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‘I am hoping the government has learnt from this pandemic,’ Nigerian Medical Association

By 'Tofe Ayeni
Posted on Friday, 22 May 2020 18:51

Virus Nigeria Outbreak
People wearing face masks to protect against coronavirus ride on motorbike taxis, in Lagos Nigeria, Wednesday May 20, 2020. (AP Photo/Sunday Alamba)

The Nigerian Medical Association (NMA) is the largest medical association in West Africa, with over 40,000 members in the 36 states and the Federal Capital Territory, and about 19,000 members in the diaspora. The Africa Report speaks to its president about Nigeria's handling of the pandemic and what needs to be improved now and beyond.

The current president of the association since 2018 is Dr Francis Adedayo Faduyile, is a consultant pathologist and associate professor in Lagos.

The Africa Report spoke to him about the NMA’s problems with the federal government, the situation with healthcare in Nigeria, and ultimately its handling of the COVID-19 pandemic.

Presented here is a transcript, with light editing for clarity.

TAR: One could argue that the NMA has had a history of conflict with the federal government. Do you agree? If so, what can be done to change this (that is, if you believe that this change is necessary)?

Dr Faduyile: The NMA’s role is to compliment what the federal government is doing. Our main objectives are to give policy support, health-related advice, and promote the advancement of health and allied sciences.

What we have found is that, if one can say that the federal government is not responsive enough in tackling health in the national outlook, the state governments are even worse.

However, it is also important to us to focus some effort in overseeing the welfare of our members, and this is what pits us against the government. In cases where the government has not done the needful in terms of welfare packages for our members, we speak out against them, and this is what is viewed as the conflict.

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Over the years, the government has been known to not stick to agreements made, in fact they often simply renege on these agreements.

The health sector is peculiar in that discussions happen with different unions at different times – this means that an agreement the government has made with Union A might be contradictory to an agreement made with Union D. So, in addition to the government being more responsible with sticking to their word, more unity is needed in the healthcare system to stop these conflicts.

How does the NMA fight for better treatment of medical personnel in Nigeria, particularly with regards to payment of salaries?

The thing to note about the healthcare system in Nigeria is that it is in the concurrent list, meaning that it is not the exclusive job of one particular tier of government.

The federal government takes care of the tertiary health institutions, the state governments of the secondary, and local governments of the primary. This means that the federal government cannot supervise what happens in terms of healthcare in the state and local governments, including the employment and thus payment of salaries of health officers at those levels.

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The state employs its own workforce for the health facilities they have, and the local governments do the same.

What we have found is that, if one can say that the federal government is not responsive enough in tackling health in the national outlook, the state governments are even worse. Many state governments have largely abandoned the health system.

As the federal government has instituted tertiary health institutions in every state, the state and local governments have allowed the primary and secondary healthcare facilities to collapse, which has put a large strain on the tertiary level.

The state governments have been very unkind to health workers – many of them are not paid a just wage that enables them to take care of their workforce.

Many state governments simply do not care. The NMA in different state branches needs to hold discussions on the welfare of health workers employed by the state. It is only when it gets out of hand that the national sector of the NMA should get involved.

Before your press release on 5 April, condemning the government for inviting Chinese doctors (who it turned out were just medical experts) to the country, was the government contacted?

Yes, there was personal contact. I had discussions to some of the top government functionaries. However, they were grandstanding, so we had no other option but to come to the media.

Do you think that keeping conversations, such as these private, might be better? Or do you think the public deserves to know if there are any disagreements?

The public deserves to know what is going on, and to know our stance on health issues. A number of members of the public called in and showed interest after the press release, and the government then listened, so we achieved what was needed.

What do you think of the handling of the coronavirus pandemic in Nigeria thus far? If you think it is good, in what ways. If you think it is bad, what changes would you propose for better handling of the situation?

Nigeria has done fairly well in containing this disease, but what the government has done is still a far cry from complete containment.

They have done well because the health situation in the country prior to COVID-19 was very precarious, with a very very weak health system.

However, the government has been able to come into the field to see how it can improve some things – for example, we started with three of four labs, but now we have 30 laboratories that are involved in coronavirus testing. This has shown a lot of capacity improvement, and monumental progress in terms of testing and bringing in equipment.

Our hospitals have hitherto been unkempt, with no beds and a lack of equipment. Although structures are still not within the normal hospital environment, we have been able to build a number of isolation and treatment centres that are of a high standard. We have seen so many hospital beds in these places, as well as increased numbers of ventilators. These pieces of equipment will surely not leave the country after the pandemic.

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So, we have had a frog jump from where we were, but it is still a far cry from what is expected [for] Nigerian citizens from their government.

Would you say that doctors have a duty to work in a time like this, even if they have not been paid?

This is a national emergency, that can be likened to Nigeria being in a war situation. The situation calls for everyone to mobilize to help to contain this infection and take care of our fellow Nigerians.

If we depend on the government and turn our backs when they do not do the needful, it will be a double tragedy for Nigerians as they are not the ones withholding salaries from the health workers, but they are the ones [who] will get infected and suffer. So, doctors have discussed [amongst] ourselves and decided to do our best possible to ensure that we continue treating the patients, within constraints of also keeping the workforce safe.

Do you believe that the oath doctors take is universal, no matter the circumstances on ground? Should doctors stick to this oath above all, regardless of lack of pay, lack of facilities, etc?

Doctors always adhere to the physician pledge, and we our best to ensure that we take care of our patients.

However, part of the revised physician pledge is that doctors take care of their own health so that they are in an optimal position to safeguard the treatment of other Nigerians.

If your hospital management has not provided you with the necessary PPE, then you are unable to take care of yourselves. Thus, we must call [on] the government, as well as the hospital management, to provide the necessary tools and equipment to enable doctors to function effectively.

Do you think that healthcare in the country will improve in the aftermath of the pandemic, or will politicians be quick to forget when they are able to go abroad for treatment again?

There are fears that, as many of the buildings and facilities put in place to mitigate against the increased number of patients are makeshift buildings and structures, will disappear post-COVID-19, and may not be added to the health facilities that we currently have.

I want to use this opportunity to drum into the ears of politicians the need to strengthen the health system, because at any time, it may be any one of us who may need to go to the health institutions to procure some management for a disease that one has.

I am hoping that the government has learnt from this situation with the pandemic, and that it will change its attitude towards funding health and putting necessities in place.

The late chief of staff to the president, Abba Kyari, passed away last month from coronavirus complications.

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When he tested positive, he was transferred from the Federal Capital Territory to a private hospital in Lagos.

Many citizens were appalled that a government official would disregard the public health system that he had the opportunity to fix. What are your views on this?

A patient should be treated in the required hospital where the necessary control mechanisms are in place, it does not matter whether it is public or private.

In this instance, I heard from another doctor that this patient was not put in the general ward, he was in a special ward built purposely for this treatment.

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Thus, the doctor who treated him had taken to necessary precautions and so I sincerely do not have any opinion against the treatment of Kyari in that facility.

Do you think private citizens should be more involved in spending on healthcare in the country? Or is it simply the government’s job?

Up to 60% of Nigerian patients patronise the private health facilities, making private practitioners major stakeholders in the health system in the country.

Unfortunately, the government sees them as competitors and it does things to hinder the progress of the private sector. They do not give them any waiver to help them to build up their facilities. I am hoping that the government will change this attitude that they have [towards] private practitioners.

Is there any previous president, or state governor, or other government health official who comes to mind who has set a good example, or at least tried to, for improving healthcare in the country (or their part of the country)?

In recent times, I think the Central Bank of Nigeria is the one institution that I can say has made a good effort. They released a soft loan with a low interest rate to boost, amongst other things, the health system in the country. This is a good step in the right direction.