THWARTING ‘FREE’ HEALTHCARE RENDITIONS; TWENTY ‘REAL’ HEALTHCARE RENDERINGS - (ONDO 2025 - 2029)
Healthcare is a commodity with demand and supply
sides, bearing in mind the cost implications of the latter. After all, nothing
is free, even in Freetown. Therefore, it is an economically dangerous approach
to ‘be seen’ to tackle Out-of-Pocket Expenditure (OOPE) for healthcare services,
which is put at between 75%-80% in Nigeria, from a narrow political view that
promises free healthcare to all. The superlative works wrought in the
healthcare space of Ondo State by my dear former Governor, Dr. Olusegun Mimiko,
becomes a reference point to balance the intention of this article. Bunch of
the accolades earned by the State’s health sector during the two-term period
that this high cerebral and healthcare-passionate medical doctor-cum-politician
fondly called ‘Iroko’ held sway were not exclusively due to the ‘free’
concept itself. Instead, Iroko’s political will, demonstrated by
strengthening necessary inputs (Human Resource for Health – number &
quality; medical infrastructure – equipment & buildings etc.), yielded
significant outputs (increase antenatal care utilization, hospital
deliveries etc.) that culminated in measurable outcomes such as
reduction in maternal, under-5 and perinatal mortalities. As much as the
user-fee-exemption increased financial accessibility to qualitative maternal
& child healthcare services, it can be argued that it brought about overuse
and abuse by both residents & non-residents. The misuse inevitably threatened
the financial sustainability of the globally acknowledged Abiye and Agbebiye
Safe Motherhood programmes even before the very eyes of the initiating and
implementing Mimiko-led government.
Therefore, ‘free’ healthcare programmes ought to be strictly served a select few who are objectively pre-qualified as socioeconomically ‘vulnerable’ (indigent) people. To that extent in current times (year 2024), political campaigns that are about ‘free’ healthcare promises to 5.3 million resident population of Ondo State would be to my mind, obsolete, whacked, poorly conceived and apparently deceitful. So, I asked myself, “if I was vying for the position of the Governor of Ondo State at this time, what would be my specific plans and interventions in the critical sector of healthcare delivery?” My focus will be to strengthen the demand and supply sides of healthcare through intentional exploration of one, more or all the following five.
i. public sector efficiency & prudence (including judicious use of Internally Generated Revenues - IGR of public hospitals),
ii. ii. private sector investments,
iii. iii. partners’ & donors’
support,
iv. iv. philanthropic promotions,
and
v. v. public (community)
involvement
Using one, more or all the five forces listed
above, I humbly recommend that the incoming administration ensures efficient supply
of qualitative (promotive, preventive, curative, rehabilitative &
palliative) health care via the strategic deployment of political will to
‘facilitate’ the following inputs in place of “free healthcare”
calls.
1. Massive health promotion services using innovative strategies
such as branded taxis & commercial buses, dedicated billboards, bulk SMS to
residents etc.)
- This is an efficient means of demand-creation for healthcare services.
- It ensures appropriate Information Education & Communication (IEC)
to the public on health-related subjects.
- For example, “Do your Blood Pressure check”, Excessive alcohol
destroys your liver & Kidneys”, “Have you taken your adult dose of
Hepatitis B vaccine?”.
- A mix use of English, pidgin English and Yoruba languages will suffice.
2. Urgent upward review of entry remuneration package of all
cadres of health workforce in public service
- To increase demand for healthcare-related jobs in Ondo State Civil
service
- For instance, it appears young and freshly inducted doctors have less
interest in being employed by the State government because the current salary
scale is comparatively non-competitive and unattractive.
3. Urgent recruitment of healthcare workforce
- To mitigate the gap created by Japa syndrome.
- The state needs to embark on massive recruitment of Medical Doctors,
Nurses, Pharmacists, Medical Laboratory personnel, Physiotherapists,
Psychotherapists & other cadres of health workforce.
- However, this can only be achieved after having done ‘2’ above.
4. Deepening of health insurance penetration
- To be done through the Ondo State Contributory Health Commission
- Ensure the commencement & rapid expansion of the informal sector health insurance using innovative premium-collection strategies and target a minimum of 20% of State population coverage in 4 years.
- Continue annual identification and enrolment of vulnerable residents on
Basic Health Care Provision Fund (BHCPF) programme.
- Facilitate & monitor the use of reimbursements (capitation, Fee-For-Service etc.) by public hospitals that are registered as health insurance providers for direct funding of service delivery interventions (For example, locally employ & pay needed
healthcare workers, purchase drugs, medical equipment and so forth).
5. Strengthening of the LGA Medical Officer of Health (MOH)
structure across the 18 LGAs
- To strengthen ‘governance’ and coordination of the operations of both
conventional and non-conventional healthcare outlets across 18 LGAs
- To aid disease surveillance across all nooks & crannies of the State
6. Implementation of a compulsory phone directory for
conventional and non-conventional healthcare facilities
- All conventional (public & private hospitals) as well as non-conventional
facilities must each register/have a designated (not personal) phone number and
phone box
- Create a State directory with these phone numbers and publish it online
for public use.
7. Electronic registration of, and improved regulatory framework
for all non-conventional healthcare outlets and privately-owned conventional
healthcare facilities
- To efficiently monitor the activities of;
o
Traditional Birth centers
o
Faith-based centers
o
Patent medicine stores
o
Community pharmacy outlets
o
Traditional herbal homes
o
Traditional bone-setting centres
o
Traditional incision centres
o
Private diagnostic centres
o
Private hospitals
8. Implementation of Electronic Medical Record (EMR) System in
all public Primary Health Care (PHC), Secondary and Tertiary hospitals
- EMR is long overdue in public hospitals in Ondo State
- For effective medical record archiving of all recipients of care.
9. Implementation of Electronic collection of user fees
(pay-points) in all Primary Health Care (PHC), Secondary and Tertiary hospitals:
- For accountability
- IGR collected per hour across all public health facilities can be
monitored real time on a remote computer screen.
10. Implementation
of an “Adopt-a-PHC facility” strategy in collaboration with willing development
partners/donors and philanthropists
- Collaborate with the Private Sector Health Alliance of Nigeria (PSHAN) that
was initiated by Bill Gates, Aliko Dangote, Ali Pate, Jim Ovia and Aigboje
Aig-Imoukhuede some years back
11. Provision
of annual incentives for 5 high-performing health workers per LGA (Doctors,
Nurses, Pharmacists, Lab scientists and Community Health workers)
- It’s no big deal and can be instituted in collaboration with willing
donors/philanthropists as statutory and objectively earned incentives.
12. Implementation of a sharing ratio of 80:20 Internally
Generated Revenue (IGR) between public healthcare facilities and the State
government respectively
- With strict financial & operational monitoring supported by
technology, public hospitals (PHC, secondary & tertiary) can be
- Allow government-owned hospitals to retain and directly invest 80% of their
revenues for improvement of critical in-hospital facilities for service
delivery.
13. Expansion/construction of Dental, Eye, Mental health and
Physiotherapy facilities in 23 secondary healthcare facilities
- Intentional investment to expand dental, optical, mental and
physiotherapy facilities across the 20 secondary facilities (General hospitals
& Specialist hospitals)
- Upgrade of State Neuropsychiatric hospital to modern mental service
center
- Revenue in ‘12’ above can suffice for these.
14. Construction of 10
units of single-room staff quarters in each of 23 secondary healthcare
facilities (General & Specialist hospitals)
- Deploy Public Private Partnership (PPP)
- It is for the welfare benefit of frontline clinical staff who get
posted/redeployed across public hospitals in different locations within the
State.
15. Purchase & installation of solar power mechanisms in 203
PHC facilities and 23 secondary healthcare facilities
- To ensure one fully powered PHC facility per 203 wards with 24-hour
electricity supply.
- It will reduce overhead costs by 50 – 60%.
16. Purchase & installation of Solar Direct Drive (SDD) cold chain system in 203 PHC facilities for vaccine chain
- To ensure vaccine potency and health security in Ondo State
- Take an inventory of PHCs that currently have SDD
- Purchase & install in those without SDD
17. Construction of 3 units of single-room staff quarters in each
of 203 PHC facilities (one per 203 wards)
- Deploy Public Private Partnership (PPP)
- It is for the welfare benefit of frontline clinical staff who get
posted/redeployed across public hospitals in different locations within the
State.
18. Construction of 6 units of 100-room per unit Geriatric centres
& old people’s homes (2 per 3 Senatorial districts)
- Deploy Public Private Partnership (PPP)
- It is for the healthcare & general care benefit of the geriatric
population.
- When completed, ensure appropriate market rates and private facility
management for effective maintenance.
19. Implementation of compulsory annual clinical and management
trainings for healthcare workers
- Ensure at least one compulsory annual ‘clinical’ training programme for
all frontline health workers (physical, online/virtual or both).
- Ensure at least one compulsory annual ‘management’ training programme
for all Chief Executives & Departmental heads of public health facilities (physical,
online/virtual or both).
- Specifically, for PHC clinical staff, revitalize, adopt and scale-up the
Practical Approach to Care Kit (PACK) piloted in 18 PHCs (1 per LGA) in 2017
for the improvement of diagnostic and therapeutic accuracies across 203 PHC
facilities (one per ward). PACK is produced in the Centre for Clinical
governance research & Patient Safety in Calabar.
20. Financial investment in the purchasing power of Ondo State Drugs
& Health Commodities Management Agency
- Budget and release a reasonable lump sum to the agency to enhance its
financial capacity to procure huge quantities of qualitative drugs & health
commodities at wholesale prices from producers and resell to public &
interested private pharmaceutical outlets at with marginal profit to ensure drug
security.
For the records, all the twenty points stated
above are in line with the six building blocks of the health
system identified by the World Health Organizations (WHO) as Leadership and governance; Service delivery; Health system financing; Health
workforce; Medical products, vaccines and technologies; and Health Information Systems. Let
the coming governorship elections and its resultant new administration in Ondo
State thwart ‘free’
healthcare renditions in preparation for twenty real healthcare renderings discussed
above. These twenty are critical Health system Strengthening (HSS) measures to
ensure affordable and qualitative healthcare services to all, including ‘subsidized’
(partial or full) healthcare services for the socioeconomically vulnerable
group.
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