thoughts on developing nigeria's healthcare

7/30/2019 Thoughts on Developing Nigeria's Healthcare

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About the Writer:

Kanayo A Odoe (BL, J.D., MSc, BSc)is a lawyer, engineer and chemist with a keen

interest in healthcare delivery. He is the Managing partner of Chancery & Scribe--a law

practice in Nigeria. He loves philosophy and history.September 2012

THOUGHTS ON DEVELOPING NIGERIAS HEALTHCARE

Nigeria has struggled relentlessly to salvage its healthcare system. In a

2000 survey by the World Health Organization (WHO), Nigerias healthcare was

ranked 187 out of 190 countries in the world that are member states. A

United Nations reportreleased May 16 2012, called Trends in Maternal

Mortality: 1990 to 2010, showed that 14 percent of the worlds deaths are

related to childbearing are in Nigeria1.

In trying to salvage the poor healthcare system in Nigeria, the National

Assembly signed a Healthcare bill which has been trumped as a great piece of

legislation that will turn the Nigerian healthcare sector around. The bill caters

for children below five years old, pregnant women and the elderly, leaving the

young able bodied citizens out of the expansive reach of the healthcare

benefits. Though the goals of the law are noble, attaining the spirit of the law

will be difficult. It is in this stead that the current Minister of Health has set up

a committee to meet the challenges of Nigerian Healthcare system.

In order to address the current healthcare crisis, Nigeria has to

determine whether to adopt a Universal Healthcare System or Private

Healthcare System in solving the healthcare dilemma.

1http://www.unfpa.org/public/home/mothers/MMEstimates2012
http://www.unfpa.org/public/home/mothers/MMEstimates2012http://www.unfpa.org/public/home/mothers/MMEstimates2012http://www.unfpa.org/public/home/mothers/MMEstimates2012http://www.unfpa.org/public/home/mothers/MMEstimates2012http://www.unfpa.org/public/home/mothers/MMEstimates2012http://www.unfpa.org/public/home/mothers/MMEstimates2012http://www.unfpa.org/public/home/mothers/MMEstimates2012


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Universal Healthcare System

Socialized medicine is another name for Universal Healthcare and is a

system of providing medical and hospital care for all at a nominal cost which is

done by means of government intervention and regulation of health services

and subsidies derived from government taxation2. In universal healthcare, the

government provides funding for most or the entire healthcare provided for by

private hospitals or government hospitals; approximately 8.4% of the United

Kingdoms GDP funds the NHS3.

Most of the Western World practices socialized medicine. Other notable

countries that practice universal healthcare are Cuba, Australia and Russia.

How best to practice effective universal healthcare raises the question as to

whether the government will also fund medicines prescribed in addition to

treatment given to patients. England provides healthcare for all of its citizens

through its National Health Service (NHS).

NHS in England

The NHS employs more than 1.7 million people including 39,409 general

practitioners, 410,615 nurses, 18,450 ambulance staff and 103,912 hospital

2The American Heritage Medical Dictionary.

3International Health Systems: Issue Modules, UK-KaiserEDU.org,www.kaiseredu.org/Issue-

Modules/International-Health-Systems/UK.aspx
http://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspx


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and community health service medical and dental staff4 catering to more than

52 million people in England. The funding for NHS for the 2011/2012 year is

around 106 million which is derived from government tax on its citizens. The

secretary of state for health, which is equivalent to our minster for health, is

the head of the NHS and reports to the prime minister.

Even with the current expenditure on healthcare by the NHS, the healthcare

delivery has been considered not as efficient because of the rising population of

baby-boomer generation5. England has however achieved relative success in

reducing the long wait times for care by increasing hospital capacity and staff

as well as setting shorter maximum wait times (18 weeks)6.

HOW NHS WORKS

The United Kingdom, which includes England, has a system of generalist

primary care delivery care delivered by General Practitioners (GP). The GPs

have two principal roles: (1) to provide primary care; and (2) to act as

gatekeeper for access to special care. An individual cannot seek speciality care

without referral from their GP7.

Private Healthcare Approach

4www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx

5International Health Systems: Issue Modules, UK-KaiserEDU.org,www.kaiseredu.org/Issue-Modules/International-Health-

Systems/UK.aspx6

Id.7

Id.
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.kaiseredu.org/Issue-Modules/International-Health-Systems/UK.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx


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Healthcare under this model is funded almost exclusively by private enterprise.

Private insurance companies, pharmaceutical companies and private hospitals

sell their services to those who can afford to pay for the services. Private

insurance companies, pharmaceutical companies and private hospitals are

interdependent on each other through pure principles of private enterprise.

This model as practiced in the USA is available to those who can afford to pay

for their healthcare insurance and they get to choose the type of healthcare

and hospitals they want. Individuals get healthcare insurance from private

insurance companies at a cost. Usually private insurance is purchased by

deducting the insurance premiums from an employees income, or an

employers business revenue. Some companies also offer their employees

health insurance as a perk. Companies have the option of choosing which

private insurance company they will use.

Although private enterprise governs the system of healthcare in the USA,

the USA government still provides healthcare to a group of persons through a

model that can best be described as social medicine or universal medicine.

Medicare is a government initiative that provides healthcare services to the

elderly and to people with disabilities while Medicaid provides coverage to low

income families.

Strictly speaking, therefore, no system practices an exclusively economic

model of medicine whereby it is either pure capitalist enterprise or social

economic theory.


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PROBLEMS WITH EITHER APPROACH

Advocates for private healthcare assert that under universal healthcare,

access to hospitals and doctors are slow with long waiting lists. The arguments

posit that due to the high demand for doctors, patients had wait times before

they could see their doctors. Experts said the NHS's need to cut costs was

prompting patients to fund their own hip or knee replacement, hernia repair or

cataract removal. "We are certainly picking up that some patients are being

asked to wait longer than they would have expected and are therefore deciding

to pay for themselves rather than wait," said David Worskett, chief executive of

theNHS Partners Network, which represents more than 30 firmsboth for-

profit and not-for-profitthat work with the NHS8.

On the other hand, under private healthcare, a patient is treated on the

basis of his insurance and on the basis of his ability to pay for his healthcare,

which excludes the poor, the young, or generally those who cannot afford to

pay for insurance.

Private Insurance in UK

8NHS rationing boosts private healthcare firmsreport

http://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhs-rationing
http://www.nhsconfed.org/Networks/NHSPartners/Pages/home.aspxhttp://www.nhsconfed.org/Networks/NHSPartners/Pages/home.aspxhttp://www.nhsconfed.org/Networks/NHSPartners/Pages/home.aspxhttp://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhs-rationinghttp://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhs-rationinghttp://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhs-rationinghttp://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhs-rationinghttp://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhs-rationinghttp://www.nhsconfed.org/Networks/NHSPartners/Pages/home.aspx


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Private medical insurance is usually designed to treat acute conditions9. It

must be noted that Private health insurance in the UK is not seen as a direct

replacement for the NHS. The exact conditions covered by private medical

insurance varies between policies, but will generally not include some chronic

conditions10 and private medical insurance is also unlikely to cover pre-

existing conditions that were present when you took out your policy.

Private medical insurance policies also vary in the level of cover provided. Most

will cover in-patient services11 but not out-patient services12.

Generally, private medical care in the United Kingdom has four main

advantages13:

1. Speed of access to treatment: For many people, this is the biggest

advantage of private medical insurance. Being covered by private health

insurance means that youll receive prompt attention when you need it,

without waiting weeks for an appointment and perhaps months on an

NHS waiting list for your surgery or treatment.

2. Choice of timing: Patients with private medical insurance can

choose when to have treatment for less urgent problems. For example,

you could fit elective surgery around your work schedule or other

commitments, or choose to have treatment when friends or family are

9These are short-term health problems that need treatment but that also respond quickly,

leading to a full recovery.10

These are long term illnesses that need constant or regular care.11

In patient covers treatment, surgery and hospital stays12

Out Patient consultations such as aftercare and drugs, and preventive medicine are generallyoptions that come at added cost.13

http://www.healthinsurancesolutions.co.uk/private-insurance Private Medical Insurance,Individual Health Insurance UK
http://www.healthinsurancesolutions.co.uk/private-insurancehttp://www.healthinsurancesolutions.co.uk/private-insurancehttp://www.healthinsurancesolutions.co.uk/private-insurancehttp://www.healthinsurancesolutions.co.uk/private-insurancehttp://www.healthinsurancesolutions.co.uk/private-insurancehttp://www.healthinsurancesolutions.co.uk/private-insurancehttp://www.healthinsurancesolutions.co.uk/private-insurance


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free to help with childcare.

3. Choice of hospital, consultant and surgeon: As well as choosing the

timing of your treatment, private medical insurance also allows you to

choose the hospital you are treated at and the consultant or surgeon who

treats you, although the number of hospitals available to you will depend

on your level of private medical insurance cover.

4. A higher standard of facilities: Another advantage of private medical

insurance is the guarantee of high quality facilities if there is need to stay

in hospital. Most private hospitals, and private wings within NHS

establishments, will provide a private room with en suite bathroom, as

well as an a la carte menu, open visiting and many other premium

facilities.

The benefits stated above for private healthcare insurance in the U.K echoes

benefits argued for by the U.S.A, which practices private healthcare.

THE NIGERIAN APPROACH

What model to adopt will depend on the economic ideology Nigeria

adopts. Whether to adopt the English system or that of United States of

America will depend on the adoption of principle behind healthcare delivery

that Nigeria chooses. Is the ideal in Nigeria in line with Universal Healthcare as

stipulated in the Universal Declaration of Human Rights or will Nigeria adopt


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the purely capitalist notion that hinges healthcare delivery on a citizens ability

to afford or pay for health care?

It is my view that there should be an interplay or coordination between

the Federal Government, State Government and Private institutions if Nigeria is

to solve its failed healthcare delivery system. Reforming Nigerias health sector

will be very expensive. Realistic as well as thoughtful goals and decent

standards must be set based on data analysis.

Comparative analysis of the UK model and the USA model suggests that

neither system practices purely Universal Healthcare as in the case of UK or

purely private medicine as in the USA. Each system borrows a leaf from the

other. It is the degree of practice that makes a system a Universal System or a

Private System.

A key issue to note under the Universal Health System is the burden

placed on the UK healthcare system due to the rising population thereby

increasing wait times needed to see Doctors. The complaint in private

healthcare as in the USA is the inability to give quality healthcare to those who

cannot afford it. However, the USA has adopted some form of Universal

healthcare for a limited class of people under its Medicare and Medicaid

programs for the poor, elderly and for veterans.


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A belief in the principles of market economy will mean that Nigeria

adopts the private healthcare initiativesthe USA model. If Nigeria adopts the

principles set fort in the Universal Declaration of Human Rights, then it means

that Nigeria will lean more towards the U.K model of medicine. Regardless of

the ideology adopted, the road to a decent healthcare delivery will have its

challenges. As stated above, countries with universal healthcare, face the

challenge of long patient wait times and cash squeeze as the population in the

Western World is increasing. However, in the private healthcare delivery system

as practiced in the USA, the number of people can get quality healthcare is

limited to those with financial. Private healthcare delivery seems dependent on

passing a financial means test.

In Nigeria, structural and institutional challenges must be addressed

before adequate healthcare delivery is attained. These issues are hinged on our

failing educational system14, a rising population, power, and data access. If

population is not checked, heavy financial and manpower burdens will be

placed on our healthcare system. On review of Table 1 below, USA, France and

UK spend 17.6%, 11.9% and 9.6% of their GDP on healthcare, which translates

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Nigeria with the failing and falling standard of our educational sector, we cannot produce themanagers and scientists for the next generation. As it stands, our universities are under

equipped with computers and up to date medical journals. Technology is the new frontier.

Please see my article,EDUCATION: PREPARING NIGERIA FOR THE 21STCENTURY. The

second arm of our educational failure is the inability to educate Nigerians on the need for clean

environments.


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to roughly 2.5 Trillion dollars, $320 Billion, and $245 Billion on a population of

314 million, 65.35 million and 62 million respectively in USA, France and the

U.K.

However in Nigeria, with a GDP of approximately $413 Billion and a

population of about 166 million people and counting, a budgetary allocation of

about 5.1% of the GDP is allotted to healthcare. This budgetary allocation

translates to roughly $ 21 Billion a year that is meant for healthcare. In the

first place, corruption must be confronted if all intended budgetary allocations

are to be spent on its intended purpose.

Money alone has never solved problems but right thinking applied

towards finding a solution to a problem. It is my position that the commission

set up for revamping our healthcare sector should dwell more on data and data

analysis and the study of different systems around the world in prescribing an

approach, which the Nigerian government should adopt.

The Federal government should create effective regulatory framework

that should govern the States or regions in Nigeria as well as the private sector.


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COUNTRYPOPULATION

(MILLION)15

GDP

($)16

HEALTHCARE

SPENDING (%

of COUNTRY

GDP)17

DOCTORS

PER

10,00018

W.H.O RANKING

OF BEST

HEALTHCARE

SYSTEM FOR 190

COUNTRIES

USA 314 15.09 TRILLION 17.60% 24.22 37

FRANCE 65.35 2.712 TRILLION 11.90% 34.47 1

CANADA 34.89 1.736 TRILLION 11% 19.8 30

UNITED

KINGDOM (UK) 62.262 2.452 TRILLION 9.60% 27.43 18

GERMANY 82 2.3 TRILLION 11.60% 36.01 25

CUBA 11.25 57.5 BILLION 10.60% 67.23 39

SOUTH AFRICA 48.81 500 BILLION 8.90% 7.7 175

NIGERIA 166 413 BILLION 5.10% 3.95 187

Table 1

ANALYSIS

Data collected by the World Health Organization (WHO) in 2007, show that

there are 13 physicians per 10,000 population with large variations between

developed countries and developing countries. In the African region, there are 2

physicians per 10,000 while in the European region there are 32 physicians to

10,00019. The World Health Organization states that even though there are no

global standards, it is suggested that at least 23 healthcare professionals

(which include physicians, nurses and midwives) per 10000 will meet the

modicum for providing decent healthcare in any country.

15http://travel.state.gov/travel/cis_pa_tw/cis/cis_987.html#country

16http://www.guardian.co.uk/news/datablog/2012/jun/30/healthcare-spending-world-country#data

17Id.

18Id.

19Physician density per 10 000 (2007) WHO World Health Statistics Health workforce, infrastructure, essential

medicines,www.who.int/whosis/whostat/EN_WHS09_Table6.pdf
http://travel.state.gov/travel/cis_pa_tw/cis/cis_987.html#countryhttp://travel.state.gov/travel/cis_pa_tw/cis/cis_987.html#countryhttp://travel.state.gov/travel/cis_pa_tw/cis/cis_987.html#countryhttp://www.guardian.co.uk/news/datablog/2012/jun/30/healthcare-spending-world-country#datahttp://www.guardian.co.uk/news/datablog/2012/jun/30/healthcare-spending-world-country#datahttp://www.guardian.co.uk/news/datablog/2012/jun/30/healthcare-spending-world-country#datahttp://www.who.int/whosis/whostat/EN_WHS09_Table6.pdfhttp://www.who.int/whosis/whostat/EN_WHS09_Table6.pdfhttp://www.who.int/whosis/whostat/EN_WHS09_Table6.pdfhttp://www.who.int/whosis/whostat/EN_WHS09_Table6.pdfhttp://www.guardian.co.uk/news/datablog/2012/jun/30/healthcare-spending-world-country#datahttp://travel.state.gov/travel/cis_pa_tw/cis/cis_987.html#country


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In a population of more than 165 million people and counting, Nigerias

educational institution needs to produce and maintain at least 379,500

healthcare professionals with one-fifth of the 379,500 healthcare professionals

being physiciansabout 75,900. Currently, Nigeria has 25 accredited medical

schools with each medical school graduating about 200 students or less every

year. Sadly, Nigerian doctors that graduate from our medical schools seek

better financial rewards in developed nations. This brain drain poses a threat

to our already failing healthcare sector.

Policies for training and regulating the admission of medical students in

to medical schools and the remuneration that physicians and healthcare

providers should expect within the Nigerian context to hinder the brain flight

from our country ought to be developed as a matter of urgency. To improve the

human capacity in Nigeria, we should review Nigerias admission process into

universities. Meritocracy as a guiding principle will save the decadence and

lackadaisical attitude we see with a lot of physicians.

There is an erosion of integrity in any system that puts emotional

preference over excellence in the admission process into universities. In the

Western World, students with the best grades, not average grades, in their

external exams, gain admission into medical schools. Meritocracy in any

system puts the best people forward and in turn this will be reflected in the

practice of medicine.


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Secondly, even if Nigeria were to meet the WHO Millennium Development

Goal (MDG) in terms of the number of healthcare professionals per the

population, it will be difficult for hospitals to meet the healthcare demands of

the Nigerian population where a lot of people suffer from diseases like malaria

and cholera. These diseases will eventually place a burden on the system

thereby making it difficult for doctors to deal with the more serious diseases.

For instance, malaria is a disease that Nigerians have had to grapple

with for so many years and it accounts for 50 percent of out-patient

consultation, 15 percent of hospital admission and also top cause of death in

Nigeria. (National Malaria Control Plan of Action 1996 to 2001). Malaria is an

economic problem. See Malaria in Rural Nigeria; Implications for the Millenium

Development Goals, Olufunke A. Alaba and Olumiyiwa Alaba.20

If diseases that are primarily environmental or structural (as in the case

of bad roads and accidents or okada riders) are not eradicated or drastically

reduced in Nigeria, training physicians will be cumbersome and national

resources wasted because in the end the healthcare system will be out-staffed

by the population of sick people who need attention. This point is further

illustrated in a speech given by Bill Clinton in 2007 where he complained about

the possible burden on Americas healthcare sector if the rising obesity

population was not checked.

20Olufunke Alaba is at the Department of Economics in University of Pretoria and Olumuyiwa

B. Alaba is with the Department of Economics at Bowen University Iwo Nigeria.


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To meet our healthcare challenges, engineering sciences must also be

used to curb waterborne and airborne diseases that place burdens on our

healthcare system as well as bad roads which lead to so many unwarranted

accidents that further place burdens on our health care facilities. The role of

physical science in improving the healthcare sector is just as critical as the role

of the medical sciences. In order to address the issue of adequate healthcare,

physicians, engineers and scientists must play a combined role.

Proper environmental engineering methods can help in eradicating

diseases such as the malaria, cholera and dysentery. The fact that Nigerians

still suffer from these diseases is inexcusable. A focused and purposeful

approach to healthcare issues will help in dealing with healthcare deficiencies.

With determination, malaria along with cholera and dysentery and other water

borne diseases would be of the past.

In context, in 1933 malaria affected 30 percent of the population in a

certain region of Tennessee USA. The USA Public Health Service played a vital

role in the research and control operations; and by 1947, malaria was

essentially eliminated. Mosquito breeding sites were reduced by controlling

water levels through proper water channeling techniques and insecticide

applications known as DDT (dichoro-diphenyl-trichloroethane). There are now

arguments against DDT but the fact remains that DDT was used to eradicate

malaria in the USA and other civilized countries.


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Strangely Nigeria still appeals to the UN, the UK and the USA for help in

the form of imported drugs and mosquito treated nets. The USA treated its own

malaria problems with DDT and proper environmental engineering techniques.

It is common knowledge that mosquitos thrive in stagnant water thus the

logical thing to do will be to eradicate stagnant water. This can be

accomplished through good drainage systems and proper disposal of septic

tanks. Mosquito treated nets basically benefits those who produce and supply

them to Nigeria.

The USA also suffered from cholera about 100 years ago and they

realized that cholera was a social problem, which required improved of

sanitation. But it takes an appreciation of the facts and serious of leadership to

tackle these diseases and issues. While Nigerias purported healthcare reform

bill seeks to mirror the United Kingdom, Nigerias healthcare sector will only

succeed when we address the root causes of the basic issues stated above.

Enactment of legislative bills without more will not eradicate a failed healthcare

system.

Rule of Law

Medical Malpractice and gross negligence are areas that have not been

thoroughly enforced in Nigeria. Doctors seem to get away with murder in this

part of the world. Criminal prosecution or civil suits against medical

practitioners and healthcare facilities should be encouraged to raise the

standard of care by healthcare providers.


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A focused plan targeted to elevating our system of education, improving

our enforcement of laws and our judicial system and appreciation of the fact

that engineering science is another leg on which our healthcare development

stands on is crucial in developing our healthcare system. It is also my position

that State governments in the spirit of true federalism should play more a

active role in providing for the health and welfare of their citizens. The burden

on the federal government should focus more on enforcements and developing

policies that will lead to a more vibrant and healthy society.

DEVELOPING A SYSTEM

On the basis of data collected, see Table 1 above, Nigeria needs about 75900

physicians to meet its healthcare demands.To strengthen Nigerias healthcare,

the issues that the Federal Government must address are:

1. Best Financial Remuneration to retain Doctors

2. What arm of medical system the Government will fund

3. What amount of Nigerias budget will go towards Healthcare (This can be

answered after proper analysis of data with regards to population and

required training institutes)

4. Who builds and maintains hospitals

5. Whether Insurance for all, Pay as you go system, or both pay as you go

and Insurance

But before adopting the right model, the Federal Government must focus on

the type of diseases that we want to treat. This focus will be based on the


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incidence of the type of disease and the difficulty involved in treating these

diseases. Thus, we must set up institutions to address our most critical health

issues. Some of the health issues that Nigerians face are cancer, diabetes,

hypertension, infant mortality and trauma as a result of accidents.

For instance, In the USA, there were 20, 380 Obstetrics/ Gynaecologists

as at 2011. Research and data shows that the ratio of OB/GYN to female

population is approximately 27.10/ 100,00021. Each year, 1200 Ob./Gyn are

produced in USA to meet the demands of the population and it costs

approximately $80,000 to train a medical student through 4 years of medical

school. An additional 6 years is needed for the specialist course of Obstetrics

and Gynaecology22.

Another leading cause of death that seems to be endemic is the scourge of

cancer. Using the USA as a standard, there are approximately 12,500

oncologists to nearly 1.4 million diagnosed cancer patients but in India, the

ratio of cancer patients to oncologists in India is 1600 to 1.

It is my view that Nigerias Healthcare model should be patterned after the

Banking Sector model where an independent agency is set up, like the CBN.

The head of the agency should be empowered to formulate regulatory

21A Critical Deficit of OBGYN Surgeons in the U.S by 2030, Bhagwan Satiani et al; Dept of

Surgery & Obs. And Gyn Ohio State Univ. College of Medicine, March 28, 2011,http://www.sciRP.org/journals/ss 22

Id.
http://www.scirp.org/journals/sshttp://www.scirp.org/journals/sshttp://www.scirp.org/journals/ss


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standards and to have an oversight function over our healthcare facilities and

professionals. It is also my view that those in the private sector intending into

build hospitals, clinics or diagnostic centers should obtain and pay a

substantial amount for licenses to operate. This form of financial hurdle will

limit the participation of unserious players and encourage serious private

participation.

Diagram 1

Provision of Healthcare should be grouped into 3 main areas.

1. Clinics

2. Surgical Centers for trauma and surgeries

3. Diagnostic Centers

HEALTHCARE PROVIDERS

DIAGNOSTIC CENTERSSURGICAL CENTERS AND

TRAUMACLINICS

21CBA


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Surgical Centers

Surgical centers are designed exclusively for short stay surgery. The centers

are staffed and equipped to treat all types of medical problems. A typical

surgical center has surgeons, registered nurses, sophisticated hospitals and

trained and certified anaesthesiologists. It is my view that the private sector,

Federal Government and State government should participate in developing

Surgical Centers.

The Federal Government should develop surgical centers in federal universities

as teaching hospitals, while the State governments should develop the State

university teaching hospitals. Private sector can develop surgical centers or

enter into agreements with the State government to manage and equip the

State institutions.

Doctors in teaching hospitals will be government employees and remunerated

by the Government. The monies used to maintain the doctors and the centers

will be generated from the National budget. To give incentives to the Doctors, a

starting salary for surgeons can be set at about =N=12 Million a year and

adjusted to inflation in Nigeria.

However, the role of the Federal Government through this new Agency will be

to regulate the number of surgeons produced from our medical schools each

year and the criteria needed to enter a surgical residency program. For


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instance, according to the U.S. Department of Labor there are 20,400

practicing orthopaedic surgeons and residents as at (2009-2010), and they

represent a mere 3-4% of all practicing physicians23. Each year in the United

States, roughly 650 students complete their orthopedic surgery program24. The

average yearly salary for an orthopaedic surgeon is dependent on a number of

factors like where they live and work, the size of the business, and years of

experience; the median salary for orthopaedic surgeons in the U.S. is $406,307

each year25.

In the United Kingdom, there are more than 18,000 surgeons currently

practicing in Englandof which 5,600 are consultants, 9,200 trainees and

3,000 in specialist or non-training grades. In Wales there are approximately

1,000 (330 consultants, 540 in training and 130 non-training)26. There are 1.1

consultant surgeons per 10,000 head of population in the UK but this figure is

not evenly spread across the surgical specialties and some specialties are

currently short of their target work-forcefor example, paediatric surgery, ENT

and neurosurgery27.

The average surgeon takes 11-12 years of further training after medical school

to reach consultant level in his chosen specialty and a surgeon will typically be

23http://www.orthopaediccare.net/orthopaedic-surgeons/

24Id.

25Id.26

http://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-andthe-nhs-in-numbers

27Id.
http://www.orthopaediccare.net/orthopaedic-surgeons/http://www.orthopaediccare.net/orthopaedic-surgeons/http://www.orthopaediccare.net/orthopaedic-surgeons/http://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbershttp://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbershttp://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbershttp://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbershttp://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbershttp://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbershttp://www.orthopaediccare.net/orthopaedic-surgeons/


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around 35 years old when they become a consultant28. Gaining the practical

craft skills needed means a close working relationship between trainees and

consultantsthere is currently an average 1:1 ratio of later stage surgical

trainees to consultant but this varies across the specialties and the average

surgeon will work in the NHS for 25 years after becoming a consultant29.

The States should be allowed to develop surgical centers but must obtain a

license from the Federal Government before building these centers. The license

should be given to States if standards set by the Federal Independent Agency

are met.

The private sector can also build surgical centers but must pay a fee to obtain

a license to build and operate the surgical center. I propose that the fee to the

federal government should be renewed every 3 years. The Federal Government

can set license fees at about =N= 25 Million for those seeking the license. Once

the fee is paid and the standards are met, the Federal Government should not

deny the private individual or corporations. The monies generated from these

licenses will be used to fund medical schools and salaries for the government

independent agency on health.

People with private insurance can go to private hospitals or people who want to

pay out of pocket. People without insurance and people with government

28Id.

29Id.


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insurance will go to the Government sponsored hospitals, which should be

medical schools with developed surgical centers.

If the hospital beds in government sponsored surgical centers are full, the

Nigerian NHS can refer patients to the private surgical centers and the

government can pay for the private hospitals visit. There is no doubt that this

model may encourage corruption as the private sector may develop fictitious

names to send bills to the government even though no surgery was performed.

This type of problem is usually sited whenever socialized medicine is practiced

or where there is government participation in enterprise.

The only way to reduce or curb this type of corruption is to enforce laws which

prescribe punishment for perpetrators. Corruption in any endeavour is a

problem.

Clinics

I believe that clinics should be a terrain for private enterprise. Like what

obtains in the Nigerian banking sector, a clinic should be defined in terms of

bed space, size of physical structure and what types of services the clinics

render. The size and scope of the Clinic will determine the type of License given

to set up. The cost for getting a clinic license can be pegged at =N=15,000,000

for specialized clinics and =N=10, 000, 000 for general clinics. A specialised

clinic can be defined as that clinic that deals with diseases like Diabetes,

cancer, stroke, geriatrics, and other complicated diseases. A general clinic can


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be defined as that clinic used to deal with fertility issues, tropical diseases

such as malaria, cholera, etc as well as other general out patient diseases.

Letters A, B, C in Diagram 1 above, are the license class issued by the

government to those who intend to run or own clinics. For instance, a license

class A gives a person the right or license to own a hospital/ clinic with a

minimum number of beds associated with the license. For instance, License A

will allow the ownership of hospital with no more than 25 beds. License B will

be given to private persons or juristic persons who intend to run a clinic/

hospital with no more than 80 beds while Licence C will be given to run or own

clinics with no more than150 beds. The cost associated with each License

class with respect to clinics/ hospitals can be pegged at perhaps =N= 7.5

million, =N=12.5 million and =N=15 million.

Certain conditions will be associated with getting a license. Strict

compliance to standards such as method of waste disposal, location of the

hospital, spacing between beds, number of nurses that must be hired, the

maintenance of data and transmission of data with respect to types of illnesses,

death and birth records, age of patients admitted etc, which must be sent to

the Bureau of Statistics and the Health Agency.

The fees associated with setting up and obtaining a license will regulate the

healthcare sector by eradicating sub-standard hospitals and establishing

strong financial base for hospitals that can afford to pay for the license. The


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license fee also allows the agency to make money, which it will use to fund

itself and to monitor as well as regulate healthcare centers. The strong

financial base of hospitals will allow for public law suits where the owners of

the clinics are negligent or fail to live up to the standards of medical.

Any license given will be reviewed and renewed once the conditions for

maintaining a healthy and decent practice is maintained. The guidelines for

setting up a clinic must be clear and any person or group trying to set up a

clinic must abide by the guidelines.

Diagnostic Centers

Diagnostic centers deal with testing of various diseases. The minimum

financial requirement for a diagnostic center can be set at =N= 5 million,

renewable with the sum of =N= 1.5 million every 3 years for the first 2

renewals, after-which the renewal fees can be reviewed keeping in line with the

economic realities of Nigeria.

Requirements for a diagnostic center will depend on the minimum number of

equipment proposed to run a diagnostic center. For instance, the minimum

standard before a license is give to run a diagnostic center will be that the

applicant will have equipment do basic blood work such as cell counts, malaria

parasite test, cholera test, and HIV/AIDS test amongst others. In addition,

every diagnostic center should have equipment needed to test for diabetes and

an X Ray machine should be present in every diagnostic center.


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Data analysis will help the Nigerian government develop and address the issues

surrounding our environment and our healthcare. The Nigerian Health Agency

(NHA) will be the independent agency responsible for analysis and

determination as to how we improve our health sector. Again, the Banking

model is the best model that will help in boosting our failed healthcare sector.

thoughts on developing nigeria's healthcare

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