 The health sector in Nigeria gets highest allocation ever in 2023 budget but fails to meet commitment. Enemies lament as Nigeria loses over 9,000 doctors in two years. Tonight, in continuation of our Town Hall series and a countdown to the 2023 elections, we assess the leadership of Nigeria and the failing health system. This is Plus Politics, I am Mary Anacoff. For the first time in the history of health funding in Nigeria, over a trillion Naira has been allocated to the sector in the proposed 2023 budget. An analysis of the proposed budget presented by President Mohammad Bukhari last week shows that 1.17 trillion Naira was allocated to the health sector out of the total of 20.5 trillion Naira for the 2023 fiscal year. However, there is still some source of failure in the system. The President of the Nigerian Medical Association Uche-Roland had said that only one doctor is available to treat 30,000 patients in some southern states, while in the north it is one doctor to 45,000 patients. In some rural areas, patients have to travel more than 30 km from their boards to the medical attention where available, and this is making access to healthcare a rarity. Also, Nigeria has lost over 9,000 medical doctors to the United Kingdom, Canada, and the United States of America between 2020 and 2022, leaving the sector largely unattended to. And that's why we're having tonight's conversation. Joining us to discuss this is Dr. Alera Roberts. She's the Vice-Chair Association of Public Health Physicians Lagos Chapter, and also joining us live in the studio is Dr. Ibitro Kemi Korubohi. He is the past Chairman of the Enemy in Rivers States. Thank you so much, Dr. Korubohi, for joining us. It's amazing to have you here. Yeah, it's good to see you. It's good to see you. Happy holidays. Great. As much as this is a lot to unpack, we're going to start from the fact that the 2023 budget looks a bit hopeful for the health sector. But one would wonder, for a country like Nigeria where we have so many problems, epidemics of all sorts, why have we not prioritized healthcare as much as we should? Well, you know, first and foremost, let's remember that there is something called the Abuja Declaration. Abuja is, as in the FCT, where 15% of your budget allocation should be for health, and that makes a lot of sense. And so far, the budget allocations for health in our country has, you know, range from 3% to 6.5% to 7%. So this is a big one. But again, when you look at the percentage, it still sorts a bit shy from the 15%. The other aspect to remember is, in last year's budget, how much was actually, you know, released allocating funds to a particular sector and actually releasing them and then having the impact to expect these are different things. So we are hopeful, we are slightly excited, but you know, the past is there to teach us. And what we've noticed in the past is that the figures that are put on pen and paper and the actual figures that get out there are not the same. Over time, Nigerians have grown, you know, amidst the underfunding of the health sector. And many people have said that they can't even afford, you know, Medicare in the country. And of course, we also know that there's been a downturn in the economy. People can't even afford a meal. Hence, I mean, let's alone talking about whether it's square or round. And it all again goes back to leadership. And that's why we're attaching it to this conversation. In the order of priority yesterday, we talked about the education and people, some people would say the educators would say prioritize education. But then Medicare is very important. We've seen our leaders and many politicians travel outside of the country, boosting the tourism, health tourism of other countries, yet ours is in shambles. Some people would say that even the doctors in the system are part of the problem. How true is that? Well, first of all, let me say that I think the COVID experience has reminded us all of how important health is. If you remember during the COVID, there were no football matches. There were no travels. There were no cinemas. There were no lectures. Everything, you know, came to a halt. And that shows you the importance of health. So the COVID showed us that if people do not prioritize their health, then nothing works. So I think the COVID has taught us the lesson. So I think the jury is out on that one. The fact is that health is wealth. The most important aspect of human day-to-day living is health. It may also shock you to know that most of the developments we have today, the houses, the water system, everything was initially geared towards health before entertainment and all that kicked in. For the aspect of doctors being the problem, I don't think so. And of course, I'm biased. I'm a medical doctor. The first thing we must remember here is that our doctors do very well outside the country. There is a big drive for our doctors outside Nigeria. I guess the question is why? That's the point. So we train our doctors better here. Our doctors are focused and resilient. And indeed, not just the doctors. I must say this. I'm sorry to cause it. Do we really train our doctors better? I ask because I'm looking at universities that are strike and the facilities that are in these departments. I'll speak from my department. I graduated from a department that did not have a sound lab. I didn't see what it looked like, but I was opportune to work in a media house. So I understood the process. But what about those who graduated with that? Well, same can be said for medical departments in some universities. First of all, I guess I'm lucky because I'm a trainer. I'm a lecturer. So I train doctors. I've been training doctors for many years now. And yes, our facilities are poor. We are underfunded or poorly motivated. But when we compare to countries like the American School in Barbados and a few other countries that actually send our students and other students to come in here for clinical attachment, when we compare them, our students are better. Now, remember recently, we had this issue with the exams with the Medical and Dental Council where foreign trained doctors had to write exams and they didn't pass. So the point here is despite our limitations, our doctors are well trained. Now, and we need not just the doctors. And it's important to put this out there. We need the nurses. We need the lab guys. We need pharmacists. We need everybody in the health sector to be well trained and motivated for us to give our people quality health. Remember that the goal of quality health is that somebody should be able to walk down to a primary healthcare center from his house. When I was a kid, for every few kilometers, you'd find a health center. Exactly. I always ask, what's ever happened to those health centers? So, you know, the thing here is the current leadership at all sectors. So this starts from the local government, state government, and indeed the presidency, they don't seem to be in touch with the health realities of the day. You see, first and foremost, you brought out a budget right. What are the driving factors that influenced how much you spend on, say, capital in the health sector, manpower development? Do you have a needs assessment on the table? I would have expected that before you bring out the 2023 budget, the body like the enemy, the narcissist body, the pharmacist body, everybody chips in, throws in, you know, shortfalls, and a needs assessment is done, and a projection and goals are set. So let's say that these budgets, the aim of this budget is to be able to improve manpower, improve the health indices for the next two, three, four years. But you and I know that that's not possible because this money is huge, but huge money can be thrown down the toilet. You need to have done a needs assessment. What are the basic needs in the health sector? Can the government actually come out and say, we have a document saying that this is the shortfall of medical doctors, shortfall of nurses. This is the laboratory shortfall. I don't think so, and again, I'm speaking personally here, but I'm part of the system. You know, like I did tell you, I'm a consultant. The consultant implies that I'm a specialist doctor. I'm a trainer of doctors. So I can tell you that a needs assessment probably wasn't done. I can also say that if you have all the money in the world and you don't direct it to where it is needed, then we're in trouble. And we should have clear set goals. If remember, right now, China has opened itself to the world from January. China has been battling with COVID. Nobody knows the true figures of COVID in China. What that tells you and I is that despite the fact that we've successfully managed COVID here, with the Chinese border open, will COVID not come? That's how we ought to think. And what are our preparations and planning towards, you know, if there be another wave, I'm wondering if this might be the ninth wave. Yes, and remember here that what COVID did was it tested the health systems. It tested our reserves. I mean, at a point we didn't have oxygen, you know? So the issue here is have lessons been learned from the COVID. Have we understood that in order to provide health, we need all players in the health sector. And remember that as shocking as it seems, you know the most important person on the health team is the patient, the community. So everything we do, we need to go back to the community and make sure that we have them participating in what we are doing. I personally think this is lacking. And you know, to throw this out there, I would say that every single politician or public office holder from our counselors to our local government chairman, governors and the president, nobody should go abroad for healthcare. Nobody should go. If you decide to occupy the highest office in the land, managing our commonwealth, then please come to our hospitals. I'm going to come to that part because that's an aspect that I'm very, very passionate about. But let's backtrack a bit. In terms of, you know, the COVID and if we've learned lessons, I remember I talked to somebody from the NCDC and he talked about the fact that now we have these laboratories readily around us and that that's something that we can say was a plus from COVID where you can easily go to a lab anywhere. And you know, that we didn't have those places where we could do testing centers as readily available as you know, we have them now. But aside from that, it looks like we haven't really learned anything. And then when we talk about primary healthcare, it falls on the lap of the average councilor or local government chairman. But then in states, we're always very quick to point fingers to governors, meaning that there's not enough information out there about how this primary healthcare works and who has what responsibility. So again, if we must channel calling on communities to get involved, if we must channel our anger or our problems or our complaints to the government, then it has to be local government. Where are they? Well, you're spot on. I think the first thing for me is that I don't think we've learned lessons from the COVID. I don't think that the fact that we have labs that I wonder if they're still functioning till now is enough. COVID showed us that we need supply chains. COVID showed us that our borders, the world is a small place now, and we need to put our ears on the ground that once you have an epidemic next door, we should be prepared. So these lessons haven't been learned. COVID showed us that budgetary allocations for health should be, you know, focused. These lessons haven't been learned. How many oxygen centers, plants have been built across the country? That's when you tell me you've learned a lesson. So we haven't learned call lessons in COVID. For the aspect of primary health care, you know, theoretically, there are three tiers of government. So you have primary, you know, local government, state government, and federal. Now, the federal government has tried several times to provide autonomy to the local government. And, you know, there was some bill that the president tried to executive order. Well, now it's time to go directly to them. Yeah, but till now, remember that recently the local government workers where they had some demonstration. The state assemblies are yet to sit and come up with a position concerning local government autonomy. So what happens in most states is that the local government chairmen are just, you know, I'm looking for a very respectful word here, but they are nicely kitted, well-driven public servants that really do nothing. How many local government chairmen live in their communities? I mean, you won't fix the primary health care, except you stay there. How many local government chairmen's children go to the community secondary school? These are things that we should ask. So most state governments dip their hands into the finances of the local government. And so the local government chairmen are powerless. Most of them were appointed by, in quotes, by the government. And guess what? Most of them can be removed from the House of Assembly. Why? If I was appointed by the people, the councilor should be who can remove me. So our democracy is still, you know, a job in progress, but every now and then we need to stop and fix things. Local government in Nigeria does not exist, and that is why primary health care does not exist. If we wanted to exist, simple steps. The local government chairmen should relocate today to the local government headquarters. He should go and register in the primary health care and get a card. His children should go to the school there. If we achieve this, development will come. But as impressive as this sounds, we have laws that we hardly ever really test. And who's to say that there's anything that's binding that would make a local government chairmen want to leave where he's, you know, in charge or put his children in public school? Again, we spoke about education yesterday and the same questions were raised. How many of these people go to public schools? But then what is the state of those public schools? Well, see, that's the point here. If the local government chairman, if I'm campaigning to be local government chairman and I know that, gosh, when I come into office, my children will need to go to these schools. I would make a promise to fix the schools and I will immediately start fixing the schools. If I know that I need to live in the community, I think a lot of my thinking will be community-based. So I think that's the key message here. Now, what law are thumbprint, the ballot box? We should get commitment from our aspirants. You know, we should sit them down and hold proper town hall meetings, which is easily achievable at the local government level and say, you know what? You're going to commit. Can you commit to us that if we vote you in, your children will come to this school? And if we get those, because you see, the honest truth is that if you're not in public office and you earn your money, you have a right to go to the best hospitals in the world. Your children have a right to go to the best private schools. But once we know that it is the common world, you must pay a price. And you know the funny thing here? Imagine a situation where all political office holders must use public hospitals, must use the public schools. What will happen is that fewer people will run for office. Most people will look at it and say, man, I don't think I can use this thing or I can live here. And they will have no choice. So we will now get only those that are willing to serve. Right now in my community, am I willing to live in the local government headquarters? The answer is no. So I will not run for office there. And this is the kind of thinking that we should have. Well, we're being joined by Dr. Roberts. Dr. Roberts, it's so good to have you, Dr. Alara. It's, I know that you've been listening while you're waiting, but let's talk about the state of the public hospitals, especially Lagos, where you reside and you work. The last time I had a conversation with you, you said something that has stuck with me that it's difficult to get a cannula half the time to treat a patient even in the emergency ward. Dr. Roberts, can you hear me? Can you hear me? I think that we have a connection problem with her, but let me pose that question to you. The true state of our public hospitals, I remember when I had a sick parent and we had to buy literally everything down to the gloves and scissors. And then I wondered, what were we paying for? But that was my experience. And I've seen several other experiences. How did it get this bad? Well, again, you know, I think that over time, the public hospitals have been neglected. And you remember that one of the problems in Nigeria is that we tend to get square pegs and create triangular holes and then take a hammer and force them in. So you have a situation where many of the people involved in the management of these public hospitals do not have the experience to manage them. How do you mean? Well, you know, for example... Because I'm trying to understand how I put a chief executive in a hospital and you're telling me that they don't know their job. How do they get the job? You see, see, that you should head a hospital and that the medical doctor is the best person to head that hospital makes sense because you have an idea of every other thing. And we have studies in the U.S., for example, and in the U.K. that showed that hospitals run by physicians did well. But these were not regular physicians. These were hybrid physicians, people that were trained in business, trained in administration, understood that you being the head does not allow you neglect or look down on other health workers that are equally experienced. I mean, for God's sake, if you want to equip a maternity now, yes, a gynaecologist would help you. But a midwife would also bring in some fantastic ideas. And you need to sit with everybody in the team and say, you know what? This is the goal we want. Cheap in your idea, cheap in your idea. And everybody works for a purpose. So I think the first thing is to create an atmosphere where all health workers feel carried along with the medical doctor. They don't feel bullied. They don't feel neglected. They feel inspired. You know, that's the first step. Secondly, it would be nice to have doctors that had these hospitals that have had some experience in private care. They've run something. They've managed something. So they know what to do and how to do. So if I get you correctly, you're saying half the time these EDs are not necessarily fit for the job. Well, I think for me that the only way I can tell if the teacher and the student have done well is the report card. Remember that the report card is not a reflection of the student. That's old, old education. Modern day education, which we call formative education. Like I said, I'm a teacher. I'm a lecturer. You know, and I have degrees in education also. Nowadays, a pass or fail is a summative assessment and it assesses both the student and the teacher. So if you want to assess how well the EDs have done, what are the outcomes? And remember that these outcomes are not only outcomes of patients. Other workers in the hospital, how well do they feel? How well are they doing? You must be able to look holistically into the healthcare system. And you need people that are experienced that understand what it takes. And again, if I should add here, we need oversight functions. Every government hospital has a management board. The management board chairman doesn't necessarily have to be a doctor. It could even be you. And that board must have oversight functions to say this hospital, how is it being managed? Absolutely because this is what we see, you know, in other climes. Dr. Lara Roberts, let's try again if we can hear you. Can you hear me loud and clear? Yes, I can. Perfect. Perfect. So I'll pose the question again. What is the state of public hospitals here in Lagos? For states that, you know, many would say, you know, is doing something better maybe than other states. You told me, like I said, the last time we had a conversation about how bad the situation in the emergency rooms are, I want to tie it to something that happened on Christmas Day. The lady who was shot by a policeman in Ajah area on Christmas Day was taken to at least two hospitals who turned her back. Is this also not a poor reflection on our healthcare system? Again, knowing that gunshot victims should be treated without any questions. Thank you very much for having me. And I'm so sorry that I couldn't join earlier or joined by Zoom. But a little bit I heard about what Dr. Combo was saying. I totally, I know he's totally speaking our mind, the mind of pretty much all healthcare workers. So if you were to bring it down to the case of that young lady and trust me, my heart bleeds because I have a daughter who seven months ago was seven months pregnant with a toddler and who takes that same journey because she lives in the area. And so I'm sitting here thinking I could be the mother of that young lady. You know, and it's so personal. Now you have to also understand the reality of the situation we face. No hospital can handle a gunshot injury of a pregnant woman except that that hospital is operating at tertiary care level. You know, it's not just a matter of legislating that gunshot wounds was treated. Treated with what? Do they have trauma surgeons? Do they have a blood band? Do they have everything that it takes? And instead of wasting time it is best to refer her as fast as possible to a higher level facility. The problem is where are the higher level facilities? What is the journey time in between? By the time they get there do they have an emergency response team on ground? So these are all things you see you can't just expect a system to work for you where we are not invested in that system. Interesting. Let's talk about the statistics that we have on ground. There's a report that says that the Bahá'í government has failed largely in the healthcare sector that it has forced over 6,000 pharmacists, 8,000 doctors to relocate abroad. And this is the question. Like Dr. Korobah was saying that we're very well trained and when we go abroad we do very well. If we have these many good doctors and other countries are coming for us why are our governments well I'm not just talking about the Bahá'í administration because this has gone on for a long time. Not prioritizing these medical practitioners. I hear that resident doctors in RBS states have been on strike for one year. I'm imagining what the health system in RBS states would be like right now because I'm sure that resident doctors are very important in this scheme of things. Resident doctors are really the bulwark of the health system in terms of delivering services and having doctors on ground 24 hours. It gives me vicarious pleasure that Dr. Korobah will agree with me on this where teachers in the medical sector where medical educators that we are actually educating our students to a level where honestly last year, the year of 2020 just before the COVID we had students in 500 level MBBS who are passing the qualifying exams for the UK without having done their final medicine exam. That is the quality of healthcare workers who are turning out. But you see like I said and I've said this in so many places the health system is beyond just the doctors and nurses. It's beyond just a particular administration or a particular party. It is something you invest in and you build over decades. It's having the entire system that is properly set up, that is properly equipped, that is properly staffed, that is properly remunerated and it's properly supported. It is about good leadership. It is about government. So that statement that you made that you said resonated with you that I said I guess it's an emergency and I can't even find stuff to insert an ID line without giving patients relatives a shopping list to go to the nearest chemist shop and buy stuff. The point is that when you're looking at the logistics and the procurement processes to make sure that all those things are in place you need to be able to even block off the leakages the wastages, the theft and the corruption. You need to block off the over invoicing. You need to block off the poor distribution channels. There are so many things that go into it that is beyond just the doctors and nurses and we don't train to be looking after those things. That's not where our focus is. Our focus is service delivery at the point of treatment. So these are things that yes, you are right. It's not just this Boarica administration we're talking about. We're talking about decades of underfunding the healthcare system and we started with the military era. I have no fear of people saying that. Okay. Let's talk about while I was talking with Dr. Korobo he talks about leadership and the seriousness in dealing with the issue maybe at some point all of them deciding to if they want to run for an office they make sure that they all decide to go to hospitals within the country and not travel out but then of course it looks like it would be easier for a camel to go through the needle's eye. But we do have a minister of health who's also a doctor who obviously is a medical practitioner who should be the one speaking on the behalf of the health sector but then we see a lot of politicization of the matter or the issues around the sector and I'm wondering why is that the case? Because I'm guessing if I put a Dr. Korobo as a minister I'm guessing that he should be pushing for that sector to be better as opposed to being a politician. My darling, how long is this program? We can sit down and talk about it. Oh, we have all day. But let's go. If you call Jesus Christ to be minister of health in this present system short of his working a complete miracle and being a lower slot for everybody he will face the same problems that any minister faces because by the time you get in there you realize that there's some entrenched interest in the system that will ensure that you cannot succeed. Oh, interesting. You want to stop people saying you want to stop them going abroad? I mean, it's an idealistic and it's a wish I've had for many decades that if you stop them sending their children to school abroad if you stop them going abroad for medical treatment then maybe they will be forced to. They will not. They will find other ways of taking the money. Let's talk about doctor-patient ratio for southern states and for the northern states. I find this very alarming. 35,000 to one doctor. To one doctor. How does that work? I mean, I understand that more and more doctors are leaving the country but what is being done to replace these doctors? Because I'm thinking if I were to be trained to be... How do you replace these doctors? Yeah. Doctors are not something you go to a supermarket and pick up a shelf. Do you even have the structure? Right now we're looking at a situation where we don't even have medical educators to train the next stage of doctors, nurses, physiotherapists, pharmacists, medical lab scientists, biomedical engineers. Because you forget that a hospital is not just doctors. If there's equipment, there's equipment that has to be maintained. Investigations that have to be carried out. The whole gamut of the health system, we don't even have the educators in place right now. So even if you throw all the money at the universities that you want to throw, we don't have the lecturers. People have forgotten that aspect of it. In 2022, we're not graduating a single member, a single new member of staff in the health sector. Wow. Together around. That is not something else to imagine. That's the reality we're facing. Wow. We'll take a quick break. We'll take a quick break. We'll be back to talk more about this because there's a lot that needs to be unearthed in this studio this evening. But we're talking about leadership and their role in the failing health sector in Nigeria. As we get ready for 2023, we'll be right back. It's still plus politics.