Professor Dayo Faduyile, a past national president of the Nigerian Medical Association, forensic medicine expert, and former special adviser to the Ondo State Governor on Health, speaks in this interview with SADE OGUNTOLA on how community and professional involvement in policies and politics can support universal health for all.
YOU have a background in medical practice, and you are also a politician. What specific policies or initiatives will you propose to improve the accessibility and quality of healthcare services in Nigeria?
The first thing we need to understand is having access to health; everything must be put in place so that everyone can have access to health. After ensuring access to health, we must also ensure adequate human resources for health. If we can work on these two, then the health system and our intervention in the health system will be great. Now, for access to health, some factors are within the health system, and some are outside the health system. We must look at both to have qualitative health. The human resource for health includes both specialists, skilled and unskilled, which must be adequate in number.
So, the policy we must first do to get access to health is that which will get people to understand and have good health-seeking behaviour. We need it to dispel a lot of myths and wrong impressions in the community. We will need to produce lots of IEC materials so that people can understand the benefits of good health-seeking behaviour and how they can access health services.
Of course, ensuring that people get to have the proper health-seeking behaviour is not only for when they are unhealthy but also for when they are healthy. Everyone needs to understand the link between good health and sanitation, as well as good diet and health.
It has been shown that a major cause of maternal mortality is that many pregnant women do not have the opportunity to access emergency services when they need them. So, the primary health facilities should be in places close to them; they must be staffed and strengthened by ensuring the equipment that is needed in these facilities is in place, which is why we are talking about increased funding to buy equipment. These should be backed up with policies that are followed to the letter, and to round everything up, we should have a comprehensive contributory health insurance system so that people can have universal health coverage. They would not need to think about how to access health facilities or health treatment when they are sick.
What is your suggestion about prioritising and allocating resources to address prevalent health issues in Nigeria?
The first thing to concern ourselves with is those health issues peculiar to the different geopolitical zones. It is not the same all over the country. So, we must be able to prioritise and allocate resources accordingly. For example, malnutrition and malaria are some of the leading causes of death among our children, and we must educate our parents on how to prevent malnutrition. Also, we can direct the malaria vaccine to immunise our children as well as strengthen our local vaccine production. So, we must fund the production of our own vaccines. We still have other infectious diseases like diarrhoea that are ravaging other parts of Nigeria, so the availability of potable water and good environmental hygiene are important.
What steps will you suggest to ensure transparency and accountability in healthcare management?
Sincerely, corruption is one of the banes of development in Nigeria; it is pervading almost every sector in the country. So, the accounting managers in health institutions must be truthful and know that any of us can fall ill and use the facilities at any time. But importantly, we need to use a lot more technology to ensure efficiency and accountability. Also, to follow each of the funds released, even to the last stage of execution, in a way that it can be easily audited from time to time.
How best should the government involve local communities in decision-making processes related to health policies, thus ensuring the sustainability of the different health interventions?
: Based on the Alma Mata Declaration of 1976, which prescribes our primary healthcare system, one of the strategies is community participation in these processes. If they don’t own the process, the management, or the use of those health facilities, you cannot force them to go there. We have societal or community groups that are directly involved with the health systems; through them, policymakers can have their views and inputs, correct misconceptions, and improve individuals’ health-seeking behaviour. In fact, that is the best way to get the best participation from the people. But importantly, we cannot rule out the effect of poverty on the health system. So guarding against the level of poverty in health-seeking behaviour requires ensuring that people subscribe to community health insurance.
What incentives can be introduced to maybe encourage retired doctors to contribute their expertise to public health care and fill some of the gaps created by the emigration of health workers, including doctors?
Unfortunately, we are having issues with the retention of younger doctors; even the older doctors are also going. We have to look at how we can better engage those who are on the ground. Unfortunately, some administrators have the wrong impressions about healthcare personnel. Whereas the university decided that their bests, that is, professors, should not retire at age 70, and it was granted to them, our judges proposed that their bests should not retire at the age of 60, so that they can give back to society, and it was granted to them. Unfortunately, when this was brought forward for doctors, especially now that we are having issues with an adequate number of health personnel and doctors in the country, there was resistance in the National Council of Establishments that the retirement age for consultants should increase to 70 years. It was not only rejected; there were some very pungent recommendations for doctors and other healthcare workers from that committee. But we should have a concerted effort to have more of our 60-, 65-, or 70-year-old health practitioners continue to work if they are fit enough so that it can bridge the gap.
Many of them still go to other private institutions, and they still perform their jobs well. So, the government needs to work urgently to start the process of increasing the retirement age of medical doctors, medical specialists, and other health workers to 70 years. Currently, in many states, they are given contract appointments, and we still have a large gap that cannot be filled. So, I feel it is a welcome development, and we can work on that. They are needed in every area of healthcare.
So, how can we use technology to also close some of the gaps in healthcare services, including tapping into the expertise of retired doctors even while they are outside Nigeria?
Theoretically, yes, technology can be used. All of us technically have an Android phone, and this can connect and work like a computer. However, there are some ethical issues about that because you have to guard against confidentiality, you have to do some tests, you will have to examine your patient, and we are having some developments in which they are doing some of these online consultations, as well as the advent of artificial intelligence. But as it has to evolve, there must be strict regulations because it can be bastardised. We must ensure that those who use it are actually licenced to practice medicine. Otherwise, charlatans will work on the loopholes and exploit the people. Again, every practitioner is registered in the country by its regulatory council. We must find a way to ensure only those who are registered and are truly members of that profession are using it.
How best can we have a mix of politics and health to further the health of Nigerians?
First, many people tend to make politicians look like very bad people, and this has made a lot of people shy away from participating in active politics. Politicians, however, create the policies that direct all activities governing the people. We cannot have good implementation of bad policies, even though we are hamstrung to work within those policies. That is why professionals on the field should take it upon themselves to contest and struggle with the political class so that they can be at the same table for policymaking and make proper policies and laws that can drive a good outcome at implementation.
Unfortunately, we have demonised those who are politicians. Also, politicians, seeing those who are professionals coming into the field, tend to work against them getting any success. They feel politics is their turf, so professionals should just be professionals. It is for us to educate more professionals that we have to struggle with them and get that opportunity to drive the proper policies based on experience garnered over the years to improve life in general for Nigerians.
Will doctors and other professionals have enough money to fight it out with the moneybags and the politicians who know that money commands respect and the ballot boxes?
It is unfortunate the type of politics we play in Nigeria. You need a lot of money to practice politics successfully, even in the US. In those places, people contribute small amounts to those politicians for campaigns, and they can get the people to support them. Unfortunately, many of the populace are still not aware of their power, which they can all use to support the particular person that they feel or believe will give them what is important. Many of us professionals, especially doctors, are running away from politics.
I don’t have that much money like the politicians, but I can use what I have to work and challenge them. Many times I have lost, but I am positive that sometimes I will make it. So we have to come together as professionals to ensure that, despite our inability to amass so much wealth and have much money to dispense with, we can make a change. We will have to use our position, our goodwill, our strength, and our money to make change. The more we continue to preach it, the more we have advocates, and we can get there once we do not relent.