Medical Mission in Benin City        P.Courtesy

If one is an endorser, fan and sympathizer, of piecemeal approach to development, they will be impressed by the often uncoordinated annual and infrequent medical missions that some Nigerians overseas embark on to their native land. Such mission is commendable, demonstrating care and concern for those who under the current Nigerian checkered healthcare environment hardly get treated. The medical missions in its rough state because there is hardly structured establishment behind it, attempts to mirror reputed organizations like Doctors Without Border. In a nutshell, it is a welcome development; therefore, it helps. But on a critical public policy review, how does such mission hamper Nigerian leadership from developing robust healthcare system whereby the rights of the patient are protected and entrenched as public policy and access to healthcare is enhanced?

Taking a look at the federal budget provides perspective which when taken to the state levels, shows a dire healthcare sector hardly set up to address the need of -/+170m Nigerians. That so called rich Nigerians go overseas for medical check-ups, is no surprise because in Nigeria going overseas for ailments that can be cured or addressed at home tells everyone, “one is rich and maybe foolish as well.” The rich in Nigeria do not invest in the system instead they flaunt their riches in such a manner it makes everyone want to be like them. That is not how to develop a nation.

The 2014 Nigeria federal government budget for Health is N262B or 6% of the total budget, behind defense, education and finance, which includes debt service. Interestingly, the 2014 budget is disappointingly less than the 2013 N279B budget; this is when the impact of lower oil prices started to hit the treasury. For ease of analysis, One Billion Naira is mere $4.45m; to put it in perspective. Using this conversion, the federal ministry of health budget is about $1.166b. Assuming on a straight line allocation for every Nigerian; the budget portends $7.07 per Nigerian or N1,590.

Now, if anyone cheers and chants there is money in Nigeria, walk away from them as they are both naïve as well as marooned. The noise does not measure up to the facts and figures. Nigerians do not like facts nor figures. They take beer parlor chants and use such to scream ‘There is Money in Nigeria.’ Sure. Just prove it. Shocking aspects of the budget includes N4B ($17m) for National Health Insurance Scheme, which covers less than 4% of the population, mostly federal employees and related political subdivisions. Some obscure agency like National Arbovirus and Vector Research Institute has a budget of N175M. National Agency for Food and Drug Administration and Control - NAFDAC, has a budget of N4B. For teaching hospitals with UNTH leading the pack, the budget is N10Billion. Comparatively, UCH Ibadan and ABU Zaria respectively get N9B and N6B, and LUTH N6B. In Dollar equivalent, they stand as follows: UNTH - $45m, UCH - $40.05m, ABU/LUTH - $26.7M.

These are chicken money no matter how anyone looks at them and when about 80% goes for recurring expenses, it shows Nigeria will not be coming up with 21st century innovation in healthcare delivery. With dire strait resources in monetary terms, the skill set need is going to be dangerously absent. It takes serious money to operate robust healthcare sector especially where standards of living is abysmal.

With the above perspective, what does it foretell of Nigeria and what solutions are attainable?  A healthy nation invariably is a wealthy one; anyone overlooking such golden rule is probably living in cave/primitive time. It is no surprise that the productivity of Nigerian workers is less than 30%, enabled by poor health of the employees and work ethic that encourages laziness and serious absenteeism.

The piecemeal development fan believes the way forward for Nigeria is let everyone chip in; build a borehole - not water system, have septic tanks - not wastewater system, have private guards - not effective police, have generators - not efficient electric delivery system, etc. While such approach can serve as short term measures, it has become standard practices of federal and state governments, especially State Governors who see Medical Mission as a gap-filler for their absent and lousy public health policy or lack thereof.

For instance, in the core 5 Igbo states, the aggregate total budget of all the Ministries of Health budget is less than $100m; equating on a straight average of say $20m per state or N3-5b. In specific terms, the Enugu State Ministry of Health has a budget of N3.625 billion and ESUT Teaching Hospital, Parklane altogether N481.5 million including money for - HIV/AIDS (ENSACA).

Medical missions in all intents and purposes, does not bring in $5m, hardly a drop in the bucket of what is needed. A welcome addition though given: the-beggar-has-no-choice culture promoted by individuals as well as the political establishments. Medical mission exposes Nigerians to uncoordinated and unsupervised treatments by medical personnel whose motives may be other than providing cure and assistance. The drugs used in most instances are hardly checked for their relevance and suitability for the patients. Data collected are not monitored as to where do they end up and what other danger is the patient exposed to.

Without Patient Bill of Rights, the Nigerian patient is left at the mercy of the itinerant practitioners who looks at the mission from boosting ego as well as appearing as ‘Daniel Comes to Justice.’ While a beggar has no choice, I would imagine that the State Ministry of Health come up with stringent conditions and rules under which anyone can conduct a medical mission.

Here are some thoughts:

1. The mission must submit the names of all participants at least 30-60 days ahead of their arrival and their medical credentials vetted for relevance to the mission.

2. All foreign participants in the mission must include information as to why they are participating and must be accompanied and supervised.

3. Data and information collected on each patient must be checked for accuracy and must never be taken outside of the country without the patient’s approval.

4. Each Medical Mission must tender insurance policy that covers any malpractice as a result of their treatment indemnifying the state ministry of health of any cost incurred as a result of mistreatment and or abuse.

5. All drugs and tools used in the mission must be submitted to the relevant ministry for clearance and brought to the treatment sites before administered to the patients. Information to be included are drug expiration date, equipment manufactured date, etc.

6. Drugs with close expiration dates, the medical mission must obtain waiver from the drug manufacturer stating that they are aware of the destination of the drug and its use in the mission. The purpose of such requirement is to put the drug manufacturer[s] on notice should there be law suits they cannot be absolved of liability. It will further ensure that dangerous drugs are not administered to patients in developing countries.

7. All patients must have their doctor/Nurse or healthcare provider available or have a release from their primary doctor that they can attend and any negative outcome from their participation absolves the primary physician from any liability. This is probably a stretch as Nigeria has no meaningful medical malpractice law and the Nigeria Medical Association is a glorified association that colludes and conspires to engage in some questionable conducts.

8. The Medical mission must have a legal adviser based in Nigeria and each patient before treatment must have their rights explained and a form signed indicating what they are about to undergo and the extent of liability or lack thereof.

Medical Mission ‘Father-Christmas or Santa Claus’ approach to healthcare delivery can never be a substitute for robust system. Because one is poor does not mean they have to be subjected to all manner of treatments whether relevant or not. The idea of one’s trash being another’s treasury needs to be dealt with in the case of this matter if Nigeria is to be seen as a country that cares. Allowing access and permitting all manners of medical missions just so some feel good, does not add any collateral value to the overall wellbeing of a nation. The statistical value of the mission is sketchy and scanty, and in all does not add 1% of the need. While every piece matters, Nigeria must recognize that its perception in the world begins and ends with how the leadership is seen as caring for the people. Healthcare delivery is a crucial aspect of economic development and it cannot be achieved allowing and permitting every Tom, Dick and Harry, to play Santa Claus as in medical mission.

To bolster the meager resources of the federal government on health, the government should consider Regional Health Savings Systems using the six political zones. One must invest in the region they live in regardless of their tribal affiliation. In this savings system, once one turns 18, they must purchase a healthcare savings bond to the tune of N1,000 for rural dwellers and N5,000 for urban dwellers, annually until they turn 25. All persons 25+, again whether rural dweller and or urban must contribute certain amount until they turn 60. The federal government in partnership with the state governments in each political zone will provide matching funds to the tune of what is contributed by a certain index. It stands that when such a system is introduced Nigeria will have available billions of dollars for healthcare delivery. Such regional savings may be used to attract foreign investments in building world class healthcare facilities and research institutes. An effective private-public partnership on regional basis will afford Nigeria a bigger and wider picture to see their health as wealth.

Except some drastic measures are put in place, the currentsituation of under budget and meager resources only goes to widen the health gap, dampen and deepen conditions that affect the wealth of the nation. A healthy nation is a wealthy one.

By Ejike E. Okpa II
Dallas, Texas.