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Nigeria needs robust health insurance protocol – Dr. Jude Ohanele

Dr. Jude Ohanele is the Programme Director of Development Dynamics. He is also a medical doctor and an activist.

In this no-holds-barred interview, the vocal medical practitioner spoke on the implication of the rift between Imo state government and the state labour unions with regards to allegations of non-payment of salaries and pensions, the poor health insurance scheme, the rising security threats in the country among other topical issues.

Excerpts:

Can you key in your data, lets know you officially?
I am Jude Ohanele, I’m the Programme Director of Development Dynamics. My friends say that am a democracy activist, that makes a lot of sense to me.

For some time now the Nigerian Medical Association, Imo State branch has been on strike, general hospitals are closed, some health tertiary institutions are not working in the state and a lot of people have been complaining, asking why and the governor has not made a statement. We are asking what’s your take on the whole situation?

My take is that I am very shocked really with the attitude of government to the strike of health workers, especially the doctors, because it is absolutely clear to everybody that it is impossible for you to have a robust healthcare delivery system when the principal actors in the system are on strike and you know they have the right to go on strike if there are trade issues.

It is also the duty of government to engage them actively to make sure that those issues in contention are resolved. I don’t have the details of the issues but am quite surprise that government is not making adequate effort, if they are making any, not to the knowledge of those of us who are part of the public as to what they are doing to resolve that issue. At the moment, it is beginning to smack of some level of irresponsibility on the side of government and my hope is that the government should understand and especially within the frame work of the ongoing covid-19 pandemic which is a major global health issue that the world is dealing with.

And of course in recent time, you would have known that the covid-19 statistics in Imo state is worrisome, the number of deaths is increasing, so it means that we need our health care workers now more than ever before. So, my hope is that government should realize this and do all in its power to make sure that medical doctors and other health workers go back to work.

Sometime ago, we had a report that as a result of the strike by NMA and the solidarity strike action also by Joint Health Sector Union and some other allied health associations, that people who are having HIV/AIDS to manage are not having access to their medications – niverapine and what have you, because they go to the Heart-To-Heart departments of some of these hospitals owned by governments to get these drugs and I can tell you except you have not asked questions that they are dying each new day or every week. If this strike persists, what do you think such people should do?

The strike is going to lead to a lot of more deaths. It’s clear of course, you know that people living with HIV/AIDS are more at risk for covid-19. The worst thing you can do is to stop them from having access to their routine medication. So I think this is something that the government must take as an emergency situation. There is no two ways about this, they need to be able to resolve this issue and have those who are managing these Heart-To-Heart Centers resume work immediately, otherwise it amounts to gross violation of the rights of persons living with HIV/ AIDS and I think it is also in their right to protest on this because this is not going to be allowed to continue like the other health sector issues we are dealing with. It’s a public health emergency and it is in the interest of everybody that the state government does something to make sure that they have access to their ART drugs and other medications that support their healthcare.

Now, there is problem in the State as per civil servants, public servants and the government. People are saying that the government has not been sincere and honest in terms of handling payments and allowances of civil/public servants and what have you, now the strike they activated the mood the other day, another group has come up with a factional NLC chairman in Imo State, the hitherto Chairman, Chilakpu is kicking from one angle, this new one has said there is no strike, what’s the implication?

The implication is that the government is possibly going into very dangerous level of politics which will not help anybody. It will help neither the government nor the people.

The whole complaints about irregularity in payment of salaries, not just salaries even pensions has been a major issue and am not sure that the large number of people complaining about this are not just complaining. This is not the first government we’ve had in Imo State. We’ve had a government that was in place before this one was brought in and all of these complaints went down. So for this complaint to have escalated as it is today, the reality is most likely that the government is not doing what they are supposed to do to take care of the welfare of the staff of the government and it is important for them to understand that breaking down the leadership of labour or weakening the leadership of same, is not the best solution for the government.

The solution is in sitting down and making sure that this salary issues are well aligned, and being transparent as to the resources of the government, because when these civil servants see transparency and openness, they are likely to relate a lot more with the government in dealing with the issues more sincerely. So rather than getting into very dangerous labour politics that will worsen the scenario for everybody, I strongly advise the current Imo state government to sit down and identify the core issues and move away from all this BVN and whatever reason they have been given, this is not the first time we started using BVN in Nigeria.

If people are not paid they are not paid. If people are shortchanged, they are shortchanged. So it is important that the government gets real with the workers and be sincere and open about this and deal with it once and for all and allow the labour unions organize themselves and choose their leaders and not infiltrate the unions and plant moles for them in the name of leaders. We are watching and we are hoping that the government is not moving in the direction of destroying the labour movement in Imo State.

Private hospitals in Imo state are taking advantage of this very strike action to rip-off patients and their relatives. You are a medical professional, do you subscribe to that kind of insensitivity at a time like this where a woman will go to deliver and pays as much as over a N100,000 to get delivered through spontaneous vaginal delivery. Is that ok?

You know the challenge of healthcare delivery system is actually the challenge of the market forces and you will agree with me that Imo state is not the only state in Nigeria that has doctors, of course, the standard practice in the country is that you have the public hospitals and private hospitals. And it is the duty of government to make sure that public hospitals are properly managed and when they don’t do that, they will create a seeming monopoly where the private sector becomes the overriding actors in the system and that is what we are seeing and the dividends of that is that prices are likely to skyrocket. But I will call on medical professionals to also understand that they have a civic duty to help and make life easier for our citizens looking at the average life expectancy in this part of the world which is very precarious and dangerously shameful.

It is important for them to also play their own role by being modest in making their hospital bills and charges.

Having said that, it is important to note that my own personal view on this is that no community anywhere in the world is going to progress on the basis of quality healthcare without a robust health insurance scheme. The challenge of Nigeria is the challenge of out of pocket payment, all over the world, healthcare is very expensive. I remember when I did my medical classmanship in Germany then in 2001, a liver transplant in the hospital where I did my classmanship in Germany then was 100,000 US Dollars and you can imagine how many people including those of them in Germany could afford a 100,000 US Dollars.

But because you have a very robust insurance system and health insurance works on the basis of everybody pays something every month. Nobody knows who will be sick, but we know that few people will be sick. So the money contributed by the majority will now be used to improve the health care system to provide for the few that will be sick – that is the basis of the insurance system and my thesis in Nigeria had always been that except both the government, the healthcare actors and the citizens will understand that it is impossible to move the healthcare system forward without a very effective all-inclusive robust health insurance scheme that will cater for everybody, so that when people are sick, .they don’t need to dip hands in their pockets to pay…
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the National Health Insurance Scheme, I can authoritatively tell you is not working. I have had issues with them, I have confronted them. A situation where a particular health-insured person goes to a hospital and complains of malaria and typhoid and what have you and in the end, was given Panadol extra and Fansider when you are paying thousands of naira deducted at source from your salary for those who are working, that is why the private people don’t want to buy into that, are you ok with that situation?

You are very correct that the NHIS is not working. It’s not been properly coordinated. That is not the insurance am talking about. Am talking about a more robust insurance protocol, which I think the government of Nigeria can midwife. It is driven by the private sector all over the world, we have the big insurance companies that run the health insurance scheme and you choose which company you want to subscribe with.

It is not a government thing, the government provides the enabling environment and the companies run this scheme and those companies actually invest up-front. The idea is that because they are managing the healthcare system in whichever environment they are working, they go into a lot of research to make sure that latest medical facilities are put in place. The health-seeking behavior improves so that people go early to hospital when they have symptoms, because when you catch this symptom very early, the cost of dealing with them comes down.

These health insurance players even intervene in the public utility system and that is why you see that most of the health insurance companies in the world are the ones that run public water supply, they make sure the public water is very safe so that the medical challenges that can come from drinking dirty water is prevented and they invest heavily in all of this. So they make sure that the air quality in the city is good. They are the ones that actually lobby and make sure that laws on emission level of vehicles are made stricter so that less pollution goes into the air because they know the implications of pollution.

So that’s why when you have a robust health insurance scheme in your country, a lot of things that are off-shore are taking care of in advance because the health of the citizenry is beyond going to hospital, that is why I am strongly of that view that the government of Nigeria must be sincere and in fact the state can even start it at their level, get companies that can do this with state governments providing some health funds to encourage them to start. By so doing, we have robust insurance protocol where you buy the insurance and the insurance takes care of you beyond the hospital, making the system safe. It is the insurance company that you see making sure that these roads are very safe because if you reduce the number of road accidents, you are reducing the amount of money the insurance company will pay in taking care of victims of road crashes.

So, it is a system that works for everybody, why that system has not been brought up in Nigeria, I think it is as a result of possibly ignorance among some people and for those who know, some level of wickedness if you ask me. So my serious advocacy is that we must do a very robust discussion on setting up this pro- people-helped insurance programmes that will take care of the health of our people and immediately this health insurance programme comes up, all of these problems you are seeing in the health sector will disappear.

Doc, this government is barely one year old now, how would you assess the government and in what areas would you want them to improve on assuming it has failed?

Well the government is one year in office, unfortunately I do not have any clear understanding of what their policies are. I have not seen any document clearly articulating their policies and because am a process person, I believe much in what you can do with public budget, I’ve not also seen clearly their budget they are working with.

I know they inherited a budget from the former government, am not sure they were able to come to terms with it but they submitted a budget last year which I was told has been passed without due process in the House of Assembly and based on the figure that was announced, the budget sounded a bit more too optimistic and the amount there, was actually looking very unrealistic. So my sense is that, having spent one year possibly to understand what is going on, the government should be a bit more realistic with that budget.

I don’t know where they are gonna source the money from, they say it has been passed. I’ve not heard that the governor has signed it into law, but if he has, they need to come out clearly on how they are going to raise the money to be able to fund that budget and then how they are going to be benchmarked in terms of their performance, that is what I think the government can do because without a very realistic budget and clear deliverables attached to them following public procurement, it is very difficult to assess any government, and most of these governments have been wasting our time.

I can’t assess a government if I don’t see their budget, so I can now look at the budget and look at their performance and be able to know where they are headed. So am hoping that the Hope Uzodinma led government would be able to understand these basics. I listened to the man they made Commissioner for Budget, he sounded quite educated and I hope he will be able to advise the governor in a way the governor will understand that it is impossible to deliver democracy dividends without a realistic budget.

The security situation in the country is becoming something else, as we talk, Orlu is under siege, not just Orlu local government, communities in Orlu LGA, Akata, Umutanze even Njaba and Oru East LGAs are in trouble right now courtesy of the clash between Eastern Security Network and the Military. The ESN has tactically withdrawn and there is full blown military operation there. How do you analyse that, do you support the idea of using curfew as a way out and not negotiation. How do you view that situation?

The situation is most unfortunate really, and I think it is important that all actors including the government realize that the lives of our people should be paramount in their political consideration and I’m totally not comfortable with any arrangement to create unnecessary and unrealistic security apparatus that will clash with each other but I think it is also important that the government understands that some of these things are driven by frustration, driven by people feeling totally alienated from the activities of the government. And I totally agree with you that there is need for the government to pursue dialogue in resolving some of these issues and not take to violence because violence will pay neither the government nor the other actors who are involved in that, and this is actually how the Boko Haram saga started when they went and eliminated Yusuf without due process and some people now took a vow to avenge and that’s why we are in this mess in the Northeast, so am hoping that in the Southeast there is no plot by anybody to put the Southeast in that kind of situation.

So, I’m calling on all actors including the Governor of Imo State to understand that this is the best time to work for peace and progress and that mistakes are not made to think that brutal military action will solve the problem of dissidence in any society.
By all standard all over the world, even the United Nations status clearly guarantee people the rights to self-determination. People can decide they don’t want to be part of the system, it is for you to provide the legal framework for them to either conclusively say they are in or out, rather than using suppressive military forces. It has not worked anywhere and it will not work in this government except unless some people are bent on destroying the Southeast.

We are watching and it is important for them to understand that all of us are subject to the International Criminal Court and people will be held accountable for their actions and inactions, and for those of us in the human rights community, we are watching and we are documenting, we will be able to provide evidence when the time comes.

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