Anarchy of Nigerian health care system By Khalid Garba Mohammed

While in many countries around the world, the poorer you are in terms of income the more government intervention on healthcare you receive as a citizen, in Nigeria, the opposite is the case.
Here comes a country where the National Health Insurance Scheme (NHIS) is most accessible to federal government employees (the formal sector), and indeed even among the government employees the most seniors often enjoy the package more.
In the state where I came from, it has become a daily routine that masses go to the media (radio stations), and most recently using social media to solicit for financial assistance related to their health most commonly when a surgical procedure is to be perform on them, notably you will hear a bill of hundreds of thousands to millions which obviously majority of them cannot afford.
During my early career as hospital pharmacist, I came across many elderly patients that are on anti-diabetic or antihypertensive medicines skipping their prescription filling simply because they cannot afford the price and what that means is an indirect signing of death warrant unwillingly.
My questions are: where is the Vulnerable Group Social Health Insurance Programmes? Where is the Tertiary Institution Social Health Insurance programme where students are charged during their registration and almost always end up receiving paracetamol anytime they visit healthcare facility in our tertiary institutions? Why is it most of the programs listed on the website of the NHIS are mere delusional and deceptive? In my opinion, those kinds of patients deserve the so called NHIS programme the most.
If the government cannot include all citizens in the NHIS programme, then special intervention team should be instituted across all tertiary healthcare facilities we have in the country to screen patients with genuine financial constrains that are not NHIS beneficiaries for immediate/temporary coverage, so that they do not need to go begging and dying along the process, while the government just watch.
Secondly, why can’t the era of PTF repeat itself in a tantamount way where the federal government intervention on health commodities reaches out to state and local government levels such that the masses could have a direct impact on their health from the federal government? Another topical issue among the healthcare professionals particularly the young generation is the decline in the job opportunities, an aspect I personally relate with an intense “who you know syndrome” in the system.
Unlike before, many young medical and allied health graduates nowadays spend several months seeking for first of all mandatory one-year internship placement, to talk less of securing permanent job, of course unless you know somebody who also knows somebody.
The worst part of it is the fact that the demand for the services of these young professionals is not saturated, of course in Nigerian context, there is still big gap in the ratio between the healthcare professionals and patients as per World Health Organisation (WHO) recommendation is concerned for effective healthcare delivery.
The federal and state governments must acknowledge that the number of healthcare personnel employed at both levels is not sufficient, but why are they not employing more to fill in the gaps? Why should our young medical and allied health graduates be roaming around for months to years seeking for employment when our healthcare system is in dare need of their services? In my humble opinion, I think the government at both federal and state levels must strategise and prioritise to absorb more of these fresh graduates into the health care system in the country in order to boost the system for effective service delivery.
It could be wise to for the federal government to engage some of the agencies like the Pharmacists Council of Nigeria (PCN), the Medical and Dental Council of Nigeria (MDCN), and their likes to centralise posting for internship placement, just as it was recently approved for some category of personnel in the country’s health care sector, so as to provide a fairer atmosphere for securing internship for newly graduated healthcare professionals.
I would like to conclude this piece with the issue on the recently conclude strike by the Joint Unions of Health Worker (JOHESU), it is very worrisome to withheld two months salaries of these staff in this trying moment of our country, a situation whereby even if you receive the salary on regular basis, so often is not enough for one to run through the next salary without additional debt on majority of Nigerian civil servants.
Strike actions are worldwide phenomena; only that in Nigeria, we tend to abuse it partly due to our government insensitivity most times.
Additionally, there are threats that the positions of some of these JOHESU members that participated in the strike action have been declared vacant for replacements; this is uncalled for and uncivilised.
In my opinion, the Minister of health as the father to all healthcare professionals in the land should as a matter of urgency address this issue.
It is a global phenomenon that healthcare delivery is a team work, and we can only thrive to excellence through mutual respect and understanding.
As health care professionals and as a team, we can resolve our differences through negotiations and collaborative measures.
Together, we stand tall! God bless Nigeria.
Mohammed is a PhD student at University of Milan, Italy