Unitary Healthcare and Surgeon General

culled from Thisday The Sunday Newspaper, 10 August, 2003, p.10

Dear Eyitayo Lambo,

Greetings from Enugu state! A state our people describe as Ebeano Country ...the place to be. I have decided to write you to take advantage of the current media fascination with exchanges of letter amongst major actors in the polity. I congratulate you on your appointment as Minister of Health.

They say that our elders see vision and the youths dream. For many years now, I have had several dreams, thus acting on my belief that the power to dream is an inalienable right given by the Almighty God to every one.

Years back in America, I pursued my right to dream. This was after achieving my own American dream. This of course included a Porsche (993 Carrera 2 Cab) in the garage, success in medical practice and the academia. As the Americans say: Been there, done that. But even having achieved that American dream, my African dream persisted. Even in the operating theatre and in-between operating cases, the dream persisted. Crawling in the long, slow, Florida traffic, the dream persisted. Even as Governor of Enugu State weighed down as I am, with vast State functions or even hurtling the road between Abuja and Enugu - such a long road-trip - the dream persisted.

This is the dream sweeping in me today as if I were the Hon. Eyitayo Lambo, Minister of Health of the Federal Republic of Nigeria. It is a dream that could also be interposed as a vision for Healthcare in Nigeria. By the way, I apologise for writing you publicly but may be this public letter could invite debate and discourse on the issues raised therein. That, in many ways, would increase sensitization and public awareness so as to focus debate on healthcare. Attendant upon the fact of Healthcare being the mainstay of any stable society, we cannot ignore the necessity to bring in every shed of informed opinion and expertise to take us to the level of sustaining our teeming populace. This will certainly underline the truism that a healthy nation is a wealthy nation.

I may well start on this by re-asserting that I have always aspired to, and indeed, played in the league of those who believe that one vital vehicle for consolidation of this democracy is by expanding on the field of dialogue and debate on issues of national importance. To this effect, it is still well by me that we are beginning to build adequate courage to take to the public podium such matters, which had hitherto remained, exclusive and sacrosanct.

For me, to guarantee true freedom under democracy, we must promote four-dimensional discussion of matters important even if it is just for streamlining and prioritizing. That way, we shall as well provide knowledge and admit inputs in healthcare delivery. I will then anchor this hint of my vision on accessible and affordable healthcare to the child, which likewise education, the sky would only be the limit for our children and tending youngsters. In other words, your child and that of your driver, if exposed under like circumstances, will probably have equal chances of success in a democracy.

For purposes of pursuing the familiar path, I want to draw directly from President Obasanjo's clear vision on primary education for all, which as already improved on from the earlier breakthrough of the compulsory Universal (Free) Primary Education (UPE), the successor-Universal Basic Education (UBE), has again kicked off a phenomenal upward leap in providing more enlightened populace to roll back illiteracy, ignorance and disease. We may now, for reasons of brevity and focus, limit this discussion on general healthcare to the less privileged and the others in the subsequent ascending order of privileges.

Mine is a vision of a National Health Agency (NHA). An organization similar in pattern to the UBE programme; whose parameters for organization and operation are made clear by laws and enactments of the National Assembly, if necessary, also, goes by concurrent legislations of the State Assemblies.

This Agency will draw support from the Federal, State and Local Governments and if agreed on, allocation paid into a joint pool concurrently, not necessarily drawn from source. This will take care of indigent patients, while care to others will be subsidized based on assessment. Indeed, a regulatory department would provide the guidelines or criteria as well as supervise the various assessment centers. These assessment centers will serve as clearing houses and entry points into the pool of National Health Agency (NHA). Consequent upon the agreement and participation by the stated stakeholders, this healthcare could be described as Unitarised under this system.

Still continuing on this piece, which you remember is only a summary of the big picture, Nigeria will be divided into health districts. Using the 774 existing local government areas, each could have two to three health districts. Each Health District will have three Health outposts. These are two General Out-Patient clinics and a cottage hospital. The General Out-Patient Clinic will provide primary healthcare services. Community Health Practitioners and Nurse Practitioners, as the case may be, could head this institution. Minor trauma, wound care, minor accidents and short-stay management can take place at this General Out Patient Clinic while the Cottage Hospital will provide the mainstay of inpatient care in the rural health district and also outpatient clinics within the Cottage Hospital. The Local Government Health Department will also serve as General Outpatient Clinic offering similar services and more. Remember, it is imperative that we pursue a policy of health administration, which will emphasise Rural Health development (via the districts) as the main programme for primary healthcare services. In other words, we shall be emphasizing preventive medicine and community health

The Cottage Hospital for each Health District will be an eight to 10 bedded unit for inpatient services such as antenatal unit, labour and delivery services as well as post-patum care. It will have beds for pediatrics and adult patients, and of course, operating room facilities. Outpatient services at the Cottage Hospital would cover pediatrics, including routine immunization and the so-called well-baby clinic; school health services and adult outpatient clinic. The Cottage Hospital will be administered by a national health physician as chief executive and other complement of staff including pharmacists, nurse practitioners, midwifes and other assistants. Each Cottage Hospital will have a dedicated ambulance with 24-hour capabilities for transfer to the next level of care. Preventive Dentistry will also be a part of the package of health of the National Health Agency at the primary level. This again is only a summary for the provision of National Healthcare services by the National Health Agency (NHA).

Necessarily, it may be important that we understand that the various centers described may not involve additional dedication of resources since there are many available infrastructure such as the party offices built for the Social Democratic Party (SDP) and the National Republican Convention (NRC), across the country. These can serve as clinics, maternities and health centers. The availability as is the case with this will enable the NHA to pay more attention to capacity building, public enlightenment and procurement of drugs, as well as manpower development and other equipment. For Secondary Healthcare, we will use one general hospital per local government area covering obstetrics and gynecology (OB/GYN), general surgery, pediatrics and internal medicine, emergency room/trauma care and various outpatient clinics.

The General Hospital can also provide some tertiary care services based on available skill and competence.

For tertiary care services, ideally, there should be one Specialist Hospital per Senatorial Zone, and that is alongside the various Teaching Hospitals where they exist. Specialty Hospitals such as Orthopedic, Eye, Neuro-psychiatry and maternity hospitals, among others, would of course continue the provision of tertiary care services.

The National Health Agency (NHA) would have its corps-member at various levels. These may be full time for primary health services, a mixture of full time and part time for secondary health services and part time, as the case may be, at the tertiary level.

The pinnacle of leadership of the National Health Agency (NHA) would be its own Surgeon General (SG). The Surgeon General would serve as the nation's core conscience and symbol of excellence in healthcare. His position will serve as a Bulling Pulpit for advocacy in such areas as Road Accident Prevention, HIV/AIDS, malaria infestation, smoking, hypertension and cardiac disease control as well as the triad of maternal anaemia, maternal infection and obstetrical accidents.

The entire programme would change markedly the sequela of yet another triad: poverty, ignorance and disease. I have for reasons best known to me declined comment on Nigeria National Insurance Health Scheme, a programme likely to end up elephantine and a major distraction; another major miss of the real points.

I hope you have found time in your busy schedule, especially at this time you are trying to settle down, to read this piece. On one of my many visits to Abuja, I shall stop by and we continue on this subject. For all we have been able to do and for that which we shall do presently, I say to you as we say in Enugu State, To God Be The Glory.