Prof. Ibadin Michael is the Chief Medical Director of the University of Benin Teaching Hospital. He was appointed in 2009 and will be exiting the office in a couple of days. In this interview with MICHAEL EGBEJULE, he speaks on the challenges of being a CMD, proffering solutions to the challenges in the health sector, among other sundry issues. Excerpt
Brain drain has become a challenge in the health sector, what is responsible for it?
Brain drain is there, we cannot stop it, its not only doctors that are immigrating, other people are also immigrating. As long as there is a mark differential between what we earn in Nigeria and what is earned abroad, people would want to travel. What I think is responsible is the condition of service. If the condition of service here is preferable to what we have abroad, people would want to live here. If you compare the situation abroad to what we have here, there is a mark in the word of difference either in terms of facilities you work with, the environment package, and the welfare package you have let alone the earnings. For instance, here, if a doctor is earning N500,000 here, its just equivalent to 1000pounds. 1000pounds is earned by an ordinary health worker in the UK. So you see that the pay is such that is discriminatory between what is obtainable abroad and what is here. However, it is not as bad as it use to be, only that, just last year and this year, there is a sudden surge again because of the down-turn in the economy. The issue of medical tourism, medical tourism means individual who seek medical help across trans-boarder movement. For instance, somebody from Niger Republic and Chad Republic coming to Nigeria for care is also a medical tourism. But for lots of Nigerians going abroad, its first and foremost because of facilities not because the doctors or support staff are not there, but the facilities are not there. Secondly, the field of practice of practice is also broader overseas than what we have here. Another thing that drives people abroad is for their confidentiality to be maintained. If a politician have an ailment, he would rather want to go abroad than have it treated here. If he treats it here, the information can leak out and he doesn’t want that. Another reason is that people just want to go abroad. Among the public servants, if there is a way the government can support them, a lot of people would want to go there.
The reason why they are mainly moving to India, Kuwait and the rest is that, compare to the west, which is America, the cost is far cheaper. A lot of people leave America to go to India because of the cost meanwhile, the health status in America is higher but they would rather go to India because they will pay the fourth or fifth of the cost they would have paid in America that is if they don’t have a health insurance. Here in Nigeria, the health insurance is there but its not robust, only 60% of Nigerians are benefiting from health insurance. As long as you are paying from your pocket, you are going to be looking at the cost.
We can reduce the number of persons travelling abroad for frivolous medical attention. First, the public needs to know what we are able to do in this country. Secondly, there must be a central clearing house for anybody that wants to travel abroad for medication should have a form of certification. The federal ministry of health can screen people by assessing if what they are going abroad for is available in Nigeria, then they shouldn’t allow them go for medication, because it can be treated here in Nigeria. Another thing we need to do is to improve on our facilities. The facilities are not up-to-date because, government alone cannot fund the entire healthcare need of Nigeria, the public sector must be actively involved. Most of the hospitals people go abroad are not government hospitals, they are private hospitals. Here in Nigeria, private hospitals are one-man business. We need to restructure the healthcare system to make it attractive for investors.
There must be a shift on the way we look at health. As it is now, we are looking at health as a social service, it will not attract any funding because, nobody would want to put money in an area of social funding because the return is marginal. Nobody wants to put money where he cannot get back profit or interest.
See what government is doing in the area of agriculture. It is going to get a lot of attraction both internal and external investors; that is because there is a paradigm shift. If we also do that for health, for instance, government can say, ‘we will not register a one-man clinic, it should be a minimum of four of five people’. Government can now come in and give soft loan, with that, you can now equip the hospital by a standard you can get some funding from abroad and some other investors. So, we have to move from this one-man business and move into conglomerate. Just as you have bank for industry, bank for agriculture, there should also be a bank for health. If you have bank for health and the interest rate is 4%, i can take the risk. I can go and take N200million, knowing that if i invest in another 4 or 5 million, i will be able to get back the money but if i am going to borrow at a 28% interest rate, i will not do it. You can only take a risk when the economic climate is good.
The health sector is notorious for embarking on incessant strike, what is responsible for this strike and what is the way out?
The reasons are many. You can trace it from what I have just said. They go on strike because they are public hospitals, if they are private hospitals, would they go on strike? For instance, in UBTH, we have about 3,500 workforce. We don’t need one-third of that to run this hospital. So, the system is weighed down by the burden of payment of salaries and the same workers are not interested in doing the work, they are only interested in the money. If for instance, this hospital was owned by a private investor and I sit here as CMD, do you think any worker will go on strike. First of all, the unions will not be there, even if they are there, they will be subdued. You have to take your work seriously because you can be sacked anyday but here, the disciplinary process is very long, Mr. A knows Mr. B and Mr. B knows Mr. C. By the time you want to punish the erring person, he will bring a letter high up in Abuja and the unions have become very notorious. Even for frivolous reasons, they will write petitions. So, the system is completely inefficient.
Secondly, apart from the professionals that are here, a lot of the support staff does not really have business being here. The truth is, government must diverse its interest in hospitals. As it is now, the hospitals are held-down by the workers and most of these unions are working at cross-purposes. When one is not on strike, the other is on strike and its all about money; remuneration, allowances whereas if you are working for a private hospital, your remuneration and allowances will be detailed out and you have no right to ask for anything different.
Some doctors refer patients whom they are suppose to give treatment to in the governments hospitals to their private clinic, what can be done curb it?
It boils down to the governance of the hospital and healthcae delivery in Nigeria. If we have a preponderance of private sector hospitals in Nigeria, that will not happen. For example, if a worker in Guinness takes a bottle of beer away, he will be sacked. If for instance this hospital is owned by a private sector investor and you take a patient to your own hospital and there is a trace, you will be sacked that day. Abroad, there are doctors who work in both public and private but they don’t allow the two to meet because you know the repercussion.
On the issue of promotion, your critics have alleged that you have stagnated them of their entitlement, including some other benefits like promotions and upgrade. What is your reaction?
There is no staff of the hospital who has a lingering promotion. The only one we have not done is the one for 2017. The one for 2016 was released in November. That was because the board was not in place. We have to send the result to the ministry. The one for 2017, I have told them am not going to do it, because, I don’t want to do it half way. In the absence of the board, some people will have to come from theministry to conclude the exercise and the result will have to be packaged and sent to the minister and until the minister approves, you will not be able to release the letters. As of today, I stand to be corrected, there is no one that will say he has not been promoted or his promotion was due and he was not allowed to take the exams. In the last 10 years, we have not had any issue of stagnation. Whoever is due for promotion is promoted, but sometimes, a staff can come and say he has done conversion, the rule is that, whether by conversion, promotion or upgrade, once you have achieved it, your new promotion takes effect from that date. Another thing I have observed is that, workers expect 100% transition. Meaning, 100 people go into the exam and pass. If for any reason, 5 or 10 of them fail, they will blame the CMD. Meanwhile, for you to get promotion, you need to score at least 60%. If they fail, they won’t say they failed, they will only tell you they were not promoted but the CMD has no role to play in it.
The CMD only play a role among the junior workers because the junior workers do not go to the ministry. What i have observed among the junior workers is that, most of them cannot write. Sometimes, we have to dictate to them. Another thing is that everybody has his own level he can get to. If you are a senior staff, there is a level you can get to. For instance, my drivers tell me they have been stagnated and I say ‘you have gotten to your peak’. If you have gotten to your peak, there is nothing anybody can do. The civil service says, ‘unless you acquire a higher qualification you cannot go further’.
Diabetes, hypertension, stroke and some other ailments are on the increase especially the young ones are also part of this, what could be the reason for this?
Firstly, the way we live is completely different from how we used to live. In those days, we were closer to nature, we eat natural food. But today, what do we eat, fast food, all sorts of junks and lots of food with preservatives. Most of the materials used for preservations, take sardine for instance, if you notice, sardine is very salty, it is part of the preservative so that it does not decompose. Then if you are hypertensive and you find nearness to salt and the rest of that, you will be treated over. Same thing with sugar and the rest. It all boils down to the way we live. No adequate exercise, but we rather work throughout the day. We now find persons who are obsessed just because of the way they live. Diabetes and hypertension are brothers and sisters. If you have one, you are likely to have the other and if you have the both, you are likely to have stroke. And if you are predisposed to stroke, you are likely to have cardiac arrest. And as one grows older, the incidences of these diseases will increase. In feeding, our lifestyle and what we consume. For instance, fruits and even palm oil are now been preserved with substances.
Your achievements in UBTH as CMD speaks volume. Tell us your secret?
In terms of achievement, we’ve made a lot of achievement but you have to categorize them so that we can put them in proper perspective. First, what people want to see, are structures. The structures are there and we are commissioning them soon. I will just name them: the fire station, children emergency building, child health administrative building, mental health wards, mental health administrative building, the O & G administrative building, anaxezia administrative building, family medicine administrative building, pathology complex, the digital x-ray machine, medical emergency, NHIS building; those are the ones we are commissioning on Monday. The ones we are not going to commission are: the new mortuary building, the conference centre, the bracket-therapy building. There are also some that are not yet completed like the new officers’ quarters. We also have some buildings in the living areas; we have a four and six-flat apartment, we have three buildings for interns and in the school, we have three classrooms of four to five blocks. In the institute of health technology, we have two sets of such blocks.
How would you describe your stay in office for two terms?
Incidentally, I will be rounding my stay in office for two terms of four years each but before then I acted for eight months. By that, its on record that I am the longest serving CMD in the history of the University of Benin teaching Hospital.
Inspite of the shortfall in budgetary allocation to the health sector, how were you able to achieve this feat?
Incidentally, until this recession set in, we have been able to remain on our foot. Some of these buildings I mentioned are actually funded from funds from within. Our capital allocation has not really being very good. The highest we have ever got was N355 million but, so the budget performance in terms of capital has ranged between 40 and 50%. We have been able to cope because most of these areas I mentioned were areas we identified as NEEDS and we look for money here-and-there to build them.
What will you be remembered for?
I want to be remembered as somebody who came, has a clear vision as to what to do and strive to achieve that. At the beginning, the targets I set for myself, I think I have exceeded them. I don’t think the history of this hospital will be re-written and I will not be remembered. As it is now, I am the longest serving CMD. Secondly, I have made some giant strides not just in buildings but in the way the hospital runs. If we were to run with the hospital’s capacity, you will not notice any form of development in the hospital. But we went beyond that though it has been very strenuous. For me, it has also interfered in my academic growth. Luckily, I became a Professor before I became the CMD otherwise, it would have hampered my life. But I want to be remembered as somebody who came and made a mark for himself. I was guided by the principle of fairness, justice and equity.