allAfrica.com: Nigeria: Corruption, Bureaucracy Are Bane of Primary Healthcare Delivery -DR Onuh (Page 1 of 2)

Nigeria: Corruption, Bureaucracy Are Bane of Primary Healthcare Delivery -DR Onuh

Dr Sunday Omale Onuh is Consultant Gynaecologist and Medical Director of Nisa Premier Hospital, Abuja. He told Sunday Trust that corruption has delt primary health scheme a deadly blow. According to him, even the National Health Insurance Scheme (NHIS) has failed to get to the grassroots. Excerpts

What really was the purpose of the Primary Health Scheme?

The primary healthcare initiative was a wonderful and laudable initiative. It was pioneered by Prof Olukoya Ransom Kuti of the blessed memory. Indeed, he put a lot of force to see that the scheme achieved its goals. The essential goal of the primary healthcare was Health for All. Then it was targeted at the year 2000. Now we're in 2008, yet far from achieving the goals.

The essential ingredient of the primary healthcare falls on preventive medicine-prevention of diseases and even if diseases occur, complications are prevented. It was discovered that there was scarcity of health facilities in the country particularly in the rural areas. It was also discovered that highly skilled personnel were not really going to work in the rural areas. But primary healthcare was conceived to take health to the grassroots because most of the health problems of our people come from the grassroots.

So what is the situation today?

Now the facilities and manpower matching the population is a far cry in terms of ratio by the WHO standards. We don't have manpower and where this manpower exists, it's unevenly distributed between urban and rural centres. Qualified personnel prefer to stay and work in urban centres but we know that the majority of the population is in the rural areas.

The primary healthcare was supposed to have healthcare posts where simple ailments could be treated and health talks given and deliveries taken in a clean environment devoid of infections and complications that might arise. The health status of a nation is measured in terms of maternal mortality and infant mortality-how many women die in the course of child birth; how many children under five die because of one thing or the other. We're really not doing well in this area at all.

Several years after the coming of primary healthcare, what do we see? It's appalling. It's very unfortunate that the whole system is almost non-existent. We went down gradually! We talk of the political will, government's participation, and continuity-when a policy is formulated, people would believe it's personal so when the person that initiated the policy goes, the programme dies with the person.

The primary health posts are just like monuments-there are no personnel inside. And where they exist, there're no facilities at all. There's no replacement for what was initially put there.

Well, today, we have what is called the National Health Insurance Scheme (NHIS). I would like to believe that NHIS has come to bridge the gap that has been created by the collapse of the primary healthcare system. But this is largely in the urban centres. The rural areas are still suffering from this collapse of the primary healthcare centres. The rural areas don't even know what we're talking about. But the good thing is the incorporation of the private sector into the NHIS, the private sector has been forced to offer primary healthcare to the populace. As such, people who ordinarily can't afford to go to private hospitals now come to private hospitals. But there're limitations in the sense that-we're good at policy-making, but implementation is always the problem.

The NHIS idea had been cultivated over decades but it came to actualisation in early 2007. We hope and pray it won't die because it holds good for the future of the healthcare of Nigeria.

Is this collaboration really successful?

I see a big communication gap-a big communication collapse between the healthcare provider and the patients who're the beneficiaries; on the other hand, between the healthcare provider and the HMOs i.e. the Health Maintenance Organisations who are supposed to be anchor people of the NHIS; on another hand, between the patients themselves and the HMOs. The national healthcare is supposed to operate in a system that people who're beneficiaries would contribute to this thing. If I'm contributing to something, I should have the free will of choosing where I should go! But you'll see a situation whereby people are contributing they're given hospitals that they don't know where they are located. It means that that healthcare provider will be collecting what we call Capitation on behalf of these people and the people would never utilise the privilege. But that is just a fraction of what we're talking about. The maintenance organisations don't have much information about the operations of the NHIS so they don't get to educate the healthcare providers adequately. And sometimes they misinform the beneficiaries. With that misinformation, they think it's the healthcare provider that isn't doing them good. Rather, it's the system as it were.

I'll give you an instance: the tariff for NHIS was actually made long ago-up to 10 years ago. And when the implementation came only last year, the same tariff was applied without a review. The capitation is N550 per head per month. It means that with this N550, even if the person comes to the hospital 20 times, they're covered. How can the healthcare providers cope with this, knowing fully well that most hospitals now especially private hospitals here in Abuja, will charge less than N500 to open a card?

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