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Socialist Democracy Nov - Dec 2005



Any Cause for Celebration?

By �Wale Eleto, Coordinator, Education Rights Campaign (ERC)

The Guardian on Sunday November 20 2005 carries a detailed story of the wonderful work being done by the Obasanjo administration in the health sector, with the refurbishment, standardization/modernisation of teaching hospitals in the country. Apparently piqued by the sordid decay of infrastructures and complete lack of modern medical and allied facilities in Nigeria's hospitals, especially, the so-called teaching hospitals, the government appointed a Presidential Project Implementation Committee (PPIC), in December 2000, headed by Emeritus Professor Oladapo Olujimi Akinkugbe, to review and advise on measures to improve the state of equipment within tertiary hospitals in Nigeria. The committee set to work and "a policy on standardization of medical equipment emerged and the estimated cost of rehabilitating and equipping the entire tertiary health sector was put at over N50 billion. As a result of slim resources, the Federal Government decided to undertake the exercise in stages. The eight Teaching Hospitals under the first phase include University College Hospital, Ibadan; ABUTH, Zaria; University of Port Harcourt Teaching Hospital (UPTH); University of Maiduguri Teaching Hospital (UMTH); Lagos University Teaching Hospital (LUTH); University of Nigeria Teaching Hospital (UNTH), Enugu; Jos University Teaching Hospital (JUTH) and University of Ilorin Teaching Hospital (UITH)."

With the successful completion and commissioning of the permanent site of ABUTH, Zaria on Friday November 11, 2005, complete with state of the art facilities and high quality staff, such that can compete competently with others across the globe, the government boasts that Nigerians will not have to go abroad for medical treatment. So, needn't we celebrate?

Public officials in the country have had to travel outside the country for medical attention even for remote ailments, at the expense of tax payer's money. This is also true for the rich and wealthy who cherish their lives. For those who cannot afford the megabucks required for the venture, in many cases, they are condemned to death or permanent deformity. Most recently, the wife of the president, Late Mrs. Stella Obasanjo died in a Spanish hospital from complications after undergoing surgery reportedly for abdominoplasty otherwise called tummy-tuck. She could just have been treated in ABUTH, with the full rites of a first lady accorded, had the refurbishment and standardization plan been conceived and implemented earlier. Not to worry, future occurrences can now be avoided. Needn't we celebrate?

The benefits of this historic project are 'far reaching'. They are listed to include: (1) A reverse of Nigeria's appalling rating of no. 187 out of 191 nations in a survey by WHO in the provision of medical facilities to one of the best in the world� (2) It will stop the medical brain drain to foreign countries which we have been suffering for the past 20 years. (3) It will encourage our medical experts that have fled the country abroad in search of greener pastures due to lack of facilities at home, to return to Nigeria since what we now have here may in most cases, be better than what they are now using. (4) The country is now able to provide excellent medical care to all the citizens. (5) There is no more need for any Nigerian to seek medical health abroad as everything required can now be done at home. (6) Huge sums of foreign exchange will be saved by the country from the large amount of foreign exchange spent in seeking medical help abroad. (7) Cost of medical treatment and check-up will be considerably cheaper for all citizens now that the facilities are available to them. (8) Nigeria will be in a position to render specialized medical services to all its citizens, its immediate West African sub-region and African continent at large, thereby earn foreign exchange for such service. (9) The project will now enable first class teaching services to medical students by all the Teaching Hospitals. (10) And last but not the least; the tertiary institutions will live up to its responsibility by contribution to produce a healthy nation which eventually will produce a wealthy nation." (All emphases ours) Needn't we celebrate?

Alas! There is no single reason to celebrate. In the first instance, it is discernible to the sober mind that these gains as listed above are largely exaggerated. One wonders aloud how eight (8) standard (250 bed) hospitals in a country of over 120 million people will achieve these feats. Surely, this is a monumental deceit. The World Health Organisation (WHO) has revealed that just 10% Nigerians have access to good quality health care service. How eight standard hospitals will automatically turn around such sordid reality will be the millennium wonder.

Again we ask why the refurbishment of the fourteen (14) teaching hospitals, indeed the entire tertiary health sector estimated to cost a mere N50 billion (yes a mere) has to be phased so much that the hope of ever carrying out similar work on the remaining six teaching hospitals after completing the first phase in June 2006 is very, very dim. The government proudly announced that it committed a 'whooping' N17 billion on the hospital project and only stopped short of going the full stretch "following slim resources". Yet, nothing betrays the utter irresponsibility and complete misplacement of priority of this government more than this. The renovation exercise, that gulped N17 billion, took government 4 years to complete the first stanza of its first phase.

But within 3 months in late 2003 and early 2004, the same government spent over N90 billion on frivolities; mere distractions. The white elephant Abuja National Stadium gulped over $65 million (N85, 775,000.00) Eighty Five Billion Seven Hundred and Seventy Five Million Naira) while N30 billion went into hosting the Commonwealth Head of Government Meeting (CHOGM). Now, the government goes to town to celebrate that what it sunk into the hospital project "would be the first time in many decades that resources of such magnitude have been committed to tertiary health care." May be the assertion is true. But is it not truer that the Obasanjo government has raked in more money than any previous regime in the country's history, particularly in the past two decades, with record prices of crude oil in the international market. The government amasses a minimum sum of $190 million per day from oil sales alone; in the past five years, it has earned over $100 billion from oil sales. With higher export price of oil this year, the annual income from crude oil sales is expected to be around $37.7 billion, and then rise another 9% to $41.1 billion in 2006. Yet, Nigerians, particularly the poor working people have not enjoyed the marginal benefits of this 'favourable season' for their economy, in crucial areas of their life like employment, education and health care. Instead, the Obasanjo government chose the period it actually made more money to impose more hardship on Nigerians. The government has increased pump price of petroleum products seven times since 1999 (more than any regime in history), such that a litre of petrol now sells officially at N65 from N20 in 1999. Thousands of workers and health sector workers too are being sacked periodically in tune with governments policy of "right sizing" the public sector. The point is that this government must stop to pretend that it means well for the suffering population. With the fabulous wealth at its disposal, as shown earlier, the N50 billion required to standardize the entire tertiary health sector would have been an insignificant drop in the bucket, for a government that really takes 'health as wealth'.

Earlier, some of the identified gains of the hospital refurbishment were said to include that "there is no more need for any Nigerian to seek medical health abroad�. The country is now able to provide excellent medical care to all the citizens. This is a blatant lie. Despite the so-called renovation/standardization, it is still health care service largely for the few rich. Asked about the affordability of services at the hospitals, Emeritus Prof. Akinkugbe replied "it will be idle talk to pretend that everyone from a rural or urban setting would have easy access to such investigations as CT scan or MRI, which costs roughly N30,000 to N50,000 apiece. Those who had cause to go abroad to undertake such tests will certainly find it much cheaper to have them done at home. But for the general run of patients in our teaching and specialist hospitals, access may be difficult unless a new system of payment for such socialized services is worked out". Oh! Prof. Akinkugbe has just said that rather than all Nigerians having access to crucial health facilities, as government want to claim, we will indeed have situations where even many hospital staff will not have access to those facilities. Not with national minimum wage at N7,500 since 2001 and inflation cutting deep into working peoples income.

The logic behind this paradox is simple. The neo-liberal market philosophy which our government rabidly pursues at the behest of IMF/World Bank requires that social services like health care and education must be subject to the "market forces" and available only to the highest bidders. Yet, Obasanjo is so obsessed by the 'unique' achievement that he spoke contemptuously to the hospital staff that may be reluctant to relocate from the old ABUTH complex, Kaduna to the new permanent site in Zaria. According to the Guardian, Obasanjo "warned that he would deal decisively with any staff refusing to move to the permanent site". Tough talk. But nothing was said about what measures government would take to ameliorate the inconveniences of relocating workers from their familiar environment like transportation allowances and other such emoluments to compensate for their sudden detachment from their immediate environment and their families. Workers must just relocate pronto because the hospital has been relocated, no more, no less. This is a reminiscence of military fiat and an affront on the workers' democratic rights.

Nigeria is currently ranked as 187th of 191 nations surveyed for health indices by WHO, only 10% of its population are said to have access to essential drugs, while thousands die of preventable and curable diseases like malaria. Child mortality is said to be in the region of 150 of every 10,000 life births, one of the highest in the world. Life expectancy is 43.6 years for men and 43.9 years for women. Worse still, 70% of the population are said to live below poverty line (on less than US $1 per day). In the light of these grim realities, government step to renovate and standardise health facilities is a good one. But the one currently taken is by far too little, falling far below what the country can afford and must pursue. In order to fundamentally improve the health care delivery system, government must commit huge public resources to health care facilities, hospitals, personnel and equipments in all existing tertiary hospitals and other public hospitals. More of such facilities must be created in areas where they are currently non-existent. In order to expand access to such facilities to the poor, toiling majority, health care services and education must be run as social services at the expense of public funds. To avoid arbitrariness, corruption and mismanagement, all teaching/specialized/general hospitals must be put into public ownership and placed under democratic management by democratic committees of workers, government and community representatives. Not until this is done will the health institution "live up to its responsibility by contributing to produce a healthy nation which eventually will produce a wealthy nation".




Socialist Democracy Nov - Dec 2005