Patmos Media Line presents this interview conducted by an Online News agency, ORIENT DAILY with Dr.Ireti Babaniyi.
Dr. Iretiola Bosede Babaniyi (FMC Paed, FNCS), is a seasoned paediatric doctor with over 40 years of experience. A former senior registrar [paediatrics] and retired consultant paediatrician, Babaniyi, in this interview with OLISEMEKA OBECHE, takes a deep look into the coronavirus pandemic in Nigeria and ongoing efforts to contain its spread as well as issues bedevilling the country’s health sector.
How would you appraise Nigeria’s effort to contain the spread of COVID-19 in Nigeria?
I believe that the government and various agencies are trying their best. However, there is a very large knowledge gap regarding this disease. Being novel, nobody knows anything about it and, therefore, there is no experience, known tests and medications to fall back on. Everybody was groping in the dark and treatment of patients was by trial and error. Nigeria was not prepared for such health crisis, not enough isolation centres or enough beds for the available few. Staff training on case handling and sample taking took time such that many frontline workers were unnecessarily exposed. Our capacity to engage in meaningful research was decimated over the years and our scientists did not immediately rise to the challenge.
Unfortunately, the issue took a political connotation, with facts mingled with fables. There are governors claiming there was no COVID-19 in their states while others rushed to report the first cases of COVID-19 in their states, even before receiving the test results.
From unfolding facts, do you think Nigeria is winning the COVID-19 battle?
This is difficult to say because our testing rate is abysmally low. We don’t have enough testing kits in Nigeria and, as of the last week in June 2020, there were only 15 testing sites all over the country and, out of 200 million people, we have not tested up to 150,000. How then can we be winning or losing the battle? The industrial crisis in the health sector is nothing new but this time they can be said to be justified because the FGN broke the promises made to them. These are frontline workers exposed to maximum risks daily. The least that could be done for them is to give them appropriate remuneration – for hazard allowance and adequate insurance to cover major disability or death from COVID-19 complications.
Do you think the country will emerge from this crisis able to tackle any future outbreak?
There is no basis for optimism. As long as people travel from one country to another, such infections will travel with them. Nigerians are like the proverbial ostrich that buries its head in the sand pretending that there is no problem. Our health indices are among the worst in the whole world with our under-5 mortality as high as 120 deaths per 1000 live births. See our national health insurance scheme (NHIS); it has become an avenue for siphoning money. A former executive director of NHIS was suspended then re-instated and finally removed from office for offences that border on corruption yet nobody is prosecuting him.
Many years after instituting NHIS, the coverage is not up to five percent. So, what level of preparedness are we talking about? Private hospitals in this country are performing open heart surgeries and renal transplants which most teaching hospitals in Nigeria can only dream about. Don’t let us deceive ourselves Nigeria was not really prepared to meet the COVID-19 associated challenges.
How would you compare the federal government containment of Ebola with that of COVID-19?
Ebola, though a public health problem, was not declared a pandemic by the World Health Organisation, WHO, because its devastation was limited to some countries where the activities of the nationals promoted its spread. Nigeria was able to contain the spread of Ebola because it was spread initially by contact with animals being used for food. With massive health education, people were alerted to the mode of spread and they desisted from eating those animals. Recall that Ebola was more devastating, with fatality ratio of 50-90 percent and spread by person-to-person contact whereas COVID-19 is transmitted in the air and all you need do to contact it is to be in the same room with a carrier who just happens to sneeze. It is difficult to compare the two diseases but our people have this unfortunately false sense of invincibility, unlike with Ebola with higher death rate.
So, what do you consider the way out of this COVID-19 quagmire?
Containing this disease will require a lot of money. Maybe, in the process, some people may line their pockets but I will not be able to comment on that. The NCDC has tried its best because before this pandemic there were only three or four laboratories in the country equipped for testing. There are now about 11 such centres; even certifying private laboratories for the tests, though at higher costs. When Nigeria is able to test everyone that needs it, we will be able to come up with accurate figures.
Before COVID-19 got here, government declared itself ready, even allowed flights from affected countries? From an expert perspective, what do you think went wrong?
It is our level of preparedness. Our health system could not cushion that emergency and the lapses became obvious. At the beginning, it was only Lagos state that had structures in place to identify, treat and prevent the spread of the disease. The federal capital and other states later came on board. Before this time, our leaders didn’t appreciate having a first-class healthcare system because they could travel abroad to access health care. However, with the lockdown, this lack of action is staring them in the face.
“The present structure adopted by National Health Insurance Scheme, NHIS, whereby health care is outsourced to middle men, called Health Maintenance Organisations (HMOs), is not working and government should urgently look into it. I believe our health systems can improve to the point that there will be reverse tourism and no one will have to travel to India, Europe or the USA for treatment.”
What lessons should the government take away from this crisis?
Let them start from somewhere and, as time goes on, more funds will be released. The test kits and personal protection equipment [PPEs] are very expensive and not enough. Isolation centres will have to be built either as temporary or permanent structures. These involve money, a major challenge for the governments as there was no provision for coronavirus in the 2020 budget. Of course, no country made any budget for it but those countries with good health systems were able to absorb the shock and use what they had to control the spread, treat the patients and engage in meaningful research.
The country’s COVID-19 effort has been impacted by lingering industrial dispute with medical doctors and other professionals protesting poor welfare packages. What’s your take on this?
There are many health professionals in the health sector working at different levels of the health sector but there is too much rivalry among them and some of them want to practise in areas for which they have no training or expertise. What I would like to see is for professionals to be comfortable in their professions without trying to usurp the roles of others. The medical doctor is the head of the team in the hospital but that does not mean that the doctor should take over the duty of a laboratory scientist. There should be mutual respect and understanding.
One of the areas of friction has been in the remuneration of staff and government has a great role to play in this regard. What I would like to see is a structured unified basic salary but the professional allowances should be tailored to considerations peculiar to different professions in the industry. So, I will plead with governments and the heads of the various government hospital to come together to solve this problem permanently.
What do you consider as the missing piece that would solve the puzzle in the health sector?
Leadership. How many of the leaders we have in Nigeria today are well educated? Many leaders are still backward in their thinking, being placed in the position for which they had no training. Even where they are educated, they often pander to too many interests.
Before the COVID-19 crisis, some doctors and nurses died from Lassa fever infection at a teaching hospital in the north-west political zone. How much did you think their families will receive for the loss of their bread-winner? Not much until coronavirus when all the frontline workers got covered by good insurance and the hazard allowance after upward review. What the government must do to retain the young doctors and nurses is to improve their welfare and put structures in place for personal advancement.
You worked in a public hospital before establishing your own. How would you compare the practices in both sectors?
Working in government hospital was stressful because the public expected so much from me and I was not able to deliver. No matter how skilful a doctor is, without the right equipment, he/she won’t make much impact. At times, money is not provided and at other times the contracts are awarded to the wrong person and you are saddled with an equipment that cannot meet all your needs. In the private clinic, you just attend to the basics and transfer the patients to the teaching hospitals.
There is low participation of private hospitals in the COVID-19 pandemic efforts in Nigeria. Why is that so?
Private healthcare practitioners are not prepared for acceptance and treatment of COVID-19 patients except one or two hospitals in Lagos. Some private hospitals proprietors were infected and had to be taken to the designated centres for treatment. Luckily, none of them died. The workers in these hospitals should not be exposed to coronavirus because most hospitals could not afford all that is necessary to combat the disease. All hospitals should observe the four cardinal points – hand washing for 20 seconds, hand sanitising, mask wearing and social distancing.
What do you think needs to be done for Nigeria’s health system to effectively cater for its teeming population?
I remember that, as a child, health superintendents used to inspect our houses and score us for cleanliness. They inspected toilets, bathrooms, kitchens, front and back of the houses. They fined those houses found wanting. There were not many hospitals and the few available ones were manned by nurses. They were well trained and committed with some of them even able to perform operations such as Caesarean Sections, appendicectomy and herniorrhaphy.
I believe that the primary health care system should be strengthened, children should be adequately immunised, health education should be given its pride of place and if all these are done, about 70 percent of our health needs will be addressed. Then the secondary and tertiary centres should be adequately funded with well-trained manpower, able to engage in meaningful research.
Finally, the healthcare insurance should be truly universal with everyone in the village or city able to access healthcare. The present structure adopted by National Health Insurance Scheme, NHIS, whereby health care is outsourced to middle men, called Health Maintenance Organisations (HMOs), is not working and government should urgently look into it. I believe our health systems can improve to the point that there will be reverse tourism and no one will have to travel to India, Europe or the USA for treatment.