On the poor state of public hospitals

By The Editorial Board of The Guardian Newspaper

The recent outcry by doctors under the aegis of the Nigerian Medical Association (NMA) over the imminent death of public hospitals underscores the desperate situation in those hospitals. Being critical stakeholders, who are compelled to work in dire conditions, the doctors are justified to have been frustrated to cry out over the embarrassing situation.

Their alarm was contained in a statement issued at the end of their National Officers Committee (NOC) meeting. According to the NOC, apart from the appalling state of affairs in the healthcare delivery system, “for almost two decades, the nation’s health sector has been unduly traumatised and continually subjected to crippling upheavals by persons who want to redefine the time-hallowed and universally accepted meaning of medicine and medical profession.” It laments that the destabilising group has been aided by the acquiescence and collusion of some persons in position of authority to foist a state of frozen conflict on the healthcare delivery system, which is to the detriment of the public.

The NOC called on the relevant authorities in government at both the federal and state levels, to come to the rescue of the nation from the impending doom in the public health sector. For one thing, it requested that the Medical and Dental Council of Nigeria should be reconstituted so that appropriate regulatory activities can be effectively executed in line with legal provisions.

The decay in the public healthcare system today is totally different from what obtained in the good old days when there were cottage hospitals, health centres and dispensaries in communities across the country. The colonialists and missionaries bequeathed an old structure that worked. Unfortunately, all of these have been destroyed.

Because the nation’s population has grown, requiring increased expenditure in public healthcare, this has not been the case, with the result that all health-care amenities have been destroyed. Basic things are lacking. There is no commensurate number of health facilities to cater for the teeming population. And as if that is not enough, there are incessant, often justified strikes by doctors, nurses and other health workers, which cripple service delivery.

Of course, health workers are not without a share of the blame. Poor attitude to work is legendary. The doctors sometimes though seem to lose sight of the ethics of the profession that honours the sanctity of life. Instead, some doctors, nurses and other health workers often exhibit the worst form of cruelty to patients. The practice whereby doctors refer patients to their private hospitals where they are exploited without adequate treatment is well known. Nigeria must return to an active primary healthcare system to stem this ugly tide.

In the past when primary healthcare was given preeminent position, hygiene was taught in schools and health inspectors visited homes to enforce cleanliness. There was civic education through which people knew their duties to their communities and country. A framework to strengthen primary healthcare is, therefore, urgently needed.

There are contending forces that need to be tackled. How to stop the strikes by health workers appears to be an urgent task. Thereafter, ethical re-orientation for medical personnel to enable them perform better is needed. This aspect should be part of the medical training.

Healthcare delivery in Nigeria, like elsewhere, should incorporate prevention, care and treatment of diseases and other maladies. That boils down to hygiene. Provision of clean potable water, draining the streets and general environmental hygiene should be encouraged as part of the healthcare delivery system.

The NOC also bemoaned the shattered peace of the public health sector as a result of power tussle within the system. Again, this is due to lack of professional discipline. The frequent contention over salaries and wages between different branches of the medical profession and government is at the root of this problem and the damage this has done is beyond repair.

Of course, that medical personnel across the country receive the same remuneration is an aberration, especially in a supposed federal system. Doctors in federal establishments ought not to receive the same pay with those in the state employment. And in the same vein, different states ought to have different payment structure for their medical workers. These are issues that must be resolved as prelude to peace and tranquility in the hospitals.

Finally, dilapidated infrastructure and equipment can only help worsen health care delivery. Enough investment should be made on the physical wellbeing of the people. It is frustrating to have medical facilities where doctors are handicapped to do their job.