BUHARI and the Future of Healthcare in Nigeria

It is no longer news that Nigeria’s former Military Head of State (December 1983-August 1985), General Muhammadu Buhari (GMB) is now its President-Elect.  Since his historic victory on March 31^st 2015, I have pondered over the future of the Nigerian health industry under a GMB and an All Progressive Congress (APC) presidency. Sometimes, to determine the future, one may have to look back at the past. Using GMB’s antecedents and the APC’s manifesto on health, one may deduce how the health sector will fare under him. Before I continue, I must state that I am not a member of any political party. I am simply a Nigerian Blogger and a concerned stakeholder in the Nigerian project.

So, what will a GMB presidency bring to the health sector? What is expected of GMB in the next 4 years?

Firstly, the foundation of a viable health sector in any country is a solid Primary Health Care System. In my opinion, without a functional primary care system, we will never get it right in the health sector as a nation. A good primary healthcare system is a necessary focal point for the prevention, early detection, treatment and monitoring of diseases. As the Petroleum Trust Fund (PTF) Executive Chairman (1994-1999), GMB helped build Primary Health Care Centers (PHCs) all over Nigeria. So, I think GMB will focus on the primary healthcare sector. He will most likely empower and adequately supervise the National Primary Healthcare Development Agency (NPHCDA) to ensure that it actually carries out its function. Increasing the life expectancy of Nigerians by an additional 10 years is one of the policies of the APC. A good primary health care system will help in achieving this dream.

In addition, a GMB presidency may educate and encourage patients to visit the primary health centers as their first contact with the nation’s health system. This will free personnel and facilities in tertiary centers to focus on research and treatment of more serious medical issues. With a strong primary health system, quacks and charlatans in our health sector will gradually be phased out. Rural dwellers will no longer visit quacks when they know that their local PHC is properly staffed, adequately equipped and stocked with affordable generic drugs.

In his first stint as Head of State, GMB launched the Expanded Program on Immunization (EPI). So, I expect the current pace of immunization to be sustained and even improved. I also see the National Health Insurance Scheme (NHIS) being rapidly rolled out to cover every Nigerian. With an improved uptake of the NHIS, healthcare will become more accessible and affordable.

In secondary care, I foresee GMB putting pressure on State Governments to ensure that the General Hospitals in the states are working. In the past, the PTF equipped many General Hospitals in the country. It is therefore easy for me to expect drugs, equipment and personnel to be available in these centers. There will probably be more incentives for doctors to actually live/work in semi-urban and rural areas where many of these general hospitals are located. I believe incentives will work better than coercion or force. The referral link between the primary and secondary care centers will have to be reinforced as well. This will help to reduce the Infant Mortality Rate as well as the Maternal Mortality Rate.

For tertiary centers, I think GMB’s commitment should be to enhance training and retraining of future specialist doctors and other health professionals. Research should be encouraged and incentivized. There is a gross absence of funds for quality and meaningful research in Nigeria. Without research, medical science cannot grow. Without research, we will still rely on medical technology from the Western world and now the Eastern world. With meaningful research on the other hand, our tertiary hospitals will grow and be able to offer specialized services to reduce the current trend of medical tourism.

One of the reasons for medical tourism is the inability of our major centers to diagnose and handle many diseases. GMB will most likely stop government officials from spending the Nation’s foreign exchange on incessant medical trips for ailments that can be conveniently handled in Nigeria. This move will ensure that these monies are plowed back into our health system and help improve performance.

Hmm, what will happen in the pharmaceutical sub-sector? Going by his love for Nigerian products, GMB will probably encourage our pharmaceutical companies to develop drugs using local raw materials and indigenous technology. In addition, I can still remember seeing the PTF branded drug envelopes containing good quality generic drugs as a medical student in the 90s. So, I envisage the availability of standard drugs in our hospitals. The influx of fake drugs across our borders will be stopped or at least reduced. The National Agency for Food and Drug Administration and Control (NAFDAC) will also be empowered to actually control the administration of food and drugs.

For private hospitals, I expect improved regulations and monitoring (not harassment) from government agencies. The aim should be to standardize practice and boost quality. I expect a closer partnership between government and the private sector in healthcare delivery. Though he was not really open to foreign investment in his ‘first coming’, I expect GMB to partner with local and foreign investors to build and operate world class specialist facilities in all the geopolitical zones of the country.

GMB should also work towards fostering unity and teamwork in the health sector. At present, teamwork in the nation’s hospitals is at an all time low. This problem is not related to Nigeria alone. Recently, I read an article highlighting a relationship issue between anesthetic nurses and physician anesthesiologists in the US. 

Though this problem seems to be universal, I think it can be reduced when there is mutual respect, less egoism and less grandstanding among healthcare professionals. There should be a consistent and conscious realization that everyone has a place in the medical team. Health professionals should remember that though the sky is large enough for every star to shine and be noticed, having two captains on one ship could lead to disaster. The patient should be the focus of healthcare delivery and not individual units of the health team.

If the way the Lagos State government has handled striking doctors is anything to go by, and if GMB’s reaction to the strike led by Professor Ransome-Kuti in 1984 is taken into consideration, then a GMB presidency may not be receptive to incessant strike actions in the health sector. Alternative dispute resolution mechanisms should therefore be sought after. Mediation and Arbitration should be actively encouraged and outcomes respected by all concerned. Using strong arm tactics may be counter-productive in the long run. It may only encourage another mass exodus of doctors that we badly need to meet APC’s target of 50 physicians/1000 Nigerians.

Before I end this post, I am quite sure that GMB will tackle the endemic corruption in the health sector. This will make certain that the money for healthcare will actually be spent on health; not on private mansions.

On a final note, I eagerly look forward to a positive change in Nigeria’s health sector. If actions do speak louder than words, then the health sector will do extremely well under a GMB Presidency.

Congratulations to all Nigerians on a peaceful and successful election. Cheers!