Professor Chris Bode, Medical Director (CMD) of Lagos University Teaching Hospital (LUTH), says in this interview with SADE OGUNTOLA that Nigeria needs to improve standards in medical education and practice.
Improving standards in medical education and practice
First, I must say that the standards of medical education at the undergraduate and postgraduate levels are high and the litmus test of that is the international acceptability of our graduates wherever they go. We have robust training programs, multi-level accreditation and security mechanisms to ensure our interns maintain commendable standards of medical practice. However, our nation’s many challenges have not brought out the best in our doctors, encouraging the departure of a skilled medical workforce that the nation has trained at great expense.
If you buy a Benz 600 car, but have no road to drive it, no meaningful support services, and you are faced with bandits who turn every journey into a grueling nightmare, the car may be considered a poor performance, but the reality may lie in the environment in which it is called to perform.
That said, standards are maintained from the admission of top-performing candidates into medical schools around the world, to the rigorous, lengthy training they are subjected to. The Medical and Dental Council of Nigeria (MDCN) and the National Universities Commission (NUC) regulate and oversee training curricula and conduct regular accreditations to ensure optimal availability of infrastructure and manpower for training in approved programs. There are also state and national watchdogs that record practices and monitor the behavior of practitioners. Professional associations also restrain their members 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 clearly define who pays for the work of medical staff. The payment method must cover everything, be well defined, adequately compensate hospitals for work well done and so regulated to get the best out of our hospitals. Doctors, nurses, pharmacists, laboratory scientists and every member of the medical team will be happy to work in any part of the country where there is a prospect of job satisfaction, job protection, good wages, safety of life and property, good roads and all other amenities of the to live. That dream is far from being realized and with it the persistent inequalities in health care 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 once the proper legislation and machinery for this commendable plan is in place. We continue to advocate for the release of more than 70% of Nigerians who pay out of pocket for health care.
Top performance of LUTH in 60 years
The recent innovative introduction of meaningful private sector participation in solving some of the intractable problems and repositioning LUTH to fulfill its missions is the best achievement in the last 60 years. As more hospitals sprang up under the Federal Department of Health, it became increasingly clear that the government alone could not fund the pace and scale of development necessary to run our public hospitals efficiently. LUTH has been enjoying uninterrupted 24/7 electricity for 4 years because a private sector player was involved. The NSIA-LUTH Cancer Center is the best in sub-Saharan Africa simply because of a PPP scheme. Our blood bank and a few other essential departments also provide qualitative, affordable and sustainable services through these kinds of arrangements.
What are we looking forward to in the next decade?
I predict that LUTH’s various improvement services will coalesce to become a formidable force in the medical landscape in size, expertise and practice volume. The combination of service, training and research in a well-run establishment is already attracting relevant attention in government, private, public and corporate spaces and the hospital is sure to become a West African medical center.
Highest Disease, Highest Killer
Diseases of the heart and blood vessels (cardiovascular diseases) such as hypertension, heart failure and stroke are the most common diseases in our patients. These are caused by unhealthy lifestyle, age-related factors, and they can be accelerated and exacerbated by other factors such as diabetes, obesity and other things. The same range of diseases also make up the most common killer.
Intervention plans for these conditions
A significant number of such diseases are best prevented through meaningful public health education, focusing on healthy eating, exercise, smoking avoidance, limited alcohol consumption and other measures. Strictly speaking, these are not the primary tasks of a tertiary institution like LUTH, but our hospital is involved in these advocacy, training and research measures. We are also expanding our facilities to provide holistic specialist care to those referred to LUTH for such services.
Autonomy of Government Tertiary Hospitals in Nigeria
These hospitals are more than 60 in number and they are owned by the federal government. The ownership structure makes the federal government the body that controls these institutions through government-appointed boards and chief boards. The government, which owns the institution, pays employees’ salaries, provides substantial financial grants, and has the right to issue general policy guidelines on how to manage them. Each hospital’s board interprets policies in the context of each institution’s needs and objectives, and management implements the programs approved by the board. There is ample leeway within this structure to achieve charities in any institution once there are good people at all levels committed to achieving well-articulated goals.
Poor service in government hospitals
Until the mid-1980s, the service in government hospitals was very satisfactory. Then came the many years of poor governance, zero growth budgets, poor health care investment and a deplorable state of infrastructure across the country. All this had a negative impact on the healthcare sector and people lost confidence in public hospitals. Private hospitals sprang up all over the country to clean up areas that public hospitals couldn’t handle.
The local authorities let go of the ball and did not invest in primary care under their jurisdiction. Most state governments also stopped funding and staffing their general hospitals, with the result that all minor and moderate illnesses that could have been treated with respect at primary and secondary level were sent to tertiary institutions. When you add in the population explosion that happened in many urban centers, you understand why the public lost confidence in government hospitals.
However, it is gratifying to note that that confidence has returned in recent years. Our government hospitals were part of the stronghold that faced the COVID pandemic when it came to our shores. The government, for its part, has started to make meaningful investments in the rehabilitation of its hospitals, which has led to an increasing number of capacities in our institutions and the repositioning of those same hospitals. If we continue at this rate, there are even better days ahead.
Free treatment for children under 5 years old
Most good things have a price. Good care is not free. If you look closely, someone has to pay for it. I will advocate for sustainable, accessible and affordable universal coverage for all. It can be worked out for the benefit of any stakeholder without the government putting money into it, if we have the political will to implement and implement it. If you make care for children under 5 free, what happens to them when they are 6 or 7 years old?
Surgical care for children
Nigeria has about 200 pediatric surgeons, most of which have been trained locally for the past 3 decades. This is far less than the expected number to handle our teeming number of children. Under well-designed universal health coverage, more surgeons can quickly train to work in this specialty. In centers where pediatric surgeons are present, many incredible pediatric surgeries are performed. This scope must be expanded to meet our obligations to the children.