Innovation and Inadequate Enabling Environment in Nigeria

Published on 17th March 2014

President Goodluck undergoes check-up
The temporal granularity which should accompany a thesis in developing a proposition or answer pertinent question is lost when the initial assumptions made are changed midway or when background noises are such that important relevant data is subsumed within those noises. In any dialogue or debate where there are entrenched views, dichotomous outcomes become the norm; nuanced solution-sets are lost in the process. This is especially so when arguments are emotionally laden which constrains reason.

The debate--innovation and inadequate enabling environment--has somewhat morphed into something unrecognisable.Some initial contributors have been misquoted and contexts have taken bizarre twists thereby generating more heat rather than light. Someone once said that wisdom does not exist within us but comes in flashes of moment. This is so true; amidst the noises, we could still tease out nuggets of information from it.

Now, let’s get down to terra firma. A  few years ago, I was in Nigeria, I visited the Medical and Dental Council of Nigeria (MDCN) when they were still in Victoria Island. I met an American doctor who came to register with the Council. He came to Nigeria with a Christian Mission--Baptist International--on a voluntary basis to provide healthcare for some northern states in Nigeria. He was to bear his own cost while providing medical services for the states. He told me that he arrived at the Council in the morning and waited all morning and afternoon, but was prevented from seeing the person in charge by a clerk. The female clerk wanted a bribe, the bloke refused to play along; she then made life very difficult for him. She even had the temerity to boast about it in my presence.

Are you still reading up to this point? Bear with me; I have a few more before tying the loose ends.

Last year, a colleague told me a story about his experience with the healthcare system in Nigeria--when he took his cousin who has a history of homicide within the context of severe mental illness. To cut to the chase, he was admitted to a federal mental health facility in Lagos. After a few days,  the cousin escaped from the hospital.

It was very worrying that staff was unconcerned that someone with schizophrenia with a previous history of homicide escaped from the hospital. There was no basic procedure for reporting the matter to relatives or the police. There was a complete lack of risk understanding or management at the hospital. The doctor in charge of the patient was not even aware of such a major incident until my colleague visited and told him that his cousin had escaped from his hospital. His response was even more shocking. He asked the relatives to look for the patient and bring him back. Further, he stated that their usual practice would be to discharge patients if they escaped from their hospital. However, given that my colleague was a fellow doctor, he would make the exception of readmitting his relative if they brought him back to the facility.

Given the foregoing, I researched Nigerian healthcare system and was most astounded by what I found. As back as 2006, WHO produced a report--AIMS report--this was a scathing report on the abysmal state of the system. Physical health did not fare any better. Incredible practices are allowed and even encouraged by the regulators. I got in touch with the co-author--a deputy director at WHO--of the AIMS report and discussed a strategic response and action plans. He referred me to his colleague based in Nigeria. The rest is history.

The WHO staff with mental health brief in Nigeria came back to me and told me that everything was in hand; and being “addressed by talented Nigerians.” Suffice it to say that this was a few months after a death in custody of a high profile prisoner, Clifford Orji.

From my research, it emerged that months before Mr. Orji’s death; the prison governor at Kirikiri prison scoured all over the country seeking a facility to accept him, given his deteriorating mental health, but none would accept him. As we speak there isn’t a single forensic psychiatric hospital in the whole of Nigeria.

As I write, the Mental Health Act bill remains sequestrated in the pipeline since 2007 while the Same Sex Marriage bill which was first introduced in 2011 was trammeled through parliament and was signed into law in January 2014. It says a lot about a responsive government that gets its priorities right. It certainly prioritises.

As someone who is involved with the courts on medicolegal matters--by virtue of my medical and legal qualifications--and I have acted as expert witness to the Crown on a number of cases at both Royal Courts of Justice, County and Crown Courts; diversion of patient from the Criminal Justice System to healthcare system is as normal routine. But in my country of origin, I did try to get things moving by collaborating with those in Nigeria and the government. Some NGO showed some interest regarding the framework I had in place to address some of the issues, but chickened out, given that they had other agendas.

Of importance was the advice given to me by a Vice Chancellor of a Northern University who is also is a doctor. He told me about his blue print on how to regulate healthcare practice in Nigeria. He approached both his state--where he has political clout--and the Medical and Dental Council of Nigeria. He reassured them that the implementation of the blue print would not be resource intensive, given that it would pay for itself by fines imposed on professional malpractices. Both are still sitting on the blue print for the last five years. He told me that life in Nigeria was cheap; he seriously advised me to steer clear of trying to agitate the status quo. He was candid and frank about this; he told me that the forces benefiting from the status quo were highly connected. Further, it costs as little as "twenty five thousand Niara to hire an assassin."

By now you must be bored stiff to the point of losing the will to live, with active suicidal ideations. Bear with me for a wee while.

A friend of mine is a professor of Mental Health and Public Policy and advises the Department of Health and Public Health England on strategy and policy. The department ear marked some money for collaborative research and publication in developing countries. He decided on sub-Saharan Africa--Ghana and possibly Nigeria. He made several entreaties with tertiary institutions in these countries to collaborate with their academics. Most of them did not even bother to respond to his correspondence. He was thinking of giving up until a few weeks ago. He sent me an email to inform me that an institution in Ghana has finally agreed to collaborate in the healthcare management research.

Now, we are at the very last of my wretched stories.

A few years ago, a hospital in England was updating all its facilities. A Nigerian doctor got wind of this and asked if he could have all the medical equipment, beds, furniture, etc. Management agreed. He called the office of the governor of his home state and they were excited about this. He informed them that he was going to make all the internal arrangements for onward freight to Nigeria. He told them that they have to pay for the shipping to Nigeria. He said that when he broached the idea, he could feel it by the overall change in cadence and the tone of the voice at the other end of the line. When next he called the bloke representing the governor, he would not come to the phone and nobody was interested to speak to him or follow through with the agreed arrangement.

Why have I gone through all these narratives, you may wonder? Green, you made a profound statement: What some of us regard as problems in Nigeria is regarded as a business or profit opportunity in developed countries.....The great entrepreneurs in Nigeria see it the same way that developed countries see it..... The point being that within problems lie opportunities. Any student of strategic management will know this. However, the peculiarities of Nigerian problems are skewed in favour of the dishonest and those with ethical and moral failure, regardless of whether they are indigenes or foreigners. A couple of weeks ago, it was reported that an Indian bozo was practising without a medical licence in Northern Nigeria. He saw those problems--lack of accountability and adherence to simple procedural engagement-as an opportunity to practise for more than a year without a licence.

Someone knew that he did not have a licence, yet renewed his contract for another year. While the genuine doctor I mentioned earlier who was part of a Baptist medical ministry was frustrated because he was legit. I am reliably informed that they are so many of them from that part of the world that are practising illegally in Nigeria. Similarly, other sectors and industries in Nigeria have same problem, given lack of regulation and oversight. It is unsurprising, given that a significant number of Nigerian politicians, as I am told, parades forged certificates.

Unlike Nigeria, Japan on the other hand, was strategic in attracting those who saw opportunities in a defeated country after the bombing of Hiroshima and Nagasaki and Japan’s humiliating surrender--their only surrender in history. Their problem was compounded by the fact that they were excluded from the Marshall Plan. Japan attracted amongst others Deming and Juran who were unknown managers and academics, but that was the beginning of the Japanese miracle in manufacturing. It all began with Japan looking itself in the mirror and telling itself the honest truth. As long as Nigerian leadership remains in denial, then our march to the Promised Land will only live in the heads of Nigerians.

Today, we are flippant about Silicon Valley, the ultimate entrepreneurial hub in creativity and innovation. This came about from generous funding from an assured market with the Defense Department and institutional leadership from Stanford University in collaboration with engineers and scientists. It is a celebration of cross sector collaboration.

On a different note, when “problems” are such that one’s mortality is at stake due to the government’s inability to provide security and the collapse of rule of law, then it will be mainly the crooked among the foreigners who will see this as “a business or profit opportunity.” They will gladly grace our shores with their presence, plying their trade in cahoot with Nigerians of similar hue. In the end the country is poorer for it.

The point I am making is aptly captured in Malcom Gladwell’s International best seller--The Tipping Point. In it, what we may term as random events, may not be random events after all. The term--tipping point--is derived from epidemiology. If an environment is enabled or geared towards the absurd, it is only a matter of time that the “negative random events” are no longer random, but can be tracked back to its root. By the same token, if it is enabled towards the path of progress, the positive replicating power is so great that a tipping point is reached where that singular strategy becomes transformational with positive spinoffs.

In conclusion a responsive government has a reciprocal citizenry. Our lack of social imagination at leadership level has cascaded and morphed into what we are as a people--for ever chasing a mirage of dreams. The entangled mess which has become a Gordian knot may take several generations to undo, given that within the leadership, there is no Alexander with a sword.

By Anayo Unachukwu


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