By Emmanuel Onwubiko
Anybody who has never gone through a near-death experience may not fully appreciate what it means to go through the valley of the shadow of death that has become the daily routine in most public hospitals in Nigeria.
It is a fact that Patients who are not financially empowered and left with the option of patronising the publicly owned general or local health centers are meant to go through a near-death situation because of the certainty of the uncertainty of quality of treatments and drugs that such a poor patient would get.
The public health system in Nigeria has systematically collapsed under the heavy weight of perennial and persistent managerial corruption, inefficiency and ineffectiveness of officials of government.
All that a researcher needs to do to gauge the real situation of affairs in the nation’s public healthcare is to pay a visit to any general hospital anywhere in Nigeria and to take the pains to visit the laboratory and ask the relevant questions of the functionality or workability of the critical infrastructures in and around the hospital. Such critical factors like survival rates, patient safety, specialized staff and hospital reputation are not available in much of these public hospitals and these are essential factors for determining the standards of hospitals.
The first sign of doom that would stare you on the face the moment you enter a public health facility anywhere in Nigeria is the environmental insanity and degradation. You would be shocked to see medical workers competing for space with rodents and cockroaches.
The medical and non-medical staff does also run their petty businesses by the side making the public hospitals appear like a multipurpose shopping complex.
The next bad sign to notice is that the moment power supply system from the national grid is switched off as is often the case with the epileptic electricity power supply system in the country; you would notice that most of these public health facilities lack functional generators to power the critical health equipment. Virtually all the public hospitals that can afford run diesel powered generating sets as sources of their electricity power thereby spreading pollutants around the environment and further exposing their patients to the risks associated with environmental pollution.
A story was once told of a man who took his relative for common surgery of appendicitis but had to also go to the general hospital with a generating set just so the procedure would not be interrupted by poor power supply.
The public healthcare system in the country is going through some of the worst forms of criminal negligence and abandonment.
One reason for this is the phenomenon of foreign medical tourism by most government officials and their family members.
Another related cause of the total degeneration of quality in the public healthcare is the lack of professional supervision and the next giant reason is the porous mechanisms of public procurements that create room for corruption.
The Bureau for Public Procurement is weighed down by multifaceted factors of corruption and bureaucratic inefficiencies.
I will return to discuss the causative factors that have led to the gradual and systematic collapse of the public healthcare but first let us examine emerging scandals from the presidential medical facility in Abuja.
The wife of President Muhammadu Buhari, Mrs. Aisha Buhari is in the news as expressing her disappointment about the poor state of facilities at the Aso Rock Clinic.
The wife of the president expressed her frustration at the total non-availability of basic amenities at the prime health facility set up by the federal government to take care of the health and related well-being of the members of the political class within the presidency and also the staff who work within the confines of the presidency.
The presidential clinic is known to be one of the most heavily funded government’s owned health facilities in the country which gets humongous budgetary releases yearly.
The question raised by the wife of the president came within few weeks of the reported castigation of the Aso Rock Clinic by the daughter of the president who expressed strong views to depict the clinic as being badly managed.
An interesting factor is that the Aso Rock Clinic was set up just like a “father Christmas” avenue whereby free medical services are offered to patients composed of the privileged few who are already earning so much money from the central treasury of Nigeria.
The Aso Rock’s Health center is said to provide medical services to the president, vice president, and their families, members of staff of the state House and other entitled public servants.
But even as the Aso Rock Clinic offers free medical services to these aforementioned beneficiaries, the question to ask is why are there no checks and balances in the management of such a prime facility?
What are the steps put in place to ensure transparency and accountability?
What steps are being implemented to ensure that drugs and other essential equipment meant for that clinic are not diverted?
These sets of interrogatories are critical because of the loose practice amongst Nigerians whereby there is the tendency by many to abuse any opportunity of benevolence because it is generally believed that with humongous crude oil money flowing into government coffers, whatever goodies anybody can grab from government must be done with reckless abandon.
In framing the above questions, one is aware of the unreasonableness of providing free healthcare services to top government officials particularly when such persons do still enjoy generous allowances.
Again, if the family members of the state House can have unfettered access to Aso Rock Clinic, what kind of family members do we mean given that in Africa the extended family system is deeply rooted in our culture?
It is possible that occupants of top political offices operating within the Presidency will open the floodgates of free Medicare to their kiths and kins in the name of being family members. African and Nigeria’s notion of big man sometimes means that those who occupy privileged positions behave like persons who are above the law. Indeed, even the militarily hand-picked writers of the extant constitution inserted a crude provision under section 308(1) which gives blanket immunity from prosecution for about 78 executive office holders such as the President, his VP; the governors and their deputies.
There is this climate of impunity that this section creates making it look like these persons can do just anything including carting away public assets even from public clinics without being called to account until such a person vacates office. So the questions of probity and integrity of the process of managing Aso Rock’s clinic are largely yawning for transparent responses.
Let’s also ask the managers, what kind of data is maintained in the Presidential clinic to record the beneficiaries and their status?
What is the quality of regular audits that are carried out in that Aso Rock’s clinic to block leakages and theft of public fund which both the EFCC and ICPC Acts criminalizes?
Why does government subsidize healthcare services for some selected few who are in the corridors-of-power whereas the people who are the owners of the sovereignty of Nigeria are allowed to die from commonly treatable ailments such as malaria fever?
Section 14 (2) (a) of the Constitution states as follows: “Sovereignty belongs to the people of Nigeria from whom government through this constitution derives all its powers and authority”.
This sacred provision therefore means that any activity of any government official that compromises the health and security of the people of Nigeria must be seen as a threat to national security and the offending government officials must be prosecuted and punished for this crime against humanity.
In such serious countries like China, Singapore and even Vietnam, public officials who steal fund meant for public healthcare are executed in firing squads.
But in Nigeria which prides itself as the largest black nation in the world and claims to practice constitutional democracy, the most attractive job is politics whereby successful public office holders do not have to worry about the effectiveness of the law enforcement agencies even if they decide to empty the entire health budget of their states into their private pockets.
It is only in Nigeria that the millions of people are left to die whereas the few government officials are ferried abroad at public expenses to be attended to by foreign doctors.
Millions of rural and urban poor in Nigeria are left to their cruel fate and do often suffer sudden deaths because of the insufficient health care facilities and medical workers at their services. Doctors and medical workers in public hospitals have lately made it a routine to always embark on strike over disagreements with government on conditions of service just as all of these persons divert their human resources to run their private clinics thereby allowing poor patients to die gruesome deaths.
These challenges of non-availability of functional public healthcare are compounded by the high rate of absolute poverty afflicting over 100 million Nigerians meaning that they cannot afford to pay for private health services which are few and far between. In the last two years the cost of pharmaceutical products has shot through the roofs due to high taxations by the Nigerian Customs services and the fees charged by the National Agency for foods and Drugs (NAFDAC). Because of non-affordability by millions of ordinary Citizens of these foreign pharmaceutical products, they are exposed to the deadly vagaries of patronising cheap and substandard drugs and quacks. These are consequences of the depraved tendencies of the elite to service their greed at the disadvantage of the many that are poor and not privileged.
Just one example will suffice to show you how crude and wicked political office holders are in Nigeria and to show you that they do not care about the welfare of the people which in any event, is the primary constitutional duty of government.
This example that has come in handy is the 2016 and 2017 annual budgets that go to the state House Abuja whereby this non-performing Aso Rock Clinic is located.
In all of the last two years, the princely sum of N22.5 Billion is budgeted for the state House Headquarters.
Then look at the shocking statistics from the United Nations which shows that 5.1 million citizens are faced with food shortage due to the insurgency in the North East.
UNICEF also stated that 2.5million children in the country are severely malnourished even as only N50, 000 is required to treat each child but the public officials spend hugely from the public till to travel to foreign jurisdictions to meet doctors for their health services at public costs.
Even president Muhammadu Buhari whose wife has raised the alarm about the state House Clinic, has spent many months in the United Kingdom for medical treatments costing Nigerians tons of millions of dollars.
The presidency has still not disclosed how much of public fund was spent for president Buhari’s several months of foreign medical tourism.
Mrs. Buhari criticized the managers of Aso Rock Clinic for allegedly blowing away N3.89 billion last year and has yet to account for N331.7 million budgeted for it this year.
The situation of Aso Rock Clinic is a huge signal to show that Nigeria’s public healthcare is in an emergency situation. If the prime healthcare center in the Presidency lacks even ordinary syringes to administer on patients, how much worst will the local health centers in Arondizuogu or Kaura Namoda be?
The Nigerian government must therefore take decisive actions to bring the public health emergency to a minimal level by tackling the hydra-headed issues of medical tourism and the different levels of corruption that have led to the collapse of the public healthcare.
The shame of the entire drama is that all the political elite have sinned and fallen short of the glory of exonerating themselves from these vices tearing down our public healthcare.
Nigeria should classify corruption in the public health sector and Defence as offences punishable by the death penalty to serve as effective deterrent and to stop Nigerians from dying only because they have no money to patronize private hospitals.
The national health Insurance scheme must be reformed to efficiently provide services to poor Nigerian and get millions of Nigerians to enroll. Besides, the corruption that surfaced recently at the NHIS must be frontally tackled and dual principles of transparency and accountability be restored.