17 February 2013

Nigeria: To Reduce Polio, We Have to Improve Enlightenment Strategy - NMA President

Benin — In this interview, the National President, Nigeria Medical Association (NMA), Dr Osahon Enabulele, said the Lagos crisis involving 788 doctors gave his newly elected exco great trouble. Excerpts:

So far, how has it been since you became president of the Nigeria Medical Association?

It's been very challenging because we met an immense task on ground especially with respect to earlier strategic approaches we had adopted as an association and the need to effectively change that strategy to be able to engage issues to be more effective and meet the health needs of the people of Nigeria as a professional organization. I got elected on the 4th May 2012 and we set a blueprint for us to appropriately drive some of these proposals.

Of course, you know that soon after we emerged as officers we had just three days to settle down when we got on our hands the Lagos crisis where 788 doctors were sacked. That was a very monumental struggle. Anyhow, we were able to rescue the situation.

We are always conscious of the cardinal principles and objectives of our association. So in the last eights months that one has been in office it's been very very engaging-very challenging but again it gives one a sense of fulfilment. We've been able to within that frame of time get people to appreciate us. We are rebranding our association. We want to make people understand that it's not just about our members' welfare but also the rights of the Nigerian people.

Prior to the Lagos crisis which resulted in the sack of over 700 doctors, strike actions were rampant. All that has stopped. Is it fear of sack or what?

For us to appropriately place the NMA as a real professional organization, we have to understand and appreciate the fact that there are certain tendencies, certain strategies we have to do away with. We will need to engage the society from a more constructive point of view. Options like strike should be the last because there are issues that can easily be sorted out through constructive engagements.

Like the Lagos crisis, the whole nation expected that the NMA was going on a nationwide strike. But we had our own options, we had our own strategies, we didn't want to further injure the masses, the down trodden, the less privileged ones, the innocent Nigerians. We told ourselves that as pig headed as they [government] were, we were not going to go into that direction. We were not afraid of sack but we devised a new strategy of engagement and that is paying off everyday for the association. Today Nigerians appreciate what the NMA stands for.

Many Nigerians are not happy with the health delivery situation in the country. The NMA has always insisted that the Health Minister must be a medical doctor while pharmacists say 80 percent of health is administration of drugs. Why does this crisis between medical doctors and other health workers linger?

This is one sore point that is very manifest in the health care industry in Nigeria. It's quite unfortunate because Nigeria is not the only country where healthcare is practised. Nigeria is not the only country where you have health care professionals. Everywhere in the world, there is what is referred to as international best practice and that is to say even without any discussions, without any attempt for territorial quest, it's accepted for the fact that in terms of medical practice doctors by virtue of their vast knowledge, by virtue of their broad based knowledge or exposure, their skills, their experience they are the most suited to head the health teams.

That is not in dispute. What has happened over the years is perhaps the tendency to politicize issues within the health care environment. It's not true that 80 percent of the management of hospitals is the administration of drugs. If anything at all, you talk of human management and the doctor is the one that sees most of the patients most of the time. In fact, without a doctor, you cannot have any healthcare activity because it's the doctor that is seen first by the patient and the doctor, as part of his statutory responsibility, very effectively and humanely coordinates the other health care practitioners, coordinates the other healthcare services to ensure that the patients get the ultimate or utmost care from that healthcare facility.

So it is not palatable to find that in this second decade of 21st century we still have this level of acrimony. There is no better management of patients than clinical care.

How far can Nigeria go in the Millennium Development Goals, health wise?

I have said it repeatedly at different fora that I'm not one of those that jump on the bandwagon of sermonizing global declarations when even at the very beginning we do not have what it takes to match up with countries. I see these issues of MDGs and other declarations perhaps as efforts to get people working towards a target not necessarily to say "oh, by 2015 everybody must have reached that". Because you cannot imagine that Nigeria starts from zero and hope that by 2015 we will be in the same place with America when America from the beginning is already ahead of us.

Nigeria has basic challenges that we are yet to overcome even as basic as water supply, potable water that is very important in driving MDG's--he issue of education, the issue of infrastructure which impacts on health, the issue of housing which impacts on health. Countries that signed onto these declarations have since conquered these problems and so they can achieve the Millennium Development Goals much faster than poor countries.

So Nigeria has no basis to sign a declaration that seeks to meet targets in a year that well endowed countries are also itching to reach. Certainly, from all indications, it's clear that 2015 will come and go and Nigeria will not be able to meet the MDGs. That is not to say that substantial efforts have not been made by governments in terms of improved maternal child care, in terms of improved educational opportunities especially in terms of the female gender, in terms of reducing maternal mortality, infant mortality, reducing poverty. All these go together.

Nigeria has done well in some aspects. For instance, the maternal mortality rate now shows some level of decline. As at 2003, the maternal mortality rate was wavering over a national average of 800 per 100,000 but as at 2012 figures were 545 per 100,000. It shows some improvements but we are not yet there. The figure is still very high, so I do not need a prophet to know that by 2015 we will not meet the targets of MDGs.

But that is not to say that the efforts that have been made by the various agencies of government are not appreciated. They are commendable but we need to intensify those efforts. That is why we question very seriously the poor budgetary allocation to health in 2013 budget. We thought that we need to step up efforts aggressively to ensure that we do the needful to meet the target of MDGs by 2015. But here we are, we still have 6.2 percent allocation to health.

Nigeria is one of the few countries in the world that still suffers polio. What is the best way to address the problem?

It's actually a sad situation. Efforts are being made especially by the National Primary Health Care Development Agency but religious barriers are preventing people from allowing their kith and kin have access to immunization services and that is why you find the disparity in the immunization coverage in the country.

That has not helped matters. We always want to put the issue of advocacy in driving improved immunization services, in improved immunization coverage especially for those parts of the country where there are still these barriers. So advocacy is very paramount in trying to breakthrough the cultural, religious, traditional and educational barrier--to let people appreciate and understand that this is not an injurious service. If anything at all, it's going to improve your productivity and our economy.

Second, as an independent country, we should begin to think of our own self-sufficiency in the production of vaccines. Nigeria today does not produce vaccines. That is a strong mitigating factor against effective immunisation coverage of Nigerian.

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