Dr Omede Idris, a public health specialist, is the National President, Nigerian Medical Association. In this interview with Winifred Ogbebo, he talks on a myriad of issues affecting the health sector while calling for the creation of office of Surgeon General/ Chief Medical Adviser of the Federation, the passage of the health bill and the resolution of industrial harmony among the health workers.

What is your view on Nigeria's poor health indices rating by World Health Organisation (WHO)?

Well, the poor health indices is by WHO rating and its quite some time now since 2003, when Nigeria was rated 187 out of 191 countries being far from behind. Since then no other rating has come but I want to believe that that rating would have improved over the years and from that period till now.

The reason for the poor indices is more factorials ranging from the side of the patient, the private citizens and the provider. On the side of patient or client, you'll discover that there is poor awareness of health needs in our society and out of that, a good number of the head of a family or family member is a main provider and if he is not available, the other member of the family may not go seeking for healthcare even if the need arises .

So part of the poor health indices is shortage from home. When sometimes you are able to take a patient to a health facility, you may have some reasons where there is delay in getting to the point of health service delivery. Particularly, people that are living far away from where the point of health services are maybe the network of the road services is poor and no means of transportation to move you from your home to where the health services are, particularly in the rural areas, this could worsen the situation.

For instance, if a pregnant woman is bleeding at home in a big rural set up and there is no means of transportation to a nearby health facility, if the road is bumpy and rough, the woman's condition will be worsened.

Secondly, at the point of delivery, there may be some delay in getting attention from the service provider. The cases of healthcare are too numerous for the number of health workers available from doctors, nurses and pharmacists to attend to such situations. It's at this point of delay that death could occur and even when you do get attention, sometimes you may not have the basic things you need to resuscitate, maybe drugs or basic facilities required for resuscitation. If the basic instruments are not there, you will be handicapped.

These are some of the things that seem to be working against the improvement of the health sector, so its multi-sectoral. Added to this, we have people out of ignorance seeking for health services even in the hands of those that are not qualified to render such services, and by the time they get to the right place where services will be provided, their condition then would have worsened, so this is why we will always advise that people should go to the right place or go to the right hospital to seek for healthcare. If people resort to quacks at the end of the day, it will be too late to do anything about it

People are of the view that doctors down tools when it comes to personal gains like salary and allowances, but not on professional grounds. Why?

Doctors' strike is not only on remuneration ground. The doctors have over the years cried repeatedly to the government to improve health facilities in our health institutions.

By this, we are talking of both the infrastructure and the tools needed to work. I told you some of the handicap of the tools needed to work. If those things are not there, no matter how good you are in your field, you will be frustrated by your work. Part of the way the medical profession has demonstrated its dislike, its frustration through this lack of infrastructure and equipment is through repeated reminders to government of need to provide the basic requirements to take care of our patients and their need and at the same time provide the basic needs to train the manpower which is also needed.

We actually abhor strikes because each time doctors go on strike, a lot of damage is done, that is why the NMA as the parent body of doctors, hardly declares strikes because of the implication. We believe so much in using part of the matter, addressing isses directly but unfortunately even in the point of addressing those things directly, the government doesn't seem to respond to those things that have the well being of Nigerians at heart. Some of the things we ask of in terms of equipment and infrastructure are basic things that if we are really sincere and serious about issues, they are nothing that will take so much out of the treasury that they cannot cope.

They are things that will put smiles on the faces of so many people, so many families even the nation because the healthier a nation, the wealthier they are to produce a healthy workforce for all the things we are talking about. We talk about theses equipment, we talk about the infrastructure and of course we talk about power because even if we get some of these equipment and infrastructure, you don't have power to use them appropriately, then you're still back to square one. Remuneration is just one of many things.

We should be talking about the injustices that have been done to the medical profession in terms of remuneration, because in the 70s, talking about 1970 or 1975, doctors salaries were comparable to any other professional group in this country. It was comparable to that of the Chief Justice of the Federation or the justices of the Supreme Court. Suddenly, you can now compare it to any other person even with all that, doctors continue to do their work everywhere. Among all the professional groups you can talk about, this is one group that the professionals can compete favourably even in the face of minimal facilities with their counterparts anywhere in the world and we will continue to provide services.

So there is a lot of commitment to the job but government is not fulfilling its own part of it. Yes, we are making a lot of effort but the effort is slow in terms of achieving what we expect the society to be. So we are calling on government to open its doors to look at these issues more professionally, rather than politically, because when you involve professionals in your scheme of things, it is easier. We've heard over time in this country when professionals become members of an executive, they just take orders from their boss, they are scared without asking questions.

So the only group that can stare at you in the face and tell you this is the issue are the associations because the appointees watch the body language of their boss and follow. So we think if the government really want to move the country forward, it must listen to associations and it must listen to professional bodies and keep the basic things that move the health service delivery together. The most important area is that we are adverse to strikes, but the system often sometimes create room for strikes to occur.

For instance as we speak, the federal government has started implementing the medical salary scale structure, we call it Consolidated Medical Salary Structure. What we want is for all the doctors across the state to be treated and paid the same uniform salary structure even if you are in the rural area because we are all in the same market.

The ones in the rural areas attend more to people, work in more adverse conditions and situations than those in urban areas. My leadership has made several advocacy efforts to address the governors' forum, but as I speak, they've closed their doors. Its when doctors go on strike that people will hear. We believe so much in dialogue. We believe so much in negotiation.

We believe so much in interaction and diplomatic discourse but when people close their doors to you over issues that bothers the people you are serving, what do you do? The providers are also on the receiving end, being pushed to the corner in terms of service delivery and getting all kinds of constraints because you're not giving clients the best of service. We should not take health as if it's a normal business; even when we talk of private partnership, primarily government knows that private concern is our responsibility and it must go all the hog to see that they provide all basic things that are required to ensure that people get the minimum health needs wherever they are. So, it does not make sense as long as he is qualified, why a medical doctor in rural area should not earn as much as one working in the urban area. So why won't the state governments do what is right?

These are issues the federal government can address, call these states together, the national council of state should be able to address, the national economic council should be able to address and see where they can proffer solution to this kind of sporadic one man show that governors are doing all over the place. Everyone is doing his own thing the way he wants it. If we want to be taken seriously, to achieve a significant level of health, to be among the comity of nations that attain MDGs, to be among the nations that achieve Vision 20:2020, then we must get serious about the issues, we should not politicise everything.

Health is not something someone should play politics with, yet we can vote money for other trivial things heavily. Our problem basically is that we have a lot of misplaced priorities and because investments in health just like education is not something someone can reap immediately, and politicians like to invest in what they can see immediately so they don't seem to keep so much attention to it. But its time Nigerians should tell the system, this cannot continue, if they are here to lead us, to govern us, then they should do things that are in the betterment of majority of Nigerians not a handful.

We want government at various levels to open their doors for discussion on health care delivery and remuneration to medical and dental practitioners and health workers. The creation of office of Surgeon General/Chief Medical Adviser of the Federation, which was there in the 60s, and passage of the health bill before the House of Representatives which will give health care delivery is an added impetus.