CHITO NWANA, a consultant Obstetrician and Gynecologist and the medical director/CEO of Tabitha Medical Center in Abuja, speaks with MODESTUS ANAESORONYE, on the need for more recognition of private healthcare providers by government, especially in policymaking. Nwana who is the outgoing chairperson, Guild of Medical Directors, FCT, talks her medical advocacy for better health care in Nigeria, women’s health and more. Excerpts:
As the outgoing chairperson of the Guild of Medical Directors, FCT, what are some of the achievements by you and your team during your tenure?
When we started, our goal was to focus on raising the standard of healthcare in the private sector to be able to improve patient trust in the health system with the ultimate objective of reversing medical tourism. We then realized that there were significant challenges in achieving these goals. One of them was multiple taxations and illegal levies that were imposed on private health facilities. These ranged from hundreds of thousands to millions of naira, adding to the operational expenses of these facilities. Coupled with the lack of financing options for hospital business, most facilities were barely surviving. So, to demand an improved standard of care (which involved the upgrading of facilities and equipment) would be an uphill task.
We also realized that the root of these challenges was the lack of engagement of the private health sector by the government. It is as if the government views the health system as only comprising the public sector. This is wrong being that the private health sector by any ramification, offers healthcare to more than 50% of the population.
Therefore, we spent the first half of our tenure advocating for the removal of these unnecessary taxes and levies. We also advocated for a stronger relationship between the government and the private sector. We believe we achieved our objectives, albeit that we didn’t realize the desired results. Through advocacy visits, judicial intervention, and legislative hearings, we were able to get the attention of the FCT Minister. The outcome of the committee that was inaugurated by the FCT Permanent Secretary yielded recommendations to remove these taxes that were approved by the FCT Minister. We are still faced with challenges regarding the implementation of these recommendations and we hope to continue to fight for them to be incorporated into law.
The evidence of the improved relationship between the FCT and private health facilities was evident with private health sector involvement in the management of the COVID pandemic in the FCT. There is still more work to be done in this regard as the government does not recognize us as providers of essential services, but merely as entrepreneurs. We are still not included in healthcare policy making which is one of the reasons why many policies are not properly implemented.
In the second half of our tenure, we focused more on ways we can build our hospital practices hence improving the standard of care and reversing medical tourism. It was evident that Nigeria has the expertise, resources, and population to reverse medical tourism and generate revenue for the country. One of our key concerns was the fragmentation of the private sector and low business management skills of the owners of these health facilities, which makes us unattractive to investors. Through webinars and strategic partnerships with national & international organizations, we were able to start the journey in creating sustainable networks that will strengthen the private health sector.
There is so much work to be done in the private health sector and the Guild of Medical Directors as a body will continue striving to achieve positive change in this regard.
You have strongly advocated for health sector reforms especially through your role as a Chairperson of the Guild of Medical Directors. What are some of the health reforms you hope to see in 2021 and beyond?
The problems in the health system are complex and we need reform in every sector of our health system in regard to medical education specialization, hospital processes, and delivery of quality health care. But I will focus more on the government coming up with health policies that will lay out a framework in which the private and public sectors will work together in achieving universal health coverage.
This kind of reform will positively impact our health system on all levels. We must also seek reform in areas that have been found to encourage brain drain of health professionals such as specialization, hospital infrastructure, education, and proper remuneration of healthcare professionals. I believe these are the areas that we should work on.
What is your appraisal of the response by stakeholders and handling of the COVID-19 pandemic? Also, as the vaccines have arrived in Nigeria how would you recommend the government handle its storage, distribution, and reach?
I will commend the national and state level (including FCT) response to the Covid pandemic particularly NCDC who started early to prepare against the COVID-19 virus. Notwithstanding there were challenges in executing some of these protocols which could be due to the novelty of the situation. I still want to commend the frontline health workers and state public departments for working tirelessly to ensure that there is minimum morbidity and mortality caused by the pandemic. One area that still needs significant work is in bridging the gap between the private and public health sectors that was made more evident during the pandemic as this negatively impacted the national covid response. Despite the spike in medical supplies, the government seemed not to be able to control the pricing of these supplies, subsidize or even supply PPEs to assist the private health sector to function during the pandemic. As a result, there was decreased access to medical care during the height of the pandemic.
I am not a public health specialist, so I cannot say much about the best way to organize and distribute the COVID vaccine in Nigeria. But I will emphasize that the same level of priority be given to the private and public health sectors in the reception, distribution, and administration of those vaccines. The whole process must be transparent to the people so that they can be confident in taking the vaccine, given the misinformation that is already out there about the COVID vaccines.
In Nigeria and other African countries, professional bodies in the health sector only come into prominence when they are battling with the government for better pay and working conditions. As a member of several professional organizations in the United States and across the globe, how can our medical professional bodies contribute to making the medical profession better?
As mentioned earlier, the problems with our health system are complex and the functioning of this system is heavily dependent on government funding and regulation. Hospital infrastructure (working conditions), process (including remuneration) must be strongly put in place as these negatively impact the delivery of care to our patients leading to the poor health indices that we see. In looking for ways to get the attention of the government, organizations that advocate for public health workers tend to go on strike. This has not provided a lasting solution further jeopardizing and risking patients’ life. So, it’s time that all professional bodies in health care create a strategic alliance (including the private health sector) to gain better attention from the government that will lead to the implementation of health reforms that will improve the care provided to the patients and welfare of the health professionals. This may make more of an impact although it presently still seems a far-fetched reality.
There is a natural curiosity about the healthcare infrastructure in Nigeria and why brain drain is more prevalent in the medical industry. Why does brain drain persist?
First of all, our health system does not yet work effectively or efficiently. It consists of the private and public sectors in which the public is solely funded by the government as opposed to private which is funded by the private, albeit regulated by the government. One of the problems is getting the system to work, which has led to the reason why we are experiencing massive brain drain in the health sector. The system makes it difficult for health professionals to realize their potential causing them to seek other avenues to fulfil their dreams. Research has shown the most common reason for brain drain are poor working conditions (hospital infrastructure), remuneration, and the desire to specialize. I believe if we find solutions to these causes, we will be able to mitigate these major problems we are facing in Nigeria concerning brain drain among our medical professionals.
On this side of the world, medical tourism is prevalent. The haves and even the have-nots raise money, fly to India, the US or Dubai, etc. for medical procedures. Why has there been no improvement in local healthcare delivery despite investments by various governments?
We must first look into what makes their health system uniquely different from ours. An expert in health care management once made a very important statement – ‘Your health care system more or less reflects how much priority you give it”. The Nigerian government has not yet made health care a priority, so the necessary interventions have not yet been geared in the direction of Nigeria becoming a medical hub in health care. One of the important interventions is the investment into the health sector by the government and the private sector. Also, there should be incentives given to the private health sector allowing them to expand their service without much constraint.
If you look at these health systems mentioned, they have been able to form collaborations and partnerships with international health organizations, they gave incentives to their well-versed professionals in the diaspora to return and contribute to the country. They also gave tax incentives to their private health sectors and health care professionals and most importantly they made health care a priority in their budget. So, I am assured we will make progress once we make it our highest priority.
For young doctors of African heritage in the Diaspora reading this, is there a place in Nigeria for them and where would their services be most needed?
Coming from the Diaspora myself, I will say it is difficult to adapt to the practice here in Nigeria. I was fortunate to have the support of my family to help me adapt to the rigors of practicing in Nigeria in the health space. I believe that there are a lot of Nigerians in the Diaspora who can contribute to our health sector as we already know we have many Nigerians in the sector that have done outstandingly in other parts of the world. There should be nothing hindering them from sharing that expertise in Nigeria.
March is recognized worldwide as women’s history month. With your experience working with women of all ages, what health and wellness message will you like to leave our women with?
We should take time out for ourselves and pay attention to our health. Most women find themselves taking care of others without taking care of themselves. We must make an effort to adopt a healthy lifestyle at all ages and ensure that we have a well-woman exam yearly. We ought to also remember that good health does not only include physical health but includes mental, emotional, social, and financial health as well. So, we can strive to achieve complete wellness. We should always remember that we are phenomenal women doing phenomenal things.
