HEALTH INTERACTIVE WITH DR. AMINU MAGASHI 

Health Sector Reform: What Model (Part Two)

At a regional course recently at Arusha  city of  Tanzania  ‘ Health Sector Reform , Poverty Reduction and Reproductive Health : Achieving the Millennium Development Goals  organized by Common Wealth Regional Health Community and World Bank Institute , I had the opportunity of discussing at length , the Nigeria’s Health Sector Reform Programme with many delegates from Nigeria who happen to be senior policy makers  within the Federal Ministry of Health . During one of such discussion, I shared my deep reservation about the reform process, particularly the National Health Insurance Scheme (NHIS), which to me is more or less helping the Private Sector to grow while killing the Public Health System.

The reader may recall that the Federal Government about two years ago had launched the Non Formal Sector of the  National Health Insurance Scheme by selecting some villages across the country as pilots. A part from the selection then , which was politically and selfishly motivated  , the programme is yet to take off in other places and even in those pilot areas , there is nothing much to see currently , as a dividend of the insurance scheme . While the Non formal portion remains a mirage , the Formal Sector of the National Health Insurance Scheme which its launching is postponed for the umpteen   time , will be launched on Monday , 6^th June , 2005 . Ironically, the government workers are yet to understand the programme, not to talk of contributing meaningfully for its success, I will come to that later .

As I said earlier on, Professor Eyitayo Lambo and his cohorts are handling reform in the health sector as if it is an oil industry or communication sector, where the investors take all. While the Oil and Communication Sectors  are Social Services, Health is a protective service. On making a comparison between Nigeria and Tanzania’s reform programmes , one is bound to see that ours is entirely Private Sector driven , while the Tanzania’s own , although the private sector has a role to play , but it is community  and pro-poor driven .

Let us examine what the Professor is prescribing to Nigerians and what is being packaged as Health Care Bill which if pass will become our Health Care Act . In that reform document , there are Seven Strategic Components : Improve the Stewardship Role of Government ( which covers review of existing policies , enactment of National Health Act , ICT development and working effectively with State Ministries and other partners ) , Strengthening the National Health System and its management ( covers revising the national health structures and institutions and revitalizing the Primary Health Care System and its management ) , Reducing the Burden of Diseases ( covers routine immunization , response to HIV/AIDS , Maternal Mortality , Malaria , Tuberculosis  and other Infectious Diseases towards achieving the millennium goals ) , Improve Health Resources and their management ( covers construction and institutionalizing  of a national health account , development of a national strategy for human resources in health ) , Improve Access to Quality  Health Services ( covers registration and regulation of traditional and alternative health care providers and reliable system for procurement , distribution and management of drugs and medical supplies ) Improved Consumer Awareness of their Health Right and Obligations ( covers awareness creation of personal obligation to better health , their right to quality care and information on health  and strategy to enhance community participation ) , last but not the least , is Promoting Effective Partnership/Collaboration and Coordination ( covers Public–Private Partnership Policy and a forum for effective donor coordination ) .

The aforementioned , are the seven strategies to ensure a sustain and purposeful reform in the health sector , while Reducing the Burden of Diseases and Revitalizing the Primary Health Care System are laudable strategies if and when properly implemented which of course is a Herculean task ,  looking at past records of government initiating a good project and quitting half way . While those two components are good, some will not only be disastrous if implemented but will kill the public health system, entirely. Take for example , the Strategy of : Strengthening the National System and its Management which among its components is to develop a Program of Devolution of Ownership and management of tertiary health institutions  which will include contracting , autonomization , corporatization and decentralization .

According to my dictionary, Devolution is an act of giving power from a central authority or government to another authority or government in a local region, side by side with that policy if agreed to make it in to a law by the  National Assembly is for the Federal Ministry to create a National Hospital Services Agency to coordinate, regulate and monitor the process of devolution , antonomisation, corporitization and decentralization.

If such law is allowed to see the light of the day , Teaching Hospitals and Federal Medical centers will assume some form of autonomy , may be also managed by few private hands or States and LGAs who have failed woefully to manage Secondary and Primary Health Centers will equally take the responsibility of managing those hospitals where they exists .On the part of the common man , the service fees in such hospitals will be highly exorbitant beyond his reach , such places will not be in any way different from Private Hospitals whose sole aim of establishment is profit oriented .

On a far more effect to the Health System it self, is its gradual collapse, Why did I said so?  Those who follow events at the Teaching Hospitals currently will have seen that the management of such hospitals despite demands and the need for employing resident doctors, their hands are tied and they are helpless due to inadequate funding from the Federal Government. With these new policies  , if implemented the teaching hospitals will be incapacitated to be absorbing resident doctors in to post graduate training , because there will not be much to pay  other consultants , house officers , other health workers not on training and non health workers . In essence the policy will ensure that any medical doctor who wishes to undergo a resident training has to pay for such training and has to scout for money to survive the period of 4 and above years . It will create a scenario of few resident doctors and invariably few qualified specialists in other places and that will affect the overall performance of the Health System.

Another effect is to the under graduate medical students training scheme. We all know that , the last three years of undergraduate training is being spend at the teaching hospitals and most of the practical sessions are carried out by the resident doctors  . With few resident doctors around, the exposure of the medical students will be grossly affected and that will reflect in their overall skills at the end of their training, there by producing less competent doctors and quake services.

In as much as no one wishes such to happen, it is a possibility if the legislatures who will pass such bill did not examine it properly and make amendment accordingly. And I want to suggest that this Bill should be open for more discussion among health professional bodies and other civil societies to ensure making inputs and comments. Lastly while I wish the federal Government success towards launching of the Formal Sector of the National Health Insurance Scheme come this Monday , that important scheme towards revitalizing the health system will form part of our discourse God willing , next week.

Dr Magashi is the Executive Director of Community Health and Research Initiative, Kano, Nigeria.