Professor Chris Bode, Chief Medical Director (CMD) of Lagos Teaching Hospital (LUTH), in this interview with SADE OGUNTOLA, says Nigeria needs to improve standards of medical training and practice.
Improving standards of medical education and practice
First of all, I must say that the standards of medical education at the undergraduate and postgraduate levels are quite high and the litmus test of this is the international acceptability of our graduates, wherever they go. We have strong training programs, accreditation at various levels and security mechanisms to ensure that our trainees meet commendable standards of medical practice. Our country’s many challenges, however, have failed to bring out the best in our medical practitioners, encouraging an outflow of skilled medical personnel whom the nation has trained at great expense.
If you buy a Benz 600 car but you have no road to drive it, no meaningful support services and you have to deal with bandits who make every trip a difficult nightmare, the car can be judged underperforming, but the reality may lie in the environment where it is called upon to occur.
That said, standards are maintained from the admission of top performing candidates into medical schools around the world through the rigorous and time-consuming training they undergo. The Medical and Dental Council of Nigeria (MDCN) and the National Universities Commission (NUC) strictly regulate and supervise the training programs and carry out regular accreditations to ensure optimum availability of infrastructure and manpower for the training in approved programs. There are also state and national watchdogs that record practices and oversee the conduct of practitioners. Professional associations also limit their membership and insist on acceptable principles of practice.
What we also need to improve is the atmosphere in which Western medicine is practiced in the country. Nigeria needs to decide what kind of medical system it wants and we need to be clear about who pays for the work done by medical workers. The terms of payment must cover everything, be well defined, adequately compensate hospitals for a job well done, and be regulated in a way that brings out the best that our hospitals can offer. Doctors, nurses, pharmacists, laboratory scientists and every member of the medical team will be eager to work in any part of the country where there are prospects for job satisfaction, job protection , good pay, security of life and property, good roads and all other conveniences of life. We are far from realizing this dream today and therefore, the persistence of health inequalities between the different parts of the country: urban and rural, rich and poor, etc.
Ensuring Universal Health Coverage in Nigeria
LUTH, as a hospital, can help achieve this goal once the appropriate legislation and mechanisms for this laudable program are in place. We continue to advocate this to liberate over 70% of Nigerians who pay out of pocket for healthcare.
LUTH’s greatest achievement in 60 years
The recent and innovative introduction of meaningful private sector involvement in solving a number of intractable problems and repositioning LUTH to fulfill its mandates is the greatest achievement of the past 60 years. As more and more hospitals sprang up under the aegis of the federal Department of Health, it became increasingly clear that government alone could not fund the pace and scale development required for our public hospitals to operate effectively. LUTH has benefited from uninterrupted electricity 24/7 for 4 years thanks to the involvement of a private sector player. The NSIA-LUTH Cancer Center is the best in sub-Saharan Africa simply because of a PPP agreement. Likewise, our blood bank and a few other essential departments provide quality, affordable and sustainable services through this type of arrangement.
What to expect in the next decade
I anticipate that the various enhancement services at LUTH will coalesce to become a formidable force in the medical landscape in terms of scope, expertise, and volume of practice. The combination of service, training and research in a well-run facility is already attracting attention in government, private, public and corporate spaces and the hospital is sure to be a West African medical hub.
Biggest disease, biggest killer
Diseases of the heart and blood vessels (cardiovascular diseases) such as hypertension, heart failure and stroke are the most common illnesses among our patients. These are caused by unhealthy lifestyles, age-related factors, and they can be accelerated and worsened by other factors such as diabetes, obesity, and other factors. The same range of diseases also make up the most common killers.
Response plans for these conditions
A substantial number of these diseases are best prevented by meaningful public health education focused on healthy eating, exercise, tobacco avoidance, limited alcohol intake, and other measures. These are not, strictly speaking, the primary duties of a tertiary institution like LUTH, but our Hospital is involved in these measures at the level of defence, training and research. We are also expanding our facilities to provide holistic specialist care to those referred to LUTH for such services.
Autonomy of tertiary public hospitals in Nigeria
These hospitals number more than 60 and belong to the federal government. The ownership structure makes the federal government the body that controls these institutions through government-appointed boards and directorates. The government, owner of the institution, pays the wages of the workers, gives substantial financial subsidies, has the right to give general political guidelines on how they should be managed. Each hospital’s board of directors interprets policies in the context of each facility’s needs and goals, and management implements programs approved by the board. There is enough leeway within this structure to achieve good goals in each institution once there are good people at all levels dedicated to achieving the well-stated goals.
Poor services in public hospitals
Until the mid-1980s, services in public hospitals were quite satisfactory. Then came the many years of bad governance, zero growth budgets, low investment in health care and an alarming state of infrastructure nationwide. All this had a negative impact on the health sector and the population lost confidence in public hospitals. Private hospitals have sprung up across the country to clean up areas where public hospitals could not cope.
Local governments failed and did not invest in the primary care that fell within their jurisdiction. Most state governments also stopped funding and staffing their general hospitals, with the result that all minor and moderately serious illnesses that could have been treated respectfully at primary and secondary care levels were sent to institutions. tertiary. If you add the population explosion that has occurred in many urban centers, then you can understand why the public has lost confidence in government hospitals.
However, it is gratifying to note that in recent years this confidence has returned. Our public hospitals were part of the bulwark that faced the COVID pandemic when it arrived on our shores. The government, for its part, has begun to invest significantly in the rehabilitation of its hospitals, which has led to an increase in the number of capacities in our establishments and the repositioning of these same hospitals. If we continue at this rate, there are still better days ahead of us.
Free care for children under 5 years old
Most good things have a price. Good health care is not free. If you examine it carefully, someone has to pay for it. I will advocate for universal coverage that is sustainable, accessible and affordable for all. It can be developed to the benefit of every stakeholder without the government investing money in it, if we have the political will to introduce and implement it. Otherwise, if you make care free for children under 5, what happens to them when they are 6 or 7?
Surgical care for children
Nigeria has about 200 pediatric surgeons, most trained locally over the past 3 decades. This is well below the number expected to handle our large number of children. With well-designed universal health coverage, more surgeons can quickly train to practice this specialty. In centers where pediatric surgeons are present, many amazing surgeries for children are performed. This scope must be expanded to fulfill our obligations to children.