Healthcare in Nigeria is a challenge only second in importance to security – citizens and patients are dying in hundreds because of lack of access to care or from poor care. Healthcare workers are adding to the problems rather than solving them – Healthcare needs a change in Nigeria. The national health service as it is currently constituted, is not viable or sustainable for patient-centred care – a real change is needed. The Nigerian national health system is like a football club that has excellent players who are not coached as teams and without a team, no club can score goals.
Nigeria missed the MDGoals and while other nations are bouncing forward to sustain their goal-scoring or winning ways in the SDGs through team work, Nigerian health care professional groups are scoring own goals! The reduction of the current crisis to arrogance versus rivalries (by many commentators) is over simplistic and unhelpful for the management of underlying causes, furthermore, the widespread caricature of this serious problem for jokes downplays the impacts on lives, caricature like this: “Can you imagine the army of a nation that would not train or work with their naval counterparts and navy pilots would not co-operate with their air force colleagues for emergency airlift of the wounded and critical supplies unless they are given air force grades?”
Sounds very much like what is going on in the Nigerian health service and it is tempting to dismiss the problem as insane and laughable until one steps back to ask two basic questions. First, why does this scenario not actually occur in the military, second, why would perfectly sane professionals behave so irrationally?
The answers are revealing, first, critical thinking and strategic planning were hugely invested to determine and develop a suitable military structure at independence. This made provisions for the position of a Joint Chief or CDS (“bridge maker”) to build and maintain effective communication channels between the various arms headed by a chief, which facilitates rapport, good relationships that pave the way for the officers and men (from various forces) to engage in joint training and working – a very active process.
For the health service, there was little attention to strategic planning at independence. The focus was very narrow – to build hospitals and train Nigerian doctors (who would develop their system for their nation). Consequently, the Nigerian health service evolved from what can be described as a small unplanned building with foundation of a bungalow into a stacked up giant tower now standing with 58 levels and leaning perilously! The main problem of the health service is at its roots (fundamental standards).
This is why every intervention so far has been like sticking plasters on a deep wound. Secondly, because the health service was left in the hands of doctors to develop for patients and for all other professions, no serious thought has actually gone into proper team building – being a doctor or being referred to as a doctor (see power dynamics displayed by the statues at LUTH entrance) became the focus rather than the needs of patients.
This led in large part to the poor judgement that occasioned the rejection of Prof. Dora Nkem Akunyili (Pharmacist)/Transformational DG at NAFDAC by the NMA in 2008 from taking up the health ministerial portfolio. This rejection caused utter disillusionment of non-doctors in the service and became a catalyst for the formation of rival unions, the drive to acquire doctors’ titles (not for patient care but for parity of esteem) and the big divide that has become filled with irrationality.
Arrogance is detestable, so is irrationality because understanding the cause of irrational behaviour does not make irrationality rational – both sides need to grow up. Are these challenges beyond remedy? No, but sustainable solutions will require re-design and re-ordering of priorities from personalities to PATIENTS and from silos to SAFETY, to be achieved through Patient Charter (“Healthcare constitution”), the Duty of candour and of course, honest and strategic leadership that will be fair to all parties (“bridge maker” role).
An essential part of a new structural re-design would be UBERHealth: a public/private partnership initiative (PFI) whereby government will focus on funding and managing healthcare (rather than managing unions’ crises), where co-located contractors delivering many services will be directly responsible for their staff. Staff directly in the employment of the government will drastically reduce, the others, including doctors having private clinics (to be referred to as part-timers) shall relate to the government through their company/cooperative representative or through an entirely new contract that will no longer bog down governments in crises management.
UBERHealth is highly effective means of delivering qualitative, safe and cost-effective care; it will save the government money that can be invested to improve the service, saves time and lives by treating patients instead of egos. UBERHealth is new and not traditional, therefore traditional health leadership would struggle – no one can give what he/she doesn’t have.
Nigerians are fed up with the status quo; even the squabbling unions accept that the current model is outdated for effective healthcare. A re-think and a re-design (strategic) in a new model of healthcare delivery are urgently needed for Nigerians. How many more thousands have to die before this system that has little concern about patients’ suffering and deaths is changed? •Dr. Isemede, a consultant, NHS England, is director of Patient Safety Africa.