Prof. Onyebuchi Chukwu, an Orthopaedic Surgeon, is the Minister of Health and fellow of both the West African College of Surgeons and the International College of Surgeons. He spoke with FRIDAY OLOKOR on some national issues in the health sector
The issue of the National Health Bill has dominated discourse in recent times. It has generated a lot of controversy in the health sector, especially from some stakeholders. What is really impeding the passage of the NHB?
Remember that the National Health Bill was first passed by the 6th session of the National Assembly in 2011 but was not assented to by the President until the period during which it should have been assented to was over. It is mainly because of what I call the pains of democracy. You can have the gains, but many things that have gains always have pains. One of the pains of democracy is that whatever in the end you are going to do, you need to listen to people. In a democracy, you are duty-bound to listen to everyone.
People were busy making noise instead of commending the National Assembly for what we call one of their greatest achievements since democracy returned to Nigeria. Some people for selfish reasons and for other reasons known to them were attacking certain sections and the President felt we should listen. And within that period, the President convened a lot of high level meetings. At least, I attended three of them in which he personally presided over to show you that he was serious about the National Health Bill. But where are we today? It has gone back to the National Assembly, and I believe that the two chambers have done their second reading and you know what it means. They are on their way to the third and final reading. So, it is on the way. And I believe that the National Assembly has also taken into cognizance some of the comments of those who have issues with some sections of the ones that they earlier passed, now that they are looking into it. It is entirely the responsibility of that arm of government to see it through and then transmit to Mr. President.
Some of the stakeholders in the health sector are saying they were not given the opportunity to have their input into what should be part of the bill. Why were they excluded?
We said it has just gone through second reading. What stops them from sending a memo to the National Assembly, to the committee that is looking at it? What stops them? That is democracy. There is nothing else we can do. That is the way the constitution prescribes out democracy. Right now, it has not been passed. Why can’t they approach the National Assembly? That is all I have to say about it.
The Association of Medical Science Laboratory Scientists and some unions within the sector have kicked against having doctors as chief medical directors and administrators of hospitals. What should be the standard practice?
The Chief Justice of Nigeria is a lawyer. What is the problem? And the Chief justice is both the administrator and the technical expert as far as the judiciary is concerned. So, why should it be different in medicine? The hospital is the only place that is totally the doctors’ territory. Every other person there, is in support system. And it is so in different areas. You have doctors who are working in the bank. In the bank, we have the economists, we have those who did finance and accounts; we have the accountants and financial experts. They are in charge in the banks. You also have doctors because some of them have established hospitals. The doctors working there are doing support work.
In the oil and gas sector, it is the zone of the engineers, chemical engineers, petroleum engineers, mechanical engineers and electrical engineers. The main business there is to get out the oil and refine them. There are doctors and pharmacists working there. But they are in the support group. We have chartered accountancy firms. Accountants are in charge there, but there are other support groups.
In the drug manufacturing industries, that is the zone of the pharmacist. Anybody going there, a doctor or an engineer going there to struggle will only be a support staff to the pharmacist. In the media, you have journalists in charge. It is not that they don’t have other people working there. Those ones are supporting them. Engineers are working there and they are just merely supporting them. In the medical laboratory science, you have laboratory scientists who are there. Any other person that gets involved is just supporting them. So, I don’t quite understand where we are going to in the country. I don’t know why the row.
When you go to hospital, who do you go to see? Let’s not do something that is different. Go to any country, it is the doctor. The Director-General of the WHO has always been a doctor. And if WHO that is not even a hospital insists that a doctor should be their director-general, why should Nigeria do its own differently? What is wrong with us in Nigeria? I have not had a single director-general of the WHO that is not a medical doctor since the creation of the organisation. And that is not a hospital. Don’t we think that is for a reason?
I have visited the largest hospital in the world in terms of bed space, a hospital that has 2, 300 beds in Vienna, Austria. It is a government hospital. The person managing it is a professor from the university. He is a pathologist. I don’t think people who are genuine are really serious with the argument. I think probably the issue is that everybody is jostling for power and it is all about negotiation and there is absolutely nothing wrong with people negotiating. But for me as a minister, I think we need to do what is right for the country. I have been showing good example. I have been fair to everybody concerned. As the chief director, I was the first to introduce internship in the country to optmometry. I have directed all our hospitals to start internship in optometry.
A lot of issues have been raised about National Hospital and many other tertiary institutions. Accusations of negligence and such issues persist. Why do we have these complaints?
Let’s start from the beginning, is there any sector that we don’t have complaints about service delivery? I just want us to place everything in context. The media can come down and let’s develop a template on how we are going to score all the sectors in Nigeria. Believe me, I am not boasting, health will be one of the top five in terms of performance. Quote me any day. Look at the construction industry. How many buildings have collapsed. And you people in the media are not making noise over it, and people have died! I am not saying we are saints. I am saying that we have to look at it as a general problem in the economy. These people working in hospitals are our brothers and sisters. They come from the same family as ours. Like you rightly pointed out, our own is sensitive because we are on the final pathway between life and death. Why do I say it is the final pathway? Who takes the blame for a retired worker who should have enjoyed his pension but is not getting it? But while he is not enjoying his pension, he becomes diabetic. He becomes hypertensive. Finally, he develops stroke. The family took him late to the hospital and then he dies in there. They blame the doctors. But nobody remembers who did not pay the pension. That is where that man’s problem started from. What I am saying is that we have overemphasised hospitals.
Coming to National Hospital, Abuja, it has had problems. Let us put it in context. Journalists have not done what I call in-depth analysis of the National Hospital. That place did not start as National Hospital. Recall that during the Abacha years, his wife, as part of her family support programme, initiated that hospital and what she had in mind was that the hospital should be a small hospital of 200 beds to cater for women and children. And the government decided to build that hospital for women and children. At a particular point, government decided that we don’t have a tertiary hospital owned by the Federal Government in Abuja, and decided to convert it and called it a National Hospital, 250 beds with all the specialists. So, many times when you go there, there are no beds. Right now, we are building more wards. If you visit today, we are building more wards at the hospital. Let’s be patient because we want to increase it to at least 500, double the size of beds.
Only recently, we investigated a case of negligence. We went through the due process. It led to two consultants leaving the hospital. It led to almost five resident consultants leaving the hospital and it led to about three nurses leaving. Some of them have gone to court; so I cannot comment so much on it. But, it tells you that government is serious about discipline.
But again, people need to understand that they have their own constraints. You can also understand why people will refuse to buy health insurance and expect that when they have problems, they will not pay. There is no way this can work. The subvention government is giving them is not enough to provide total free health care for people. They have to, based on what we approve for them, charge fees. And if people refuse to pay, that hospital will totally collapse.
There has been this issue of cough syrup containing codeine and a lot of people are concerned about its abuse especially by youths. Why has government not done anything about it?
This has been one source of abuse in the country. A lot of our youths, and even some adults, have been abusing it. I am told that it makes them high. That is why they are all buying all the cough syrups with codeine. Before the next two weeks, you will hear a pronouncement which will say clearly that those syrups with codeine will now be treated like other narcotic drugs, in which case, it will only be accessed the way narcotic drugs are accessed. This means that you can’t find them in any ordinary shops. It will be found in hospitals only.
