Associate Medical Director for Patient Safety and Consultant Obstetrician, Basildon and Thurrock University Hospitals NHS Foundation Trust, England, Professor Rotimi Jaiyesimi, speaks with Wale Adepoju on how to reposition the health sector for better efficiency.
Our healthcare is one of the worst in the world. How can it be fixed?
I will start on a positive note. Nigeria has brilliant people, intelligent people. What is happening in the health sector is the absence of the political will in terms of investing in the infrastructure.
Secondly, what is happening in the health sector is that there is no framework to monitor the performance of doctors, nurses and other ally healthcare workers.
You could have doctors who are on calls and you don’t see them. You could have surgeons who are supposed to be operating and who don’t even operate for a year; and nobody within the health system holds them accountable.
So, what we need is a framework to help us make sure we deliver what we promised: good quality care and safe care.
As a doctor, the very first thing they tell you is ‘Do no harm.’ But in Nigeria, we know that a lot goes wrong in hospitals and nobody says anything. We will like to see this new government delivering accessible, affordable and safe care to all Nigerians. That is what we need to put in place.
Where should we start from?
We should start from primary care. The primary care has to be looked at. The rural areas, the smaller cities are where most Nigerians live. That is where most Nigerians die.
Nobody wants to go there and serve – doctors and nurses.
Therefore, we need a very well-established, well-run and well-equipped primary healthcare system. But aside having a primary healthcare system to stand alone; if something goes wrong, we still need a secondary care. More so, you need like a referral pathway to secondary and from there to tertiary care.
Nigeria is not short of policies. Various past governments have created policies but the problem we have is in the delivery of the policies. And the reason is there is no accountability. People have got to be held accountable for their actions. If people are held accountable, then things will go well.
Ministers as well as politicians should be held accountable. Every four years, they go to the ballot box and expect the people to vote them in again. What have you done in four years? That is what I will like to see – a framework in place, political will. We spend about three percent of the GDP on health. That is inadequate.
We need about six per cent. I would recommend 10 per cent if we are serious about health issues in Nigeria.
How can the problems be solved?
I have good news for you. We will not solve all the problems in one day. But today, for the last 12 months, Nigeria hasn’t had one case of polio. That is due to what the last government did in terms of polio vaccination and immunisation.
Malaria is something that kills a lot of Nigerians. Today, however, it has been announced that a vaccine has been made available. It has been agreed in Europe. The next thing is to get it to African countries. I will commend Professor Olikoye Ransome- Kuti because he did a lot of works. Other governments have done things too.
The thing about health improvement is a step-wise improvement. It’s continuous. You never get to a level and say, ‘Yes, we are there and we can no longer improve’. Building on what other successive governments have done is the thing. That is what I will like to see this government do.
Malaria drug vaccines and other items for treatment are imported yet these are tropical diseases. Do you foresee a situation where Nigeria can produce drugs for Nigerians? When do you think we will get there and how?
I will look at it in different facets. If we look at research before any drug comes into the market it could be 15 or 20 years of animal studies of phases one and two before going into use.
Nigeria has a National Institute of Research. Perhaps, it is not well-run or perhaps not well-funded. That is why you are not getting the desired output from it. But things are getting better. What is being done now is that some universities are being identified as centres of excellence in its work.
The University of Ibadan has an Institute for drugs and drug introduction. They are constructing the building. I saw the VC about three weeks ago. And again, once that is established, drug manufacturing will be good.
Now, we are forging a link between FIDSON and University of Sunderland. FIDSON is into manufacturing. But now, it wants to go into research, and this is just an opportune time. We were supposed to sign a memorandum of understanding two weeks ago but because the doctor travelled, it didn’t take place. So, there are links and things are going on between the pharmaceutical industries as well. There is research going on within and outside this country with even Nigerians in the Diaspora involved. It is a lot of work.
There is a battle of superiority among healthcare practitioners. How can this can be resolved?
I believe we need to come together. If we don’t see ourselves as a team in this sector, we cannot deliver healthcare. Doctors, nurses, midwives and scientists must come together. We shouldn’t be looking for prominence in the profession but the good of patients.
Without a nurse can a doctor operate? Without a patient can I be a doctor? Therefore, it is a system where everybody has to be respected for what they bring to table.
The weakest link in a chain destroys the system. Everybody brings something to the table. I was brought up where it was a hierarchy of system. As I said earlier without a porter to take a patient to the theatre, you cannot operate.
If your hospital works on generator, without a plant’s man you cannot do anything. So, there is respect in work. You have got to recognise that everybody brings things to the table. Reward, recognise them for what they do.
Once we all understand that we are here for the benefits of the patients and not for our own positions or hierarchy, things will be fine. Unless we do that, we cannot get anywhere. There has to be on-going discussion.
I will give you an example. In the UK, pharmacists don’t just stand behind the counter and dispense drugs. Eight to 10 years ago, pharmacists started coming into the wards to look at what doctors have prescribed.
We, doctors, make mistakes in writing out dosages. But pharmacists are trained to do dosages. Even now, doctors phone pharmacists to ask ‘What’s the dose? So, I think it is recognised now. Physiotherapists, nurses and midwives are professionals in their own rights.
If you look at the universities now, some are employing non-academics to be vice-chancellors. A doctor doesn’t need to be a medical head of a hospital because doctors are trained to diagnose and treat. It brings everybody to the table, respecting themselves. That is what I think will help us solve this.
Government can facilitate this. It will need a mediator, a facilitator. That is the role of the Federal Ministry of Health. If you don’t talk, then maybe, you are living a different life. And everybody is trying to position himself. It’s a surmountable problem.
Maternal mortality is another big challenge. Why is it rising?
Any mother who has a delivery will bleed to some extent. They will need blood replacement. Do we have blood bank service hospitals? No! But people have to go and buy blood. That should be provided by the hospital service. But how do you provide blood in the hospitals? It is through public health campaign for people to come and donate blood.
In the ’70s, people came freely to UCH to donate blood. So, there was no issue about blood not being in the blood bank. There are various areas we need to address. If you have a blood bank in Lekki and the hospital is in Ilupeju, how do you get it here?
Do you have an ambulance service? Or should you have a system where you have small blood bank? That is how I think we should handle maternal mortality.
Infections kill too during childbirth. We can treat infection easily. From a professional point of view, simply watching my hands with soap and water or using the sanitisers before I touch a patient helps. This has brought down infection rate in the UK.
But here, if you diagnose somebody with infection or sepsis, ideally you need one hour you have the golden hour, where you need to do six simple things: give oxygen, take blood, send it to the lab for culture, give antibiotics and IV fluids. Again, these are very cheap things. But not knowing what to do, at times, put us in that difficulty.
But it is not just a Nigeria problem. The UK is waking up to the fact that sepsis kills a lot of people more than prostate cancer or cancer of breast. It has gone to the parliament. It is now a big issue and they are pushing it. So, we have to do the same by doing simple things.
But must doctors always be heads of hospitals?
I disagree with this. As far back as the 70s or 80s when I was in UCH, the Head of the Laboratory Services was not a medical doctor. It was an issue but the man said, ‘I’ve got my PHD in Microbiology? So, why can’t I be the head of the laboratory?’
That hierarchical system shouldn’t exist. There should be respect for everybody. They are all the same. It is no longer a parameter.
Non-communicable diseases are increasing by the day. How do you think they can be controlled?
Two things: lifestyle – the things we eat and what we do. So, it is what goes in and how you burn it out. We are eating all these processed foods. There is KFC and Macdonald.
And, the potion of food Nigerians eat – is a lot. Weight reduction is good. Watch your weight! Nigerians consume a lot of alcohol. We handle it well. Nigerians drink and drive home – they take four bottles of beer still drive. English people will drink and can’t drive home. But it’s damaging their liver silently until they have liver failure.
