigeria's poor state of health system is attributable to the collapse of the primary and secondary tier levels of medical care brought about by several factors, notably the shortage of skilled medical personnel at the primary health care level and gross under-funding of the health sector by the State and Federal Governments. Inadequate funding of health leads to poor facilities which has encouraged medical tourism. The governments at all levels have failed to integrate and coordinate the orthodox, alternative, and traditional modes of health care delivery in the country thereby leaving their acceptance to individual’s whims.

The major challenges to the Nigerian health care system is the lack of trained cadres of health manpower and this is compounded by competition for superiority amongst the various groups of the heath care workers. This has led to incessant strike actions among their unions, which are demoralizing and have left the populace wondering about the benefit of accessing long term treatment in government hospitals, preferring private practice instead if they can afford it, otherwise they seek alternative medical care or spiritual interventions. Many now consult government hospitals only for emergency care or in terminal stages of their diseases. The bane of our challenges is the quest for personal gains, which leads to corruption, attitudinal problems and mismanagement often seen in all establishments in the country.

The solution to challenges in health care system in the country starts with attitudinal change by everybody, which involves being faithful, diligent and sincere. When both employers and employees maintain fidelity at work, all obstacles to effective management will be removed. Governments should give priority to the provision of quality health care with improvement in facilities. Also, government and their agencies should address manpower development, including specialists and non-specialists training, and develop / improve the ailing infrastructures such as good roads, electricity, water etc. Since the governments cannot do these alone in the present state of our national economy consideration should be given to public private partnership in health care financing and management. The overseas sub-specialists training abroad should be rejuvenated in specific areas of need and medical tourism should be discouraged in all its ramifications.

I am very happy to be here to deliver this lecture as an Old Boy of Government College Ibadan (GCI). I entered the College on January 15, 1966 and thanked God that I was able to make it for many reasons known to some of you here. I was young, inexperienced and small in stature but due to the help of some of my seniors and house teachers I was able to weather the storms and be what I am today. Succinctly put GCI formed me and gave me the self-confidence and self-discipline (i.e. self-respect, self- control and sense of duty) that I needed to forge ahead in life.

The topic of this lecture is very timely because health care delivery in this country is in disarray and has not progressed as one would expect if one had been alive in the 50s and 60s. In 1960, during the first-term holidays in primary school, I sustained a spiral fracture of my right femur and had to be rushed to the University College Hospital, Ibadan (UCH) by our house maid at about 6pm because my parents were not at home. She had no money for taxi so she carried me on her back from Ososami Road, Oke Ado to the hospital on foot.

I was taken straight to the Casualty where I was attended to promptly by a young white doctor called Dr. Pristman, who took me for X rays and got me on gallows splints before 9pm. I was discharged in the Gallows traction bed (Figure 1) on the same day with my feet hanging up and was given a 2 weeks appointment for follow-up. I had spent only 3 hours in the hospital without paying a penny. My parents only came to take me home at the point of discharge. The doctor visited me at home a couple of times before my appointment was due.

That was the situation in UCH at that time. Can we boast of such these days? You can hardly get attention in the hospital today if you do not know a senior person very well and loaded with money for treatment. Thus the topic of this lecture “Challenges of the Nigerian Health Care System” is very timely and relevant. I thank the organizers, especially Falore, Jolaoso and Agbaje for giving me this opportunity to deliver this lecture.

Firgue 1: Gallows Splint. Courtesy

To most people, the concept and measurement of health has generally focused on ill health due to the fact that for most of human existence the health problem facing society has been overcoming diseases until recently. After the Second World War, in mid-20th Century, the health picture changed from disease-ridden to the idea of positive health.

Therefore, the World Health Organization (WHO) in 1946, defined state of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The definition made explicit that disease and infirmity, when isolated from subjective experience, are inadequate to qualify health. Thus it describes an intrinsic relationship between the good feeling of the self and the good state of the body, both of which are inseparable. It also changed the tune of health from “sane mind and sound body” to encompass social health, which defines the social responsibility of individuals as “the responsibility of being able to live in peace and contributing to the welfare of other people”.

Although including psychological and the social dimensions to health was a major advance, it had no direct operational value. This WHO definition of health has been criticized as being too holistic, euphoric or utopian, and that it suggests that everybody is sick since complete wellbeing cannot be guaranteed for every individual at a particular period.

The outline of this lecture will be as listed below;
• Nigerian Health indices
• The challenges faced by our health system.
• Prescribed solutions
• Concluding remarks and recommendations

Nigerian Health Indices:
The average life expectancy of Nigerians at birth has dropped from 54 years in 2005 to 45 year in recent years despite an overall decrease in population per physician as well as a decrease in population per nursing staff in the country. This sharp drop is largely contributed to by several factors, including deterioration in both structure and organization of the healthcare system, lack of skilled personnel especially in the primary health care centers and, lack of financial and geographic accessibility to the limited healthcare facilities by majority of the populace due to bad roads, political instability and unemployment.

The recent upsurge of road traffic accidents, insurgencies, diseases and poverty have made prominent contributions to the number of people dying in the country. Compared to African countries like Togo, Ghana and Tunisia, the country has the lowest life expectancy at birth (Table 1).

Table 1: Life expectancy in years at birth by sex and country. (World Health Statistics 2007)
Country Male Female
USA 75 80
UK 77 81
Denmark 76 80
Tunisia 70 75
Ghana 56 58
Togo 52 50
Nigeria 47 48

The health status of a country is judged by the number of women and children dying within a specific year. For Nigeria, the number of women dying from pregnancy related issues is the 2nd largest in the whole world, coming after India in Asia and contributing 14% of the 600,000 maternal deaths worldwide.

When put into figures over 800 pregnant women per 100,000 live births die in a year during pregnancy, child birth and within 42 days after delivery irrespective of the site and duration of the pregnancies. In a nut shell, about 145 pregnant women die on daily basis in this country. This means that for every 23 pregnant women in Nigeria, 1 woman will die in the prevailing circumstances.

It is very pertinent that the death of a woman in the house has a disastrous consequence on her family and relations. For every woman that dies, a larger number is disabled physically, mentally and economically by the after effects of the diseases, and this brings about immense socio-economic burden to the family.

The number of infants dying each year from communicable and non-communicable diseases is equally high and so is the number of children under the age of 5 years. The under 5 mortality rate is 143 per 1,000 births, and the neonatal mortality as a percentage of under 5's mortality is 28. According to the World Health Organization, the infant mortality rate in Nigeria is 201 per 1000. These abysmal demographic statistics mean that for Nigeria the health status is still very poor and under developed.

Death from diseases has remained high, although Nigeria has played a key leadership role on health in Africa considering the number of health summits that have taken place in the country. There is an upsurge of deaths from non-communicable diseases such as renal failure, diabetes mellitus, hypertension, cancers and liver failure; and communicable diseases like hepatitis, sexually transmitted infections (HIV/AIDS); parasitic infections (Malaria); and others such as tuberculosis, cerebrospinal meningitis, Haemorrhagic fevers (e.g. LASSA fever), tetanus etc.

Environmental pollution and toxic wastes contamination have also contributed immensely to the number of people dying through unchecked human activities.

Accidental deaths has become rampant in the country in recent years. According to the Federal Road Safety Corps, the number of persons dying from road traffic accident continues to rise despite the measures put in place to stem the tide. Deaths from insurgency in the North East of Nigeria is alarming, although this is now on the decline following the military’s counter insurgency tactics. The health plight of the internally displaced persons resulting from this conflict is still worrisome. The Fulani herdsmen incursion into farm lands and communities in the country during which many people are either killed or maimed is of equal importance. Kidnapping and oil pipe vandalism, with their attendant cost of life and human suffering, have recently become another epidemic in the country. Most accidental deaths involve youths, especially men between the ages of 20 to 35 years, who are supposed to be the prime movers of the national economy. These needless deaths puts a lot of pressure on the meagre resources of the communities.

It is noteworthy that majority of deaths recorded are based on reports from urban centres, whereas there is a silent majority that die quietly unannounced in the rural communities. For every death that occurs, a large number are injured and left with disabilities that put a lot of social and economic burden on them and their relations.

The Challenges:
The three existing systems of health care delivery accepted and regulated by the Federal Government are orthodox, alternative, and traditional but these are poorly integrated and coordinated in the country. Thus various stakeholders get fragmented information leaving their acceptance to individual’s whims.

At the moment there are inconsistencies in medical practice in Nigeria and hospitals across the nation lack a standard approach to managing medical emergencies. Access to healthcare services due to inability to pay, inability to reach existing services and inadequate services bedevil our health care system in the country. There is a general lack of good data and related analysis on health that could allow a systematic review and management of causes of death at state and national levels. Furthermore, there is no national forum for the states to share either their best practices for reviewing ailments and deaths or the relevant lessons that they may have learned.

The Nigeria's poor state of health system is attributable to the collapse of the primary and secondary tiers of medical care brought about by several factors, notably the shortage of skilled medical personnel at the primary health care level and gross under-funding of the health sector by the State and Federal Governments. Manpower challenges is compounded by competition for superiority amongst various groups of health care workers and incessant strike actions by their unions. Poor funding of health leads to poor facilities and medical tourism. These will be discussed further below.

Manpower Challenges:
There is no doubt that Nigerian health workers are well trained to perform basic medical care judging by the ease they fit into the health care systems abroad.

For example, the President of the Neurosurgical Association in United States of America in 2003, Dr. Oyesiku, and one of the best Nephrologist in North Carolina, Dr Yele Aluko, are both Nigerians trained in UCH, Ibadan. Similarly, Dr. Tunde Gbolade and Dr. Rotimi Jayesimi to mention a few, both GCI Old Boys from 1966 -72 Set, are making waves in England. Another Old Boy, Dr. Yomi Olopade is well grounded in toxicology research in the US. I am certain that there are many GCI Old Boys making waves in developed countries.

An appreciable number of well-trained health workers, in search of job satisfaction and personal fulfillments, are lured away from the country to more developed countries where adequate infrastructure and compensation packages are available. Over 10,000 health professionals are estimated to have emigrated from Nigeria to overseas countries in the last decade.

The depressing fact is that a number of these are not practicing their professions due to the restrictive laws in their host countries. Although data on Nigerian doctors that have legally migrated overseas are scarce, it is well known that older brilliant professionals that could have trained their upcoming juniors left the country in the last three decades in large numbers (the brain drain saga). Those who returned after their long sojourn abroad found it difficult to get back into the system. This had left the country with inadequately trained professionals until recently.

Figure 2 shows the proportional densities of doctors and nurses per population in the country between 2005 and 2008.

There is also internal migration of trained personnel from rural to urban sectors for similar reasons within the country. Reports indicate that there are more medical doctors and nurses in Lagos State than in the whole of the states in the northern part of the country combined. Thus there is a dearth of medical health workers in the rural areas.

A survey by WHO in 2007 showed that only 41.9% of primary health facilities provide antenatal and delivery services and 57.73% of such health facilities work without any midwife or physician. In addition, about 20% of such facilities operate without midwives or senior community health extension workers.

The few health professionals that work in the rural sectors are faced daily with substandard working conditions such as overcrowded clinics, lack of appropriate or adequate equipment, long hours of work and delay in getting essential materials from the ministries. Therefore, they are overstretched and constantly faced with motivational challenges that negatively influence their attitudes to their patients and performances at work. Some may exhibit a lack of courtesy to patients; lateness or failure to report for work; poor quality of process such as failure to conduct proper patient examinations, and delay in the management of patients.

Figure 2: Densities of doctors and nurses per population in the Nigeria between 2005 and 2008.
© 2010 Africa Health Workforce Observatory - all right reserved.

Industrial actions in the Health Sector:
Strike actions by health workers have hampered health care services in the country. Nationally in 2014, National Association of Resident Doctors (NARD) went on strike in May for 50days while Nigerian Medical Association (NMA) and Joint Health Sector Union (JOHESU) were on strike for 4 months from November the same year. This was followed by many strikes in 2015. This year alone we have had 3 warning strikes by doctors and 7 days warning strike by JOHESU. Most of the strike actions are based on agitation for financial remunerations.

Lately, some State Governments have reneged on their responsibility to pay health workers salaries for months, and thus fan the embers of industrial actions in the health sector. Unfortunately, the unhealthy rivalry amongst health care groups now seems to be the major cause of strikes. A screaming headline in one of the dailies goes like this; “Nigerian Medical Association threatens strike action if their benefits are shared”. The paper went further to elaborate on the rift between NMA and JOHESU over supremacy and financial compensation from the Federal Government.

Many associations have cropped up in recent years in the health sector. The Nigerian medical Association is made up of the National Association of Resident Doctors, Medical and Dental Consultants of Nigeria and Association of General Public and Private Medical Practitioners while the Joint Health Sector Unions (JOHESU) is made up of Medical and Health Workers Union, Nigerian Union of Allied Health Professionals, National Association of Nigerian Nurses and Midwives, and Senior Staff Association of University Teaching Hospitals and Research Institutes.

The consequences of these industrial actions include disease progression and untimely death of the patients needing treatment. Take for example, a 2 year old with an eye tumor that was confined to the globe that would have been treated successfully by enucleation of the eye. However, due to the strike action treatment was delayed till the eye ball disintegrated and the tumor spread to the whole eye orbit (Figure 3).

Figure 3: Progression of untreated eye tumor in a 2 year old during an industrial action. (Courtesy Dr. G.B.K Ajayi)

The needless strike actions by these groups are demoralizing and have left the populace wondering about the benefit of accessing long term treatment in government hospitals, preferring private practice instead, if they can afford it, otherwise they seek alternative medical care or spiritual interventions. Many now consult government hospitals only in advanced stages of their diseases or for emergency care. This results in delay in the provision of appropriate medical care required by the common man.

It is noteworthy that Federal and State Governments have their own share of the blame for not anticipating pending strikes and proactively preventing them. A government that does not provide social security benefits, does not pay workers salary and pensions for several months, and fail to keep to industrial agreements should not expect unqualified loyalty from her workers.

Poor Health Facilities:
The progressive deterioration in both structure and organization of the healthcare system, lack of financial and geographic accessibility to the limited healthcare facilities on account of bad roads, political instability, unemployment and lack of political will by the Federal and most State Governments to invest adequately on health have combined to compound the problems of health care delivery in the country.

A major challenge to health care delivery system is the archaic and substandard nature of health facilities. Some states in the Federation still rely on the old General Hospitals built by the colonial masters pre-independence. Those that have attempted to renovate their facilities have done so without putting all stake holders into consideration. Many facilities do not have modern day equipment needed for the current trends in medical practice. Some lack the basic needs like portable water, anaesthetic equipment, furnished laboratories, and essential drugs. The degradation in facilities cut across the three tiers of health care institutions being worst at the primary health care centres.

Poor funding of health occurs at all government levels. Nigeria has a low domestic commitment to health, with less than 5% of the country’s GDP going to health, despite WHO recommendation that countries should spend at least 10% of their GDP on health. Compared to the 15% budget allocation to Health recommended in the Abuja Declaration in 2001, the country has very low budget allocations for health programs depending on nongovernmental organizations and foreign agencies to help in the funding. This poor funding has definitely affected the health indices of the country in comparison with other African countries (Table 2).

Table 2: Percentage of GDP allocation to health in some African countries (O.E.C.D 2014)

Country Percentage of GDP allocation
Eritrea 2.6
Tanzania 8
South Sudan 2.6
Swaziland 8.5
Congo 3.6
Algeria 9.8
Nigeria 4.6
Rwanda 10.2
Ghana 5.6
Sierra Leone 15
Cameroon 6
Liberia 17

This inadequate allocation to health care affects both the hospital infrastructures and personnel. At the moment only few hospitals can train doctors that have just graduated for houseman-ship. It is sad that even those that used to do so have lost their accreditation due to either the lack of trained specialists or facilities necessary for the training. Most General / Specialist Hospitals in the country are culprits. Therefore, many doctors that have just graduated from the Universities in this country now roam about without the necessary placement for houseman-ship, and if they do not do so within 2 years post-graduation their certificates are in jeopardy.

Medical Tourism:
Medical tourism is the travel of people outside their country of abode for the purpose of obtaining medical treatment in another country. It involves affluent people from under developed countries going to developed ones for optimum medical treatment. On the other hand, people from developed countries can travel to underdeveloped ones to obtain cheaper treatment.

In Nigeria, wealthy people seeking medical care outside the shores of the country is now a common phenomenon. Over 5,000 Nigerians travel abroad for medical attention every month, resulting in the loss of N78 billion annually to capital flight. The main reasons for seeking medical treatment abroad is the lack of adequate facilities in the country to handle four major areas of healthcare, namely: cardiology, orthopaedic, renal dialysis issues and cancer.

The upsetting issue is that some of these medical tourists do so for flimsy medical conditions that are treatable in Nigeria. There is nothing wrong with someone wanting the best for himself if he can afford the cost of such services but the irony of it all is that most of the trips by affluent Nigerians are sponsored by government or her agencies. Thus medical tourism constitutes a drain in Nigeria’s foreign reserves and underrates medical practice in the country.

The Vanguard Newspaper publication of May 12, 2014 put this succinctly in a report as “The Chief Executive Officer of Nigeria Sovereign Investment Authority, Uche Orji has said that about 30,000 Nigerians spent $1 billion annually on medical tourism”. This echoes the concerns of the country during the World Economic Forum on Africa organized by Price Waterhouse Cooper in 2014. That colossal amount of money can be spent to upgrade Nigerian Health institutions and will provide necessary amenities to prevent medical tourism. If the affluent class has the will and determination to end the capital flight and invest the money back in the local economy and private medical institutions, the need for medical tourism will disappear.

Attitudinal Challenges: Individualism / Self Centeredness.
A major challenge of Nigeria is the failure of elites to live up to the expectations of the populace. Our elites that have been put in position of decision making and execution of policies have personalised their mandate and cared only for themselves, their relations and friends. This individualistic attitude pervades all the ruling class and elites in the Nigerian society.

An incoming governor will abandon the projects started by his predecessor just to start fresh ones in an attempt to “make a mark” irrespective of how laudable his predecessor’s projects are or how inappropriate his own projects are. Some will embark on elephant projects without considering the welfare of their citizens or the projects that will improve the economy of their communities. What is the sense in building airports and highway bridges when workers’ salaries are not paid for months?

Such wasteful projects however are of no benefit to the common man who has not been paid his wages and cannot feed his family. This attitude has led to colossal waste of resources that could be channelled to important projects like improving our health care services. Those who corruptly enrich themselves with the resources that should have been used to improve social services and the lots of the community are accessories to murders or murderers themselves.

However, the attitudinal challenges of Nigerians is not limited to the elites. Most common men are looking for opportunity to get wealthy by whatever means. It is in this country that a man begs for a job but after he has been employed he requires begging to do the job appropriately. Commitment to work is lacking in all aspects of our public service. There is an abject lack of proper maintenance culture in the country among both the elites and masses to such extent that facilities deteriorate earlier than scheduled.

The Solutions:
The solutions to our health care challenges will start with attitudinal change which perceives Nigeria as single entity and treats the people with fairness and in unity. Everybody has to be committed to his job and work to the best of his ability. Corruption is multifaceted. It stems from fraud, dishonesty, malpractice, exploitation, bribery to outright stealing. Not doing a day’s job and collecting the pay is absolute corruption. This should be vehemently resisted in this country.

The current approach by the Federal government may succeed only in exposing some corrupt individuals rather than stop the practice. On the other hand, a carrot and stick approach may prove better and should be considered. On the long run, convincing the populace to have an attitudinal change or an enforcement of attitudinal change may be the solution. The “Change begins with me” slogan of the present administration should form the basis for policy formulation that needs to be embraced without reservation. The populace should change her current consumption mentality to a productive one. If we cannot produce what we need, we will be continually dependent on others to produce them for us at higher costs. India and Singapore now fabricate their hospital equipment.

Provision of quality healthcare for Nigerians:
The various tiers of government have the responsibility for the health of the people which shall be accomplished by the provision of adequate health and social service facilities. The Federal Government should take a cue from Cuba that has one of the best health care services in the whole world despite her poverty. Quality health care services come from policy formulation, adequate planning and funding of the services. The aim is to let Nigerians enjoy good health services with limited out of pocket spending.

Ondo State Government has shown the world how government’s commitment to improving health care services can reduce maternal and child mortality. In the State, maternal mortality was reduced from over 500 per 100,000 live births in 2008 to 170 per 100,000 live births in 2015 (Table 3). Therefore, there is no reason why a woman should die in an attempt to bring someone to life.

Table 3. Confidential Enquiry into Maternal Deaths in Ondo State (CEMDOS)
Year Maternal mortality ratio
2008 545 / 100,000
2012 / 2013 253 / 100,000
2014 / 2015 170 / 100,000

There were 81 maternal deaths in Ondo State between June 2014 and May 2015. The number of annual births is an estimate – 47,700

Governments should embark on the provision of basic infrastructures like good roads, transportation and other means of communication in the rural sector. Standard of living in the rural sectors should be raised, including the provision of basic amenities that improves education, health and wealth of the people. This should be coupled with the establishment of health care centers for the provision of basic health care services such as immunization against the major infectious diseases; mother and child health care, including family planning; treatment and prevention of communicable diseases (including STIs); the provision of basic diagnostic tools; and treatment of non-communicable diseases.

It is important to note that the successes of developed countries and Cuba in their health services is the provision of adequate emergency care services. Therefore, ambulance services, which are lacking in most Nigerian communities should mandatorily be provided in all local government areas as seen in Lagos and Ondo states.

For example, Ondo State Government acquired and commissioned 50 tricycle ambulances (Fig. 4), to be stationed at villages and other communities to administer first aid treatment on patients before they could access the major medical attention. Lagos State, on the other hand, procured ambulances (Fig. 5) to assist in quick evacuation and treatment of accident victims in the state. In addition, all governments should provide enabling environment for health workers to work effectively without sacrificing their families’ education and social lives.

Fig 4: Ondo State Tricycle Ambulances (Courtesy

Fig. 5: Lagos State Ambulance service

The role of traditional and alternative health services in the country should be very well defined and supervised by the governments. Their integration into the current orthodox health services should be carried out appropriately so that the public is not cajoled into patronizing quacks and self-serving practitioners.

Addressing manpower shortages:
The challenges due to shortage of manpower cannot be addressed by the importation of foreign doctors as it is being practiced in some states.
Experience of some states in the country in the 70s has shown that those we can get are not real experts as no foreign country will allow the best of their brains to leave her country. Therefore, Governments at all levels should address the unsatisfactory working conditions characterized by heavy workloads; lack of professional autonomy; poor supervision and support; long working hours; unsafe workplaces; inadequate career structures; poor remuneration/unfair pay; poor access to needed consumables, tools and information; and limited or no access to professional development opportunities.

All efforts should be made to encourage the training of specialists in all health sectors by bringing back the overseas training scheme for postgraduate medical training (The one year abroad). In fact, each state should have a postgraduate training center for medical and dental practitioners, which should be coordinated by the National Postgraduate Medical College of Nigeria.

The non-availability of health workers in the rural communities should be addressed by providing training centers in the rural sectors that give special allocations to the indigenes of the area, and by giving incentives to health workers in the rural areas in terms of hazard allowances, free accommodation and scholarships to their children.

The duties of every health worker in public service should not be limited to a single hospital. Rather each health worker in urban areas should be encouraged to adopt a rural health center for supervision and consultation for one day or two in a week. As compensation for the services rendered, government should pay such practitioner for transportation and lunch each time he visits the center. This will provide assistance to the rural communities without the health worker having to be displaced from his place of abode in the cities. This kind of arrangement still obtains in developed countries e.g. UK.

Postgraduate training should be restructured to allow for exit of trainees at specified points before the completion of the Fellowship programs. This will provide a lea way for those who are not interested in becoming University lecturers but desire specialist training. The training should be directed to satisfy the needs of the country.

The continuous brain drain from Nigeria due to the current harsh economic policies and chronically under-funded health systems can be reversed by improving the remuneration given to health workers and providing incentives to those working in unattractive and harsh areas. This should be coupled with efforts to reduce the growing unemployment among registered doctors and other health workers. Health workers that have left the country and are willing to return to the country should be encouraged to do so by providing job opportunities for them in the communities.

Combating medical tourism:
Medical tourism can be reduced, if not totally stopped, by simplifying the healthcare delivery process either through better time management, cost savings, addressing shortage of manpower, commodities or infrastructure, and improving process of care. Initiation of subspecialists training after initial specialist qualification and provision of enabling environment for graduates to practice will provide the much needed expertise that affluent people seek abroad. The current encouragement of public private partnership that gives wealthy individuals freedom to set up private practice within government institutions should improve infrastructural development.

This will give governments the opportunity to divert funds that will otherwise be spent on procuring expensive medical commodities and equipment required for good health services to infrastructural development. These private investors may help to provide technical expertise needed for sophisticated procedures such as renal and cardiac transplant, eye surgery and assisted conception treatments that the elites seek abroad at a lower cost. Governments on the other hand, by allowing private practice in public service can pay adequate attention to scaling up the improvement of health facilities in the rural communities.

Addressing industrial actions in health institutions.
Industrial actions in health sectors will do nobody any good. Instead it demoralizes the parties involved and does more harm to the sick. All parties must work hard to prevent industrial actions in health institutions. Government should strive to strengthen workers motivation by protecting, promoting and building upon the professional ethos of all health workers. In this regard, governments at all levels must appreciate and promote health workers’ professionalism to meet intended community and personal goals through career development and subspecialty training.

The health workers, on the other hand, should work within the ethics of their profession exuding professionalism in all cases. The fight for supremacy among health workers will be a thing of the past if every cadre of health workers keeps to the stipulated job description and professionalism is allowed to prevail. Both government and the health workers need to consult each other and keep to agreements made at such meetings.

Funding of health services: National Health Insurance Scheme (NHIS) and Public-Private-partnership (PPP).
Governments at all levels should make the health of the citizenry a priority and urgently increase funding of the health services in the country. Allocation of funds to health should meet the bench mark set by the WHO in the first instance while additional funds should be solicited for from donor agencies. The public private partnership scheme is another way to increase funds to the health sector. At the moment, the NHIS does not seem to have permeated to the public as expected, especially to those in the rural communities. The discouraging bureaucracy that surrounds accessing treatment by those already in the scheme should be addressed immediately by governments and the agencies concerned.

Government should consider leasing expensive equipment from manufacturers rather than the outright purchase of such equipment for the hospitals. This will ensure that the equipment are maintained in good working conditions and upgraded appropriately by the lessor at a cheaper cost than when they are purchased and maintained by the hospitals. It will also reduce the syndrome of buying refurbished equipment that will eventually become irreparable when they break down because they are obsolete and lack spare parts. Governments should encourage and fund researches in health services geared towards data collection and policy formulation to ensure improvement of health services to the nation, with emphasis on preventive and curative medicine.

In conclusion, the challenges of health care system in Nigeria is daunting but not insurmountable. Most of these occur due to insensitivity of government and stake holders. An attitudinal change is all that is required from us all to save our health system and statistics. Government need to make all efforts required to strengthen health workers' motivation and, protect, promote and build upon the professional ethos of health workers.

This entails appreciating their professionalism and addressing health workers' professional goals, such as career development and further qualification. Importantly, government should improve on the existing infrastructures and develop the work environment so that health workers can meet personal and organizational goals. Provision of essential materials, equipment and other supplies, along with ambulant services should be made a priority at each tier of the health services to enable health workers carry out their work appropriately and effectively.

The practice of alternative medicine should be reviewed and properly integrated into the country’s health system without undue privilege to any of the groups.

Governance and leadership in health must now be expressed as tangible actions that result in senior managers and policy-makers appreciating and respecting health workers in order to stem the current tide of incessant strike actions. Making job description available to health workers and, promoting professionalism and work ethics will make individual unions perform within the confines of their dictates and reduce clashes between groups. Medical tourism should be discouraged and made strictly self-sponsored. The provision of facilities for the treatment the elites seek from hospitals abroad should be made a priority through funding and encouragement of public private partnership.

I thank the organizers of this program for this opportunity to give this lecture and the audience for listening. I pray that things improve in our country very soon. Whenever there is the will, there is always a way.

This lecture is dedicated to my family tree in CARR HOUSE i.e. my house teachers – Ofili, Ayoade, Olayode, Ogunjobi; and my boys Femi Odumosu and Tunde Akinmoju (the 1st Head of Powell house.).

Thank you and God bless.

Professor Ayodele O. Arowojolu (FMCOG; FWACS; FRCOG).
Fertility Research and Endocrinology Unit, University College Hospital, Ibadan. Nigeria.

A lecture presented by Ayodele O. Arowojolu, a Professor of General Obstetrics and Gynaecology, of the 1966 Set and a member of Carr House; at the Annual National Reunion of Government College Ibadan Old Boys Association on Friday, 21st of October, 2016, at Lalekan Are Hall, GCIOBA House, GCI, Apata, Ibadan.


Item circa: 


File Classification: 

Design and Development by websesame.