31 December 2012

Nigeria: How Would Yobe's Health Care Investment Impact Its Future?


Thomas Carlyle, the witty nineteenth-century Scottish philosopher, captured an abiding, elemental truth about the centrality of sound health to the functioning of any society when he said, "He who has health has hope; and he who has hope has everything". There is no greater wealth any people can hope for than health.

A healthy citizenry nourishes and guarantees reproductive futurism, that is, the intergenerational perpetuation of humanity. That was what British statesman Winston Churchill meant when he remarked that "Healthy citizens are the greatest asset any country can have."

Given how pivotal health is to humanity's continuity, national governments and international organisations have devised several policy frameworks to systematize healthcare delivery to the society, especially to the weakest and most vulnerable elements of the society. The question that pops out effortlessly from the foregoing is: what is Nigeria's healthcare policy? The truth, as we all know, is that there is really not so much to make a song and dance about. However, as a public health enthusiast, I have observed that in spite of the general bleak outlook in Nigeria's healthcare policy regime, there are a few bright spots in some states.

One of such states is Yobe. Although the state has its own fair share of challenges in healthcare delivery, its overarching short- and long-term policy framework seems to me not only praiseworthy but a model for states that share similar characteristics. In other words, states that are rural, agrarian, educationally disadvantaged, geographically distant from the central government, etc. can learn a thing or two from Yobe State's health care policies.

From the perspective of an outsider who nonetheless has an intimate familiarity with the healthcare policy of many Nigerian state governments, it seems to me that the Yobe State government's health care policy rests on three interrelated planks: provision of affordable or free healthcare to the neediest in the state wherever and whenever possible, incentivizing medical practice, and investing in medical education for the state's indigenes.

It is common knowledge that the people who are apt to suffer total disruptions of life as a result of medical emergencies are the poor. Most of them die preventable deaths because they can't afford the cost of medical treatments that involve surgical procedures. The pathos of this sad reality inspired the Yobe State governor, Ibrahim Gaidam, to introduce a never-before-seen policy of free surgery for vulnerable members of the society. Other kinds of surgeries have been so subsidized by the state government that they are almost free. For instance, a caesarian section (CS) that goes for N700, 000 or more in some private hospitals in Abuja costs only N4, 800 in Yobe. Yobe is probably the only state in the country that provides free surgeries to its citizens.

In addition to free and/or subsidized surgeries for its citizens, Yobe State also implemented a policy of providing free drugs for pregnant women and children 5 years and under. The policy, which lasted two years, has been temporarily discontinued for now because of some anomalies the government observed in drug quality and distribution system. However, Governor Gaidam has disclosed, during an inspection of medical facilities in Damaturu last Thursday that the policy will resume in early 2013 after the problems that led to its suspension have been sorted out and resolved.

While the health sector is retrofitted gradually, the government also provides medical assistance to patients all across the state to treat ailments that could not be treated locally. These include, but apparently not limited to, kidney transplant, spinal cord injury, brain surgery, and orthopedic cases. So far around N300 million is said to have been spent in medical assistance to people from different parts of the state over the last two years.

However, as much as the government is desirous of providing free, affordable and qualitative healthcare to its citizens, it has to come to terms with the reality that its location on the fringes of the country and its educational disadvantage deprive it of much needed medical manpower. Governor Gaidam decided to confront this time-honored problem in two ways: a short-term strategy of encouraging the medical professionals currently serving in the state through incentives and enticing medical professionals from other parts of the country with attractive packages.

In furtherance of this strategy, the Yobe State government went on record as one of early states in the country to implement the CONMESS salary scale for doctors and the CONHESS salary scale for nurses and midwives. Yobe started the implementation of these salary packages nearly two years ago. Some states are only just now beginning to implement them. This move has served to both keep current medical personnel in the state and as a possible attraction to others from elsewhere.

Other ways the state government encourages medical personnel in its employ is that it grants, without fail, the requests of all doctors who apply for scholarships for residency or for post graduate studies. In spite of the risks that such magnanimity entails (for instance, some of the doctors may decide never to return to the state after the acquisition of their additional qualifications) Governor Gaidam has told people close to him that he is a firm believer in the virtues of giving professionals opportunities for re-education and self-improvement. Similarly, to ease the work of doctors who work in the state, the government has recently provided new medical equipment, beds and mattresses worth over N300 million for the major hospitals in Damaturu, Gashu'a, Potiskum and Gaidam.

The result of Yobe State's indulgent treatment of its medical doctors manifests prominently during international assignments. For instance, according to information from the National Hajj Commission of Nigeria(NAHCON), for the past two years, Yobe State has often emerged as one of the states with the best medical teams during the Hajj to Saudi Arabia.

But, after all is said and done, there is a limit to how much the state can continue to depend on people from outside its shores to man its healthcare delivery sector. However much "outsiders" love the state, they will have to go to their places of origin someday. It's the inescapable reality of human existence. Governor Gaidam realizes this and therefore began an aspirational investment in the medical education of Yobe State indigenes. As Napoleon Bonaparte once said, "If you want a thing done well, do it yourself." The government is pursuing the "do-it-yourself"policy in the following ways:

First, medical students of Yobe State origin studying in institutions of higher learning have been automatically put on a monthly salary on GL 06. This has now been revised upward to GL 07. The intent of this policy is to encourage them study at ease and return to the state after graduation. And, although many of the beneficiaries of this gesture go elsewhere to practice after graduation, the government has still continued with the policy.

Second, nurses who spend mandatory two years in the employ of the state government are automatically given sponsorship to study for a bachelor's degree in nursing. In many other states, nurses are never extended the privilege to go back to school after just two years of service.

Third, the state government supports medical students at the University of Maiduguri to organise "Yobe Week" every academic session where they undertake outreach activities in local communities. This periodic exercise keeps them wedded to the community and increases the chances that they would choose to stay and practice in the state upon graduation.

As part of its investment in medical education--and in the future of Yobe State citizens' health care--the government also built a new 200-bed hospital in Damaturu, which it has designated as a prospective teaching hospital for the fast-rising Yobe State University when a medical faculty is established for it in the future. The ultramodern hospital, whose equipment are underway as of the time of writing this piece, is expected to be commissioned sometime in 2013.

For me, the most impressive of Governor Gaidam's health policy is his massive, praiseworthy investment in the medical education of his people. It takes a far-sighted, statesmanly governor to look beyond immediate gratification to a distant future. Perhaps Governor Gaidam is familiar with the works of Greek physician Herophilos who once said, "When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied."

The best any government can do to its people is to invest in their health. Yobe State seems to be on the path to doing this.It isn't quite there yet. As the saying goes, the room for improvement is the biggest space in the world. The hospitals, for example, could do with more equipment and personnel. Fortunately, the state is blessed with a governor who recognizes that government needs constantly to review and improve on services from time to time and that any observed lapses are always noted and addressed.

This inspires confidence and hope that in the near future, Yobe people would not have to go anywhere beyond the state for those colonoscopies and endoscopies and mammograms - services that Yobe professionals, supported by the state government, can provide for their own people. Perhaps Hafiz Hirazi's poetic line, "I went in search of heaven, did roam, return and find my heaven is here at home", finds some resonance here.

Abba Alhaji, a public health enthusiast, writes from Sabon Pegi, Damaturu Yobe State

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