Can we meet you?
I finished medical school at University of Ibadan. Then I came to Lagos and had my residency training at the Lagos University Teaching Hospital (LUTH). I also spent some time outside the country. I had my academic career at University of Lagos, starting as a Research Fellow, then a Senior Lecturer and was later appointed a Professor of Medicine. So basically that is what I did up to 1993 when I moved out of mainstream academics into what I call medical administration. I was appointed as the Secretary of the West African Post Graduate Medical College. In that position, I oversaw the activities of both the West African College of Surgeons (WACS) and the West African College of Physicians (WACP). I did this for a number of years. From there I went to the West African Health Organization (WAHO) as the Director of Human Resources Development. The West African Health Organization was created by a merger of the West Africa Health Community and the francophone counterpart, which was called OCCGE to make the West Africa Health Organization under ECOWAS.
What would you describe as your guiding principle?
I have always believed in a passage in Proverbs in the Holy Bible, which says there is no work in hell or heaven, therefore whatever you find your hand to do when you are on earth, do it to your utmost best. Also, I believe in hard work, honesty, faith in God, faith in humanity and fairness to everybody.
What would you describe as your greatest challenge?
I would say the greatest challenge is how to relate and work with human beings. Human beings are the most unpredictable animals that God ever made. When I was a researcher, it was easy to plan my life. I knew if I add acid to alkali, I will always get a salt but with human beings it is not the same.
How does your current work impact healthcare in Nigeria?
What you have asked is a very difficult question to answer. The bottom line is how do people get health care if there are no people to deliver it? Most of what I have done in the last ten years or thereabout has focused on universal access. This entails every human being, wherever they are, having access to the right health worker who does the right thing at the right time and has the right qualification. All I have been doing is ensuring that we have adequate, well trained and competent health workers everywhere. I also ensure that the health workers are supported by government. As you know, we are governed by people who are unaware of most of these things and the only way you can convince them is by providing evidence. So it is getting that evidence of number, distribution, competence and capacity of health workers that is important to ensure that we can get our decision makers to see the need to make the right policies. You can have all the money in the world to buy drugs and the best equipment but if you don’t have adequately trained and encouraged health workers to deliver the healthcare, you would be unable to achieve universal access.
Are Nigerian doctors adequately compensated for their efforts?
When you take a class of thirty (30) in SS3, most of the people that are going to be doctors will be part of the top 10% or 20% of that class. Fifteen (15) years down the line, your best brains will then realize that they are worse off for going to study medicine – seven years of hard labour and emotional stress. They feel worse off in terms of their buying and earning power. Their children cannot attend schools that children of less intelligent colleagues in class are attending and they see the inequality in society and to make it worse, they don’t see the others working harder. Under the colonial rule, the colonial government recognized the importance of civil service structure and the importance of proper grading of people. Therefore, when you graduated as a doctor, you were not just in the same class as any other graduate. You were given an advanced level (Senior Service) as a way of appreciating your length of study, the nature of your work and what you are contributing to the society. Then we had the Udoji Reform in 1974. Chief Jerome Udoji was a very brilliant manager from the private sector and he was asked by General Yakubu Gowon (former Head of State) to review salary structure in the public sector. To be honest with you, in his report he said “there is one (1) class of people I could not classify properly by our system”. Because the system of management in the private sector is about hierarchy - How many people do you control? What is your span of control? He couldn’t see the span of control of doctors and consultants. Therefore, he honestly said he couldn’t classify them and therefore they should have another review, because there was no way he could classify them with the system he used. Unfortunately, like you know, a report comes out and the civil servant sits on it and because for the first time it favoured them over and above all the professionals; the permanent secretaries never agreed to review it. The bottom line is that the problem of doctors on salary structure till today arose from then. That was the one point in time when the public sector revision of salaries was not fair and didn’t take into consideration the existing parities of relation of different professions to each other. Individual doctors also feel that look what crime have I committed? All the ones that are not good as I was in class are better off in the society than I am. I am not working less hard. I am not lazy.
What is your opinion about doctor–healthcare worker rivalry?
The health sector itself is in trouble and it is in trouble because of the politics of Nigeria and the way we run things in Nigeria. To the best of my knowledge no other country in the world has as many boards and councils like the health sector of Nigeria. At the last count I think about twenty-three (23) of them and each of them is a ‘profession suis generis’. What that means is that I control my profession, I decide the standard and quality of training, I decide what services I should offer and no other profession can question it, even though all of them arose from medicine - because the first profession in health was medicine. There is that internal confusion and rivalry within the health sector that is not allowing the health team to be effective, particularly in the big public sector hospitals. In the private sector, the man who owns the hospital decides what he wants to do. But in public sector, everybody is struggling to control the system. Every union is fighting other union and that is why when one goes on strike and comes back, the next one goes. My personal view is that until such a time that the Ministry of Health sits down to create a Super Council, which would be able to rationalize all these, there cannot be a solution. Every profession has gone to get his ‘Act’ approved without any body seeing the overlaps with the other professions. There are too many overlaps today between Pharmacy, Nursing, Medicine and all that. There has to be some Super Council that will sit down and “regulate” everybody together; harmonizing all grey areas once and for all, and each one would know where his territory and limit is.
What is your opinion on Universal Health Coverage?
The National Health Insurance Scheme (NHIS) is both a success and a failure. It is a success because we have moved beyond where we were 20years ago. More people are getting access to it and more people are contributing but we have not gotten there. A lot of State Governments are not subscribing to it because of the issues of ‘concurrent list’. Take the whole of Lagos State with a population of about fourteen (14) million not being fully part of the NHIS. If each person was paying as little as one thousand Naira (N1,000) annually, fourteen (14) billion Naira would be available to the NHIS to provide services but Lagos State government wants to say, pay to me and I will create my own Health Insurance Scheme. Every State wants to have its own scheme. We are not going to move anywhere, so we need evidence as to what is working and not working, and why it is not working. Then based on this evidence, we can take decisions to enable us move forward. Again, we need to ask why we are at 3% of people accessing health care in the country instead of 97%. If you know why we are there, then you will understand the processes you need to put in place to get to 50% and more. The three (3) core issues to access are – firstly, geographical access: How near is the hospital to you? You also expect that when they get there, they will receive good service, there will be qualified human being there to treat them and there will be drugs and equipment. Secondly, financial access: Do you have the resources to be able to access what is available to you? And thirdly, confidence and traditional beliefs: People feel reluctant to go and seek help partly from previous experience and partly from traditional beliefs. Except we can deal with those three effectively, we cannot improve. In a place like central Lagos, you probably have coverage as high as 60% or 70% because not only are there enough government facilities but there is also a high number of private facilities and the resources available to the residents are such that there is no financial constraint to having access.
What is your advice to young and upcoming doctors?
My first advice goes back to secondary school. Don’t let your parent tell you to go and do medicine if you don’t want to do medicine. Don’t go into medicine because someone says you are brilliant or go and study medicine because we don’t have a doctor in our family. There should be a “conviction and commitment that medicine is a profession I would love to practice (more like a calling into priesthood)” This is very important because there will be challenges all the way. Even after you graduate and complete your house job, reflect and decide whether you want to continue practicing medicine or not. Ask yourself: Is it the profession for me? Do I really love doing it? If you don’t love doing it, get out there and then! Don’t wait for five (5) or ten (10) years. Carry your title and go and sell rice or do something else, because at the end of the day you may become a bad doctor and grow old frustrated.