Why we opposed the National Health Bill; Dr. G.C. Okara

Dr. Godwill Okara has said that doctors are not equipped to head the health sector, he explains why other health professionals are opposed to the National Health Bill.
What is the way forward for the health sector?

Take a look at a scheme of service, from 2001, addressed to the minister for health, telling him of eleven schemes of service for professionals in the health sector, to be implemented. The then minister caused this letter to be circulated to all chief executives of hospitals for immediate implementation. Up till now, this scheme of service has not been implemented because doctors feel they are the ones to [lead].
Take the medical lab science cadre, at its apex is a director for lab services. Apologists have no such thing in their service; what they have for scheme of service is medical laboratory and consultant pathologists.
Apologists are clinicians, medical doctors licensed to practice medicine and surgery, to run clinics in their various specialties. Instead of setting up clinics, they are struggling that they are the ones supposed to run laboratory services. They are obstructing the implementation of this scheme, so how will there be orderly conduct? Health care practice in the 21st century is a multidisciplinary endeavor. The days of one man being the all in all in the health sector is gone forever.
There are laws: do your own, let me do my own. When people think that they are above the laws of the land, it is an open invitation to anarchy. And the kind of situation we see in the health sector, there could be no greater anarchy than it. Despite the immense human and material resources in Nigeria, the Nigerian health service is being rated 51 out of 53 in Africa. It’s a shame. Instead of facing these facts, they gang up, become partisan and want to protect the interest of their colleagues against all others

While all this is happening, what happens to the patient?
The patients have a role to play by calling the actors to order. What you see in Nigeria is that everyone keeps silent. The was a report from a committee chaired by a high court judge which doctors are kicking against. The former president of NMA wrote to the chairman of the committee and condemned it . When you say these things they call you all sorts of names— like radical, revolutionary. It is the usual Nigerian pattern. When you make your point, they say “oh, two elephants are fighting”—they even reduce it to a laughing matter. And of course the effect is obvious—that’s why people are trooping to India, Egypt, Germany, and Saudi Arabia for treatment.

With these sorts of grim expectations about the health sector, can we move forward?
The MDG, since it is being driven by another agency, to an extent is performing well. It is under a different framework. If it was brought under mainstream ministry of health, this same matter would have affected it.

What have your association done to bring light to all these issues?
We have spoken, addressed press conferences, spoken to powers that be. But even when we write to ministry of health, they don’t reply.

Is Nigeria, the only country operating this kind of backward health system?
We decided to impose this on ourselves. Before now we were ranked fourth in the commonwealth. Patients were being referred to various University Teaching Hospitals in the country even the Lagos University Teaching Hospital.

Why is the health sector so saddled?
Money is not the issue, so long as the management is not skewed. It is only the federal ministry of health that you have 52 people in top management committee. Out of this 52, 40-something are medical doctors trained and licensed to serve but they prefer to stay in the ministry controlling programmes.
It is society that pays for all this—my money and your money is what is used to maintain the ministries. So if we decide to keep quiet, anarchy will continue to reign.
There was an attempt to use the platform of the National Health Bill to try and usurp the regulatory powers conferred on different professional laws, to emasculate and gag them; that was why we protested against it. They come to the public and say 2 ½ % is meant for primary health care, but they don’t tell you the poison. It was the same story when the national health insurance was being set up; has it solved our problem? The same story when Decree 10 of 1985 was being set—that if people in the health sector are in charge, things will be better.
Has it solved our problems? We should not be deceived. That was why other members of the health sector stood against the National Health Bill. If that bill is passed into law as it is, it will amount to pouring petrol into fire. If there is anything remaining in the health sector, everything will crumble to pieces if that bill is passed. Because in the 21st century, you cannot enact a law and pretend there is no law. You can’t build something on nothing. It doesn’t happen.
So we said, in the opening paragraph of the law—section 1 subsection 1—inset the clause “without prejudice to the extant professional regulatory laws of various professions, full stop.” Once you do that, you have recognised the existence of various professional regulatory laws, and they didn’t want to do that. Instead of accepting that there was relevant points in what we are saying, they say “oh, no law is without imperfection, pass it…when it is time to amend, we’ll amend it.” In Nigeria? They tell us to pass a law that is faulty, and it will be corrected after ten years. We tell them, tell that to the marines. This is where we are.
We call on the press to take active interest in what is going on, sensitise the public to see what we are talking about. Not just 2½% of annual budget for primary health care. Some of us have been privileged to work even at primary health care level. For three years, I worked in hinterland of Ondo state supervising routine and special immunisation activities. I saw firsthand how funds by development partners are frittered away.
For two years, I worked in Ebonyi state, supervising special and immunisation activities at the primary health care level—at village and ward levels. I saw these things firsthand. People make it sound as if money is the issue; money is not the issue. All they are waiting for, even all the clamour about the National Health Bill, is that Global Fund and UN will give us money—that’s all. And when the money is voted, you don’t see it translated into appreciable improvement in health status and indices. We are in it together, we are all Nigerians. We should express active interest in what is going on so that we can address these issues once and for all.
We are in a government that professes rule of law and due process. Rule of law means codified law should be allowed to hold sway. We can’t have a law passed by the national assembly of Nigeria, and some people arrogate to themselves powers to obstruct the implementation of such law. If they do, it is an invitation to anarchy.