Professor Ume Okafor is a well-known Professor of Medicine, Consultant Physician and Consultant Nephrologist based in Enugu. A soft spoken personality but who attacks questions with precession of a surgeon’s knife, he predicted that “in the next 5-10 years there will be only few doctors left to take care of the Nigeria populace,” pointing out that Nigerian doctors “are leaving the country in droves.”
He spoke with Sam Nwanze in a no-hold-barred interview on the current strike by Resident Doctors and other challenges facing Nigeria’s health sector.
Excerpt:
Que: Please, who is Professor Okafor and what are you doing currently?
Ans: Thank you. My name is Professor Umezuluike Okafor. I am a Professor of Medicine, a consultant physician and a Consultant Nephrologist. I am currently working with the Enugu State University of Science &Technology (ESUT) Teaching Hospital. I am married and God blessed us with children.
Que: Let us start with the current strike of the Resident Doctors. Who is a Resident Doctor? And what kind of work do they do? What kind of problems that have created their constant strikes in the Health Sector?
Ans: We are starting with who is a Resident Doctor. Resident Doctors are those who are doing their Post Graduates in Medicine. Medicine here is a generic name covering all care specialists in medicine. We have categories of Resident Doctors with variable experience and seniority. We have those who enrolled immediately after Youth Service. We have those who have passed the first stage of the exams (primaries exams), those that have passed the second stage of the exams (part 1 exams), those who have passed the third stage of the exams (part 2 exams) and awaiting appointment as a consultant.
All of them are Residents. So, for them to measure up with current state of things just like every other arm of government currently asking that there will be adjustments they are on strike. You understand? And they are the bulk of the doctors in most of the Teaching Hospitals and Specialist Hospitals. Like I said, they are in training and also working. They play very crucial roles in the hospital system where they are residence.
Okay. On second part of the question, the problems that their constant strikes have created in the health sector. I think we should also talk about why do they go on strikes. What made them to go on strikes?
Like I told you, they are like the workforce of the Teaching Hospitals and Specialist Hospitals. And even though they are in training, they perform that bulk of work.
Residents training actually, when it started is supposed to be sponsored by the government. Even though they are working, they are not being paid what is commensurate to what they ought to be paid. And there is what we call the Resident Doctors Act. An Act establishing the Resident Programme in this country allow that they should be trained, that government will sponsor part of their postings outside their local hospitals. And we find out that over the years the government has been reneging in most of those things that hitherto was in the Act establishing them.
And because of that from time to time, these things are being revisited. You find out there is disagreement. And also, you understand what the country has been, the spate in inflation, the state of our currency. So, for them to measure up with the current state of things, just like every other arm of government currently asking that there will be adjustment in the pay, so these are some of the things that brought about disagreements that lead to the incessant strikes like the current strike they are in. The current strike is because there was an agreement but the government did not keep to their own side of the bargain. And if you cast your mind back some weeks, there was also a warning strike and nothing was done. And that led to declaring strike.
So, most times it is actually the government side of it that trigger the strikes. And I can tell you the younger ones, unlike some of us who have been in the system for a long time and can bear and endure a lot of things, can’t bear it. So these young men and women have a lot of future ahead of them and unfortunately we have government that before they honour the agreement that have been made, you have to go on strike, you have to be warned, the upheavals and so on. So, the incessant strikes are because most times the government don’t honour the agreement reached with the residents.
Que: What are the kind of problems created by their constant strikes to the Health sector?
Ans: They are numerous. The truth about it is that if we have a system where the populace are taken into consideration, nobody should think about such hospitals getting closed. Currently they are talking of most teaching hospitals are not functional, most specialist hospitals are not functional. Those that are functional are rendering skeletal services. The surgeries that should be done are not done. The people that could have been saved are not saved. So, a lot of people die. They ought not to die. You understand? Because of the strikes.
Irrespective of whatever we say, we still have the best of hands in those hospitals. And also their cost is much much friendlier than costs of the private hospitals. So, these incessant strikes have led to distortion in trainings. Currently, Nigeria is faced with big challenge, very huge challenge with the current mass exodus of medical doctors leaving the shores of Nigeria daily. And even the little left they cannot treat them well.
I am going to tell you that even though Resident Doctors are being trained, they also train the medical students. There is distortion in their own trainings, there is also distortion in the training of medical students. So, you find out that they are worsening it. In fact, most of those training as medical students, almost 90% of them are planning to leave the country. There is also threat to succession in the medical profession as the young ones are not encouraged to practice within the country. Thus training and subsequently production of more doctors/specialists are in jeopardy. It is terrible.
So, the strike is not helping matters. It has caused a lot of problems. There is human capital loss, there is also the loss of economy. There is also the loss of the social aspect of even the populace.
Que: As a senior doctor, what do you think should be done to make the Resident Doctors stop their frequent strikes?
Ans: Well, first of all is that we have a government that is insensitive. Though we tell people that the allocation to health should be about 15% or 20% but most times the subsequent governments including the last government, except that the current government is promising to make it 10%, you find out that allocation to health is 5%. So, you find out that most times things that are supposed to be done to stop these situations are not being attended to.
So, let’s have the government that is sincere and is going to keep the agreement reached with the residents.
Then, also to have government that will bring the health status of the populace to the fore. If they are sincere, and honour those agreements, obviously these strikes cannot hold. For instance talk about the claims on hazard. How much is being paid? Then, what we call the Resident Training Fund. It is a fund they are supposed to release to fund the training. But it is difficult thing for them to do so. So, let the government honour the agreement made with the residents.
Then, things are getting tough, things are getting rough. To register, the Residents end up using almost the whole money to register for training. The government should try also to help them in their training. To help sponsor some of the exams, sponsor some of the conferences they go. Also let whatever stipends they are getting from the government be paid as at when due. The inflation is going higher, they should touch their salary so they will be able to meet up with the current inflation in the country.
The Residents end up using almost the whole salary (which is not commensurate with the work they do) for training and exams. The government should try also to play their part in their training as specified in the Act. To help sponsor the updates, conferences, postings, exams etc. If they will be able to do that, it is going to help. Also it does not look popular but the government has thrown over a carrot. We know there is real challenge of privatizing the health sector.
Privatizing will bring so many problems to the country. Some people will not be able to afford that. But we cannot run away from that. We can also go into Private Public Partnership. It is going to help maintain the hospitals and also to stop these strikes and interruptions that we have been having in the hospitals. So, honouring the agreements and also government boosting up the Health Centers will help reduce the problems.
Que: As an expert who has been in the system for a long time, contributing to the medical needs of the people at a higher level, give us your views about the status of the health sector in the country.
Ans: I think you should have used the word abysmal. I have been opportune to have traversed the states in about 5 teaching hospitals in the country. And I can tell you that Health Sector has been nosediving from there. I remember in the late 80s and early 90s that we were in school and probably the young doctors then, there were things that were in the scene, and now 30 years down the line, instead of improvement they have gone down.
For instance, I know as a medical student, we had wonderful Intensive Care Unit (I.C.U) that were functional 24/7. They may not have been the state-of-art equipments but they were functional. We had refrigerators. We had functional oxygen packed. But now you find out that you have I.C.U. they spent millions of naira to establish but they are not functional. They cannot be maintained. Covid-19 exposed these terrible state of facilities in our health institutions with poor maintenance. Most of the facilities acquired then have either disappeared or non functional. You will be surprised that you have teaching hospitals that cannot run basic investigations like x-ray.
It is that terrible. I have had a situation where hospitals cannot afford cleaning materials. Surgeries being cancelled because of oxygen.That will tell you the state of the health sector in this country. And we are talking about tertiary institutions. Nobody is talking about the primary health centres. I have a primary health center in my town. Whenever I go there I keep wondering. It is like a one man show run by a Nurse or Community health worker. There is usually no doctors and nothing like supervision. I keep wondering what the health supervisors including Commissioners report.
And you find out that each year, probably also people report rubbish, reporting they have done this or that. They have not done anything. If you go to most hospitals, you will cry. And to worsen the situation the populace itself, their awareness on issue of health is low. We have done a test knowledge attitude and practice of several ailments and found out that the Nigerian population, they are very very ignorant of most illnesses. And that is also a very big issue. And each day, you have Arms of Enlightenment Health Educationists. You begin to wonder, what are they doing?
So, it calls for concern. It is also unfortunate that life expectancy in Nigeria is comparable to life expectancy in neighbouring Niger Republic, life expectancy in Chad and such African countries. If you look at that you will cry for Nigeria.
Talk about the infant mortality; prenatal mortality. It is very high. It is a terrible situation. In my area of specialty Renal Medicine, well we thank God for one or two or three helping centres that came up. Irrespective of how big that government hospital is, none can stand the test and say they have what it takes. Apart from one private centre (BUTH) in Kano that can manage kidney in totality from prevention to kidney transplant. That will tell you the hopelessness of the situation. But people like us believe that tomorrow will be better.
Que: Also, what are the possible things to employ so that the country can enjoy good health system where both the healthcare practitioners and the Nigerian people can be happy?
Ans: Sincerity of the government. Everything rests and revolves around government. It is not easy to run a private hospital in Nigeria thus, private hospitals without support from government and its agencies will not solve our health needs. So, it is sincerity in government. Most advance countries they have Health Insurance that run majority of the health care. But what happens with our country? The National Health Insurance Scheme (NHIS) was established about 10 years ago, we thought that at last the problem has been solved. But the insincerity of the government agencies that have been given the roles to supervise this ventures ensured it didn’t succeed.
Recently, the National Health Insurance Authority (NHIO) has been established which makes it mandatory for all Nigerians to enroll into healthcare insurance. This is very good policy but if not well implemented with all sincerity, it will still go the way of NHIS where the health providers and the populace were shortchanged by the health maintenance organizations. A well implemented health care insurance is the key to alleviating the current abysmal state of our health.
Also, government should increase health budget to acceptable level. Let people be paid what they are supposed to be paid. The current president, I am surprised that he is talking about minimum wage. I remember during his campaign, he said he was not going to pay minimum wage, but living wage. The country where we are now, we should be able to pay people living wage. The wage that they deserve. The health sector is in a terrible condition. The truth about it is that if nothing is done, I am telling you that in the next 5-10 years, we will hardly find doctors that will take care of people. And it is unfortunate.
I keep on telling them that doctors are moving out of Nigeria in droves. Make provision for adequate supply of management of the hospitals. And let insurance work. If the insurance starts working, truly functional, in fact, a lot of things will change. And I think this will be the starting point. If insurance starts working, you find out that the health practitioners will be happy and the populace will be happy.
Many highly skilled and experienced doctors who are expert in different areas have left the country to look for greener pastures abroad the reason is that they are being underpaid. Those that stay for the love of the country let them be paid well to avoid financial insecurity. So, the main driving force for leaving this country is money. People are not being paid well.
Imagine that you are in Nigeria, you are collecting the equivalent of about one thousand dollars. The consultant in this country. In fact, some of us the younger ones, they collect less than one thousand dollars a month. And you move to a country like Saudi Arabia, they are paying 10-12-15 thousand dollars a month. The difference is homogenous. In fact, it is terrible. We have my colleagues that are in Sierra Leone, some of them have gone to Liberia, some are in Gambia right now.
So, it is to improve the remuneration. So many of us that say we are not leaving this country because we are too old to start going out, but the truth about it is that if you think of it, you keep saying is it really worth it? So the challenge is that people are being underpaid, the second one also is insecurity in the country. Because people want to be happy where they are working and feel secured. So many doctors have been kidnapped or killed in this country.
Currently, a consultant in Calabar has been kidnapped for about a month now and yet to be released. And also, the facilities are not being well equipped to provide the basic equipment that they need to work with. There should be conscious and consistent efforts by those in government to make the health sector functional in this country for good of the people. It is said that health is wealth but we seems not to take this serious in our country. This is bad.