Wednesday, 12 December 2012

Another MANSAG meeting in the UK

Each year, the umbrella group for Nigerian Doctors in the UK, MANSAG, holds an annual conference. The 2012 conference held recently in Leeds and there was a good turnout from Nigerian doctors, nurses and medical students and their families from across the UK as well as key speakers from Nigeria and the UK. 

IKE ANYA attended for Nigeria Health Watch. His reflections from the event are summarised below. 

The theme was “Investing in Healthcare in Nigeria” but my arrival in a very cold Leeds at about 10 am, meant that I missed the welcome address from Mr Gbolade, chair of the Local Organizing Committee and the opening remarks from the outgoing President of MANSAG, Professor Dilly AnumbaGetting to the venue, the foyer was filled with exhibition stands from various companies keen to sell their services to the Nigerian doctors- from insurance companies and financial advisers to Nigerian property developers, to a Mary Kay cosmetics stand.

Arriving in the hall filled with over 200 people, I caught Dr Kukoyi of Ace Medicare clinics speaking on investing in healthcare in Nigeria – the state and future of CPD. He talked about his work running 6 international free CPD conferences in Ibadan in association with Indian and American hospitals, and marvelled that some Nigerian doctors cannot use computers and some do not even have email addresses. He mentioned that since 2010, an annual practising licence for doctors was now conditional on evidence of CPD, paying tribute to Prof Shima Gyoh and Prof Roger Makanjuola, under whose tenures as chairs of the Medical and Dental Council of Nigeria the regime had been developed and introduced.

Under the new system, the acquisition of 20 CPD points is now a prerequisite for annual licensing as a doctor in Nigeria. According to him 22 000 out of the 67 000 doctors registered in Nigeria used this process in 2012. There are currently 94 public and 39 private medical CPD providers registered, but only 1 offers online courses. The current cost is about 1000 naira per CPD unit for institutional providers, and up to 5000 per unit for private providers. Citing challenges, he highlighted access to relevant CPD, the cost of participating in CPD for doctors in rural and remote areas, and having an independent CPD regulator that is not MDCN as areas that needed to be addressed.

He was followed by Prof Mike Chukwu, the Minister of Health, who began by recognizing MANSAG’s medical missions, donations and input to the production of a template for undergraduate medical and dental curriculum in Nigeria. He humorously overran his allotted time by over half an hour, highlighting the progress that was being made by the Goodluck Jonathan govt citing areas such as power and rail transport as examples. He also emphasised a new approach to medical negligence, insisting that they were determined to crack down on cases like that citing a current case where they had to dismiss a senior doctor following an incident where a tourniquet was left on a patient’s limb for hours, subsequently leading to death. He also cautioned Nigerian doctors abroad coming on medical missions to be careful of how they practised, arguing that diagnosing diabetes on a medical mission and providing a fortnight’s worth of drugs without making arrangements for follow up care was negligent. He spoke of how he had successfully argued that the national life expectancy targets should be removed from his performance indicator set, arguing that security, transport, works and other areas which had a direct impact on the life expectancy of Nigerian citizens were beyond his control.

Also of great interest was the presentation from Jide Olanrewaju of Satya Capital, investors in the Hygeia HMO and Folabi Ogunlesi of Vesta Healthcare Partners who shared their experiences on investing in healthcare in Nigeria. Folabi suggested that focusing on specific areas might be easier to achieve returns rather than big hospital projects, citing the example of the endoscopy clinic in Lagos set up by a number of UK based Nigerian surgeons. Jide identified skills and capacity as one of the greatest challenges facing anyone trying to invest in and deliver excellent clinical care to comparable standards. The vast disparity in pay for specialist doctors between Nigeria and the West meant that it was difficult to match the salaries on offer and therefore it was difficult to attract staff from abroad, leaving a gap that locally trained staff were often unable to fill.  The final speaker in this session was Ms Ugonna Ogueri who had moved from a career in management in the NHS back to Nigeria to work with providing Nigerian hospitals bespoke health management support packages. Highlighting that many hospitals and clinics did not have any basic management, budgetary or procurement processes in place, she spoke about how rewarding she was finding her work in beginning to help put these in place. She spoke of her motivation to move back, saying “ I used to sit in an A&E in the NHS in the UK trying to deal with complaints from patients who were not seen quick enough, and then I thought, most of my people in Nigeria do not even have an A&E to go to” She also spoke with horror of how the commercial flights from Lagos to Delhi were often like air ambulances, filled with ill people heading for treatment in India.

NMA President at MANSAG

I managed to catch the Nigerian Medical Association president’s talk before I left. Dr Osahon Enabulele brought back my memories of student activists as he lambasted the Nigerian government and some other previous speakers for not supporting Nigerian doctors to attain the standards that they criticized them for not reaching. He argued that banks did not offer loans to private hospitals to enable them expand and acquire the necessary skills and equipment, arguing that in other countries like India, the government helped facilitate this process. Just before I left, a speaker from the audience expressed a discomfort, which judging from the ripple that ran through the room, many felt about the seemingly private sector and profit oriented tone of the day’s presentations, arguing that for many ordinary Nigerian, a good strong system of public healthcare was still the only option.

By the time, I left there seemed to be a consensus emerging that both private and public sector healthcare in Nigeria required investment and that Nigerian doctors in the diaspora had a key role to play in achieving this.


Anonymous said...

Dear Chikwe,

Thank you for bringing Ike Anya's blog on the recent MANSAG annual meeting to us.

I thought it was very interesting and gave some insights into the home-diaspora interface of Nigerian born medical doctors ( and other health professionals). But I was getting worried about the market driven tone of the contributions until I read Ike Anya's comment ''---arguing that in other countries like India, the government helped facilitate this process. Just before I left, a speaker from the audience expressed a discomfort, which judging from the ripple that ran through the room, many felt about the seemingly private sector and profit oriented tone of the day’s presentations, arguing that for many ordinary Nigerian, a good strong system of public healthcare was still the only option'.
I was reassured after reding the comment.

In a country that UNDP/ UNICEF/ WHO/ World Bank/ IMF / others, all agree that over 70% of the population live on less than $1 per day, and they contibute the same percentage in total disease burden, and often present late for treament because of poverty by which time any illness they suffer has reached incurable stages in many cases, the absence of ' a popiulation wide model health system with gauranteed universal access at point and time of need, deals disaster to everybody : man, woman, rich and poor. And irrespective of religious, ethinic, culture and political orientation. In 2005, we shouted hurrah! when the National Health Insurance Scheme (NHIS) was launched. But, alas. we shouted too early.

The NHIS has performed well below expectation, whether in terms of coverage of the population or support for providers of care. As one of the early cheer-leaders ( as commissioner for health, I took Cross River State into that NHIS in 2006!!!), I worry every time I hold a consultation with patients, which is most days of the week, when I am in Calabar. What is the problem with the NHIS? Why cant it work in Nigeia like elsewhere? Trust me, I have asked both the small and very boig men involved in running it. Sadly, I am still waiting for the answer, meanwhile millions of potentials benefactors lie sick and many die!.

I am glad that the Minister of Health himself was there in person. Such interactions are often useful to achieve meaningful impact in the long run. I wished that somebody had asked him why Nigeria still does not have a Medical & Dental Council since the last one ( chaired by eminent Professor Roger Makanjoula) was aborted mid-tenure in September 2011. And this was when every commentator was saying that the MDCN at last had woken from its long slumber. That is 15-whole months ago?. Who is running the regulation of medical & dental practice in Nigeria in that time?. I am told that the same fate befell other professions allied to medicine. So, who is regulating the health professionals in Nigeria today?. Is it the civil servants in the Federal Ministry of Health?.God help Nigeria..

I was alo glad to read what the current NMA President ( Dr Osahon Enabulele) said. Basically he was saying let the government and other stakeholders put their money where their talk is! They should work the talk!. And I totally agree.

Joseph Ana

Anonymous said...

Thanks for bringing this conference to us. I am particularly interested in the CPD requirements by the MDCN and I am glad that I am not the only one thinking about FREE online CPDs as is obtained in some western countries. The compulsory CPD (or CME) recently introduced has been a means of exploitation by bodies certified to issue them. Most doctors only pay just to acquire the CPD without actually gaining any increase in knowledge. Many target two 10point CPDs to make up the required 20 points. Free online CPD's awarded at 1 point per topic will allow a doctor exposure to at least 20 different CMEs covering an array of vital day-to-day topics.

Olivia Terry said...

I hope Nigeria's medical sector started looking up after this conference. To have not a permanent medical and dental committee that maintained medical standards is unimaginable today, but seeing that it actually is still happening makes it more unsettling.