Dr Michael Nwoko, Senior Special Assistant To The Governor on Health Monitoring speaks to newsmen.
Dr Michael Nwoko is a Senior Special Assistant to the Delta State Governor on Health Monitoring.
He is a consumate health care practitioner and he spoke passionately about creating the right environment for credible professionalism to thrive within the sector.
In this interview, Nwoko laments that though the best medical practitioners across the world are Nigerians, there are issues that still need to be addressed to create the right environment that will stem health tourism and the attendant capital flight.
What is the update on the duration given to health facilities in the State to revalidate their registration?
I had seized the opportunity of being here earlier to notify members of the public on the strategy adopted by my office in collaboration with the Ministry of Health towards sanitizing private practices in the state, knowing full well that the private facilities are strategic stakeholders with respect to ensuring accessible, affordable and quality healthcare service delivery across the state.
Yes, it was resolved in the tripartite meeting that was held between my office, the honorable Commissioner for Health and the Director, Medical Services and Training of the ministry of health that these private facilities who are yet to validate or regularize their certificate with the state ministry of health will be given two months to validate or they be shutdown.
Yes, there have been lots of spectrum of activities after that, we have tried to monitor compliances at the part of these private facilities and as I speak to you, quite a number of them had complied; we also have a number of them that have not also complied. But what we do is to collate figures as to know the number of people who have complied and those who are yet to. And we are also aware of the number of these private facilities who have come to the relevant department of the ministry of health to obtain registration forms There is fresh registration for potential private facilities, when they approach the relevant department at the Ministry of Health, they obtain a registration form and they pay some certain prescribed fees and once that is done, the relevant department will then arrange an accreditation visit to the facility. If the accreditation criteria that is duly spelt out by this relevant department of the Ministry of Health is fulfilled, then of course, the facility is enlisted as a private facility. That is for fresh registration.
Then for those who are already operating as private healthcare of the state, usually, they attract an annual renewal, so we realized that there are people who have been operating over the years, that are even yet to register with the Ministry, while we equally have a large number who have been registered over the years but have not been able to renew their registration. And we felt that it is a misnomer. It does not conform to acceptable standard when it comes to effective healthcare delivery in any environment.
This has become imperative, haven realized that His Excellency, Senator Dr. Ifeanyi Okowa, our Governor has recorded a lot of successes when it comes to revamping the healthcare sector in the nation. His antecedent while he was a senator of the Federal Republic of Nigeria is still fresh in our memories. Haven to do with the bill that he sponsored for the National Healthcare Act and of course, the Basic Healthcare Provision Fund which most states are currently accessing. And haven achieved that feat at the national level, it is a known fact that as the governor, it is important for him to domesticate this credible policy which is exactly what we are seeing in the state. And for us to be able to achieve this, it is important that the standard of these practices and standard of these healthcare be enhanced. From the primary healthcare facilities to the secondary and private facilities we must ensure that they are of standard.
Now, haven looked at the statistics that we have been able to put together as to the compiling level of some of this private facilities, we have a number of them that have obtained form and currently undergoing the process of revalidation of their facilities to the ministry of health . Yes, the deadline they were giving for this revalidation was on the October 31, 2019, it has elapsed and haven realized the fact that we have a lots of them who have obtain form, we felt that it will not be ideal for us to begin to shut them down when already they have began the process. We now agreed to give them a grace period of two weeks between the 31 of October to the middle of November for those who have already obtained registration forms in order to register and for those who have commenced the process of revalidation of facilities to be able to complete the process. Because we felt it will not be fair to them. They have been notified but what I can tell you is that, machineries have been put in place by the relevant department in the ministry of health which is directorate of medical services and training to commence action, once the two weeks grace period elapses and they are aware. Any steps that will need to be taken will be communicated to different associations because this involves healthcare professions regulated by professional associations. So we have already communicated to them so they have two week grace period, those who have already commenced the process, it is not our intention now to go ahead and shutdown facilities who have already made efforts and commitment towards registering and revalidating their facilities with the ministry of health. And so we gave this grace period and it is expected that when this period elapses, actions are going to commence. The team members are already on ground and they are combat ready to move once this grace period elapses.
What is your reaction to this issue of ‘out of stock syndrome’ for drugs and how long more do you think it is going to take to resolve this issue?
We have been receiving complains before now in respect to the running of the Delta State Contributory Health Scheme, these complains have been coming from the enrollees of the scheme and this underscored the need for the office of the senior special assistance to the governor on healthcare monitoring to be created so as to carry out on the spot assessment of these facilities and know what the challenges are and also bridge the gap between the healthcare providers and of course the enrollees.
During the course of our monitoring, we have been able to interact with staffers of the facilities and the enrollees of this scheme right there in the facilities. It is not a matter of calling hospitals from our office but visiting the issue as it were in order for us to do proper appraisal and address them. But we must understand the fact that some of these problems do not really exist the way they are painted by these persons who call to complain. Most times when we go to the field, even though we appreciate that these issues are there, but it is not entirely a bad situation. And so we assess the reality of the issue that is already on ground with the view to be able to addressing them.
You mentioned the issue of out of stock syndrome; yes I am aware that medical practitioners usually will prescribe the chemical name of medication and not necessarily with the brand name because you can have a particular drug formulary that comes in different brands. But what is really important is the drug formulary, that is the chemical content of the drug, okay? And so you get to a particular facility, they don’t have a particular brand, they have another brand. So in order to solve the whole of this problem for simplicity, I am aware that medical practitioners prescribed the chemical name of this drug and not necessarily the brand name but, what we realized was that some of these enrollees are used to a particular brand, for instance someone who has been managing a condition using a particular brand by way of self-medication or with prescription that she has been getting from her doctor, when she visits a health facility that has been accredited for healthcare services and the doctor now prescribes a drug (a brand) different from the one the enrollee is familiar to, that enrollee goes out to the public and complain that they have given him/her drugs to a condition instead of the one they know because there is a stereotype view on the mindset of the enrollee that this is the particular medication that I need instead of that which has been given to me. When a doctor gives an enrollee a different brand that does not mean that they have not addressed the problem. You can understand where this is coming from, so I am not aware that you have visited a facility and there are no medications to be prescribed, of course that is not possible. but one thing we must understand is that these drugs come in different brands and that not given a particular brand that you are expected to get does not mean that the doctor has not solved your problem. So we must understand these facts and that is one thing that has actually brought complains, but we will do our best in the course of our monitoring exercise as we interact with these enrollees to be able to enlighten them on some of these issues that they present, that it is not an entirely bad situation. We have equally stated in different forum while we interact with top management functionaries of these healthcare facilities that there is need to carry out town hall meetings on a regular basis, having the host communities as your target audience because that is where you get much of your enrollees from. We must continually engage them on the workings of the scheme so that they can ask questions in order to get answers to some of these problems that exist. It is just a communication gap and I want to believe that if we are able to bridge this communication gap, then this complains would whittle down. And of course with what we have done in the course of our monitoring, the activities of some of these facilities, it has helped to bridge the gap between these healthcare service providers and the enrollees of the scheme. So we must be guided accordingly to be able to understand how the scheme operates.
How can government enforce the Patient Centre Care (PCC) to improve patronage of our health care as against health tourism?
Starting with the first question, in line with his Excellency’s declaration at the just concluded national health summit organized by the Nigerian Medical Association (NMA). Yes, the governor, by reason of that declaration, he is sending a message across That Message was electrifying because you cannot guarantee effective healthcare delivery without adopting the concept of the patients centre care. The patient is the key stakeholder in the healthcare delivery system, now we are talking about enrollees looking at the dynamics of the healthcare system in the state right now. Who is the patient in these facilities?
Healthcare facility system cannot exist without the enrollees. This makes them strategic stakeholders.
Now talking about patients centered care, it has a lot to do with healthcare practitioners, practicing with a high level of integrity and also ensuring that the input of the patience and of course the family of the patience is respected, it is key, okay? Now, the analogy that I gave earlier haven to do with registration pattern of medical practitioners haven realize the fact that they cannot tie themselves to a particular medication, knowing full well that there are various brands. But What the patient center care tend to address according to the declaration of His Excellency, is to be able to engage patients and engage their family members. And of course by way of professional practice, it is clearly encapsulated in the counseling nugget virtually across all the healthcare professions. You do not just examine your patient and prescribe drug to your patient without counseling your him or her. Counseling is an integral component of patient management. You cannot remove counseling from patient management precisely because it is an integral component. During the course of examination, if you want to carry out an examination or any laboratory investigation, you must be able to tell the patient that this is what I’m about doing and this is the reason we are about doing this. When you arrive at your diagnosis you should be able to counsel the patient. Such counseling and interaction with the patient to a large extent, gives a high level of reassurance. Because there are patients even with a chronic condition, when they walk into a facility, what a healthcare practitioner will do is to embrace the patient and smile, the impression that you create to a large extent, will determine whether the patient will be well or not. That is psychological approach of patient management which is why counseling comes in. so your further engaging and listening to the patient will go a long way to also reassure the patient to acquit the patient the condition and reason why he/she is in that particular facility. Even though he or she is an enrollee of the scheme, you just explain to the enrollee that yes deductions were made and all that. To a large extent it is their right, accessing healthcare under the scheme is their right and so you should be able to inform them on whatever you are doing.
How come that some enrollees are made to pay when some surgeries are carried out on them?
I think this really bothers again on the essence of understanding the way the health insurance scheme is structured. We must understand that under the contributory health insurance scheme, there are three spectrums of activities, one at the primary healthcare, secondary and the tertiary care. Different spectrum of operations in the health sectors are captured under these different groups. Surgery is not captured under the primary health service; some minor surgeries are captured under the secondary healthcare, while major services are captured under the tertiary care.
There are facilities accredited for primary healthcare services only, you do not expect them to render secondary care to an enrollee who visit them for primary health service. So we must understand this that is why there is need for awareness creation. We must engage the people, the host communities where these healthcare facilities are domiciled so that they can understand the dynamics. Health insurance entails a lot of dynamics in the healthcare delivery system all over the world for people who must understand how the system operates.
Now you have been referred, you cannot just jump into a secondary healthcare when it comes to health insurance. You must start from the base which is primary healthcare, now if your problem cannot be solved in the primary healthcare; you are referred to the secondary healthcare. The secondary care has a lot of operations that are clearly spelt out there, minor surgery while major surgery can now be accessed at the tertiary healthcare level. The scheme still is evolving for instance, Federal Medical Centre (FMC) Asaba, is a federal government’s owned tertiary healthcare facility but currently it is accredited primary healthcare service under the contributory health scheme. You cannot walk in there and say you want to have a major surgery, because that is not captured under the capitation of tertiary healthcare.
So there is need for people to understand this dynamics and again, the communication gap must be bridged and that is one very important and critical element in my duties as the Senior Special Assistant to the Governor on Health Monitoring, to be able to bridge this communication gap. We are planning, there are going to be different seminars and summits, so we are using this opportunity to inform the public on this issue in respect of bridging the gap that exist between the enrollees and the facility.
For how long would we continue to run the Health sector with less qualified medical practitioner?
Thank you very much, this takes me back to the action that is being taken by my office in collaboration with the Ministry of Health. We are trying to sanitize the health sector of the state, this is really very critical in the area of quackery activities in the system and I want to assure deltans that in no time, it is going to be a thing of the past. Given the implementation of the strategy that has been adopted now by my office in collaboration with the ministry of health to ensure that practices are standardized . The idea is to ensure that what they do in the course of their discharge of duties conform to internationally acceptable standard. That is the only way we can attain universal health coverage because it is a universal health phenomenon.
The message we are sending across by raising of this strategy, is to ensure again that healthcare practitioners, abide by their professional callings. If you know your job as healthcare practitioner and a pharmacist and a busy one at that, you will not think of setting up beds for your outfit and setting lines to cure patients in your pharmaceutical outfit.
As a certified pharmacist and you know you are honest, you will know that there is a lot to be done in your area. And of course a proud Medical Scientist knowing full well his calling in the healthcare services, is really determined towards the services of the system.
A very proud dentist will understand that for him to contribute his quota towards ensuring optimal performance of the facility he finds himself either the government facility or private facility, your own services as a dentist is key. I can go on and on, but professionals who are proud of their profession, have no reason whatsoever to practice another man’s profession through the back door.
Healthcare in the world particularly in the countries that have higher health indices is a team spirit and a team environment, that is why when we go to India for instance, it will be difficult to see a big facility that is owned by one person, different healthcare practitioners will come together with common understanding and vision they poll resources together and set up a comprehensive healthcare facility. They have a common understanding and revenue sharing formula is not a problem. It is very doable here, different healthcare practitioners can come together to be able to set up a comprehensive healthcare centre. Because it is difficult for one person to set up comprehensive healthcare facilities and in fact, if anyone sets up a substandard facility, it is better you do not even venture into it because ultimately, it will fail. So it is a lot better that professionals come together and partner?
It is better for people who have been trained in their different fields to come together than for you to have a small one that is not up to standard and then assume to become a jack of all trade, it is not possible, it will ultimately fail. So I want to believe that with the dynamics in the healthcare sector, it is imperative for healthcare professionals to come together and with a common goal and establish comprehensive healthcare services especially under these healthcare arrangements. Having a standard in line with the universal health policy, to a large extent, it will give a lot of credit to that facility and increase your enrollees’ strength and if your enrollees strength is enhanced, it will increase your capitation from the health insurance scheme and you will be the benefactor.
So is it not better for you to be prepared than for you to go into a half baked practice?
What level of funding do you think is advisable to take the health sector from where it is to a desirable level?
The world health organization recommend 5% of Country’s National income towards funding of healthcare but if you get to some nations of the world, you may realize that given the revenue strength of these countries as it were. But again coming to Nigeria, I want to believe that even though I know that there are a few challenges when it comes to the revenue and of course the robust nature of the country there about, there are few challenges. But again, that is not to say that the health sector should not be given enough funding. We want to believe that yes there is this outcry that what is being given and what is being released to fund the health sector in the county is a far cry according to what the World Health Organization prescribed. I think that it is important for Government to consider the increase of funding to the health sector. It is very critical in the way of the dynamics of the health sector for a lot of resources to be pulled towards ensuring that the practice and services are standardized both at the private and government facilities.
Government has a lot to do to be able to enact the healthcare policies and programmes and also implement the policies of the program. A lot has to be done in the area of regulation and stabilization of the sector. All these critical elements require a lot of funding. So I want to believe and think that the government should step up funding to the health
In what ways is the government managing our nutrition in the society as regards to women and children?
You will agree with me that the state government places very high premium on maternal and child health. In fact, the pilot scheme of the contributory health scheme began with the maternal and child health and that was in January 2017 and of course the previous administration also brought in so much in this program which means that children under the age of five and pregnant women can access any secondary healthcare facility for treatment without having to pay a Kobo and during the course of our monitoring, we understand that the program is working and it is so effective. The idea is that the state government subsidizes medical bills for pregnant women and children living in the society and that is a whole lot of sacrifice. the whole idea is to encourage that group of people living in the population who are actually women and children they are really very vulnerable.
The issue of nutrition you talked about is encapsulated in the entire program. If a problem of malnutrition is discovered in a pregnant woman, of course it is a holistic package that will also be addressed alongside other parameters involved in the pre-maternal programs .The same thing with children.
For simplicity, dietary system of a young lady is different from that of a pregnant woman and naturally it will change when a young lady gets pregnant and they are taken care of under the maternal program, so the issue of malnutrition is not severe as it is taken care of.
Do you ever envisage a time some training can be given to tradomedical practitioners in the society and also have them incorporated into the orthodox system?
I’m aware that there is a recognition given to the tradomedical practitioners in the country, this has lend credence to their official registration with the Ministry of Health both at the national and state levels. So talking about organizing a seminar for them, there are programs designed for them in order for them to improve in their practice and take it to the next level. So one thing we must understand is that, the source of their medication comes from plant extracts, although not as refined as the orthodox medicine ? That is the reason why they have been a little bit encouraged, so there is a way they can advance towards ensuring that they come out with more quality and refined products. That is the whole essence of bringing them on board. And they are already on board. So they have an open space for them to cultivate, all they need to do is to do more research and see how they can come up with a much more refined products and when these products undergo clinical trials, to a large extent, they will be introduced to the market and if you mention India, they will also mention Nigeria.
We have a lot of medication, some of them come in liquid form, they are products of tradomedical practices and they are very efficacious and very potent. So in the same vein just like you have advised, it will better for our tradomedical practitioners to cultivate the opportunity that has been given to them by the federal ministry of health to see how they can conduct more research and see how they can come up with better refined pharmaceutical products that will be efficacious and potent. And they will take the credit as they would have contributed so much in the health sector.
Culled from the Pointer Newspaper, Asaba.