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“Nigeria has the capacity to produce vaccines locally”

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"Nigeria  has the capacity to produce vaccines locally"

Kunle Olawepo

Prof. Kunle Olawepo is President of Nigerian Orthopaedic Association; Treasurer, West African Orthopaedic Association and a former Chairman, Nigerian Medical Association, North Central Zone. In this interview with STANLEY JOHN, he proffers solutions to current challenges and issues in Nigeria’s health sector

There have been many strikes in the nation’s health sector. What is the cause of this development?

The state of healthcare delivery in the country in contemporary times is deplorable because the government is essentially shacking its responsibilities in the sector. Our President (President Muhammadu Buhari) not long returned from the United Kingdom (UK) for a medical check-up; Have you ever heard about the Prime Minister of UK or President of the United States of America (USA) going abroad for a checkup?

He who wears the shoe knows where it pinches!
If top government functionaries and their families attend/utilise public health facilities in the country, then they will see first-hand the true state of affairs and can therefore agree to a need for a complete overhaul.

Strikes are the endpoint of a long harrowing process of pains, complaints, lamentations, and frustrations caused by the excessive workload on doctors, unfriendly work environment (infrastructure and services), non-availability of optimal appropriate work tools, and inadequate remuneration which is further nose-diving on a monthly basis for no reasons whatsoever.
All of these, inconsistent government policies and audacious draconian circulars together with lack of commitment to honour agreement freely entered into by the government are factors responsible for what has turned out to be incessant strikes by residents and other groups of doctors over the years in the country.

Is the nation’s health sector not being endangered by these incessant strikes?

The nations health sector is seriously endangered already and that is what the doctors’ strikes are either meant to correct or draw the attention of government, stakeholders, and or the general public.

Strikes, I repeat, is the endpoint of a dysfunctional health system and the consequent frustration. It has never been a first option or a reflex reaction.
The negative effect of strikes is unfortunate, even doctors are affected too as we are patients too and we have patients who are our relatives too. So it is very unfortunate!

What should be done to prevent further strikes in the health sector?

Going back to the original drawing board to fix the fundamental issues usually culminating in strikes such as maintaining a decent doctor:patient ratio, adequate budgeting for health and adherence to World Health Organisation (WHO) recommendations or African Charter agreement, a friendly and healthy work environment, provision of necessary equipment, ensuring that government functionaries attend public hospitals and adequate remuneration for workers shall go a long way in fixing the mess that the health sector has become. Imagine Doctors earning a hazard allowance of N5,000 across all cadres even with the advent and persistence of the ravaging COVID-19 Pandemic whereas in this same country, lawmakers who are not seemingly endangered in their daily function allegedly take multiple folds of that home monthly as the same hazard allowance. Once the issues raised are addressed, strikes shall become history.

Is the approach of the Federal Government towards the ongoing NARD’s strike right?

Strike has never been the first option nor is it a tea party, remember that doctors took the oath to save lives. Also, remember that Labour laws provide that adequate notice must be given before commencement of any strike; why is that? To enable the government to address grievances, but what do you find?

Not until the commencement of strikes before concerned authorities start scampering up and down trying to blackmail doctors!

Government should address the issues raised, including previous agreements freely entered into with resident doctors to resolve all areas of discord rather than employ the slave-driver or the slave/master approach. Resident doctors are also aggrieved that some House Officers have not been paid for several months in spite of work done!
Also, there is an obnoxious circular by the National Council on Establishment seeking to remove House Officers from the Federal Salary scheme.
All are germane issues to be addressed and resolved; definitely not by threats or coercion.

Has the National Association of Resident Doctors’ leadership not rebuffed all efforts by FG and the Senate to resolve the impasse?

On the contrary; no!
They have made themselves available for engagement and discussion towards a resolution to the best of my knowledge but it seems to me that Government wants to give orders and expect it to be obeyed with military fiat. Over the years, NARD has learnt that Government may not be consistent in the implementation of agreements reached and so may insist on the signing of documents instead of suspending an industrial action based on verbal commitment.

Are you happy with the state of the nation’s health sector? If, not, could you suggest measures for improvement?

Definitely No! No one living in this country would be happy with the current public health sector.
In addition to measures mentioned earlier, the provision of a National Health insurance policy aimed at covering everybody in the country will go a long way in alleviating a huge burden from the cost of accessing quality health care.

Also, Universal Health Coverage; meaning no matter how remote one lives in the country, access to quality specialist healthcare must be available within a short distance to wherever one resides.

How has your particular specialisation faired? What should be done to address some of the challenges in your specialisation?

Well, the field of Orthopaedics and Traumatology is one area where excellence has been the watchword. It is a field of Medicine where precision has to be strictly adhered to. Virtually all subspecialty of Orthopaedics is freely practiced at the top level in the country and this has allowed the field to contribute significantly to the reversal of medical tourism; a son of President involved in an auto crash was treated by our specialty and has recovered completely and in fact, is billed to get married soon. A former Governor of Kogi State is also a beneficiary of the expertise of practising surgeons in our speciality in this country too with complete recovery.

The challenges of my specialty are that it is a technologically driven field, so the cost of acquisition of instruments, equipment, and implants is relatively high, so emphasis on the government’s support/intervention to enable acquisition of the state of the art equipment is important, especially in bringing down the cost to the end-user. Universal coverage of the National Health insurance Scheme would be of great benefit in this regard of allowing affordability on the part of the average man on the street.

Nigeria has spent a lot of money importing vaccines from abroad. Should it not be better for arrangements to be made such that some of those vaccines, even essential drugs too can be produced in the country?

Sure, it is always best to be in control and not waiting or begging for the benevolence of others.
In the 1950s up to the 70s, vaccines were freely produced in Nigeria but over the years, production stopped. India is one of the leading vaccine producing countries since the advent of the COVID-19 pandemic.

Nigeria has the capability and manpower to produce vaccines for its citizens if bureaucracy and bottlenecks are expunged. Essential drugs to the best of my knowledge are freely produced in the country but we can do better by stepping up; a lot of cancer cases are diagnosed needing treatment and production of such drugs locally should drastically bring down cost and naturally increase affordability on the part of the patients, improving survival and the quality of life.

Is there a cause for concern about doctors emigrating from Nigeria?

Oh yes!
To put things in proper perspective, it is not just emigration but a massive exodus of doctors; the number now leaving monthly would scare anyone.
In the 1980s and 1990s; foreign countries were only poaching Specialists/Consultants from Nigeria but in this new wave, all levels and strata of doctors are being employed abroad.

As a teacher, I get requests for reference letters in numbers weekly; some of whom have already arrived on the shores of the recipient countries.
Nigeria needs to get its acts together otherwise the gains of producing doctors in numbers to cater for our health system at cheap cost and huge economic impact will be completely eroded in no distant future. The list of recipient countries continues to swell by the day; UK, US, Canada, Australia, Saudi Arabia, South Africa, and the list goes on; especially following BREXIT and its implications to the UK and also the employment of front liners in the global war against the ravaging COVID-19 pandemic which has been changing virulence via various strains unnecessarily prolonging that scourge and its attendant negative effects on all spheres of human endeavours.
Interestingly, I attended the West African College of Surgeons Annual Conference in Cotonou, Benin Republic in June this year and was embarrassed to see that the country may soon join the list of recipient countries above!
For the whole week that the conference was held, there was absolutely no power (electricity) disruption, together with a close to an excellent work environment in the hospitals.
Remuneration for Chief Consultants / Professors in the Teaching Hospitals were more than three (3) times the income of commensurate scales in Nigeria!
So, Nigerian Doctors may just not need Visas to emigrate anymore but walk across the border to experience a blissful Medical practice.
The time to wake up and fix the infrastructure and functionality of the public health system in Nigeria is now before we lose all of our good hands and have to rebuild from the scratch; remember Rome was not built in a day!

Don’t you think there is a need to improve on the course content or curriculum of the medical students to be in tandem with global standards and dynamism in knowledge?

The curriculum of Medical schools or even Postgraduate training in the country has always been topnotch and never defective!
The Medical and Dental Council of Nigeria (MDCN) together, The National Universities Commission (NUC), together with the Postgraduate Medical Colleges (Nigerian and West African) continue to insist on best international practices and that is why the doctors emigrating to all parts of the globe easily fit into the host countries and indeed may be bringing resilience and how to work in a suboptimal environment onboard. The challenges here are infrastructure, work environment, equipment and motivation; curriculum and course content have never been antithetical.

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