By Emmanuel Onwubiko
Article 3 of the universal declaration of human rights
says “everyone has the right to life, liberty and security of person.”
Closely following this international precept of human
right is the section 33(1) of the Nigerian constitution which guarantees right
to life.
The provision contained in that specific constitutional
code goes thus: “Every person has a right to life, and no one shall be deprived
intentionally of his life save in the execution of the sentence of a court in
respect of a criminal offence of which he has been found guilty in Nigeria.”
Sections 17(3) are more primarily concerned about the
health rights of Nigerians.
These sub-sections of the Nigerian constitution states
as follows: “The State shall direct its policy towards ensuring that- (a) all
citizens, without discrimination on any group whatsoever, have the opportunity
for securing adequate means of livelihood as well as adequate opportunity to
secure suitable employment; (b) conditions of work are just and humane, and
that there are adequate facilities for leisure and for social, religious and
cultural life; (c) the health, safety and welfare of all persons in employment
are safeguarded and not endangered or abused; (d) there are adequate medical
and health facilities for all persons: (e) there is equal pay for equal work
without discrimination on account of sex, or on any other ground whatsoever;
(f) children, young persons and the age are protected against any exploitation
whatsoever, and against moral and material neglect; (g) provision is made for
public assistance in deserving cases or other conditions of need; and (h) the
evolution and promotion of family life is encouraged.”
Following from the above is the need to state that
implementation of public policies in all its ramifications are the functions of
bureaucracy and other administration organs of government.
The public policy expert R. K. Sapru made the above
points very clear in his authoritative book titled: “Public Policy:
formulation, implementation and evaluation.”
He wrote thus: “The principal function of public
administration is the implementation of public policies. Public administration
has concentrated on the machinery for the implementation of public policies, as
given, rather than on making them. In an era when about 2/5th of
the Indian work force is employed by government, the functions and roles of
government employees determine what happens after a policy, in the form of a
law or a statue has been adopted.
The expert said also that Public policies in India, as
in other countries, are implemented by a complex system of administrative
organizations and agencies.
They perform several activities.
What this means is that the day-to-day running of these
enterprises becomes a matter of wide public concern.
The main agencies which are implementing government
activities and public policies are as follows:
Bureaucracy and other Administrative Organizations.
RK Sapru defines these institutional organs that
implements public policies ss follows: "The bureaucracy is an executive
branch of the government. It is an administrative organization consisting of a
legal body of non-elected employed officials which is organized hierarchically
into departments in accordance with the rules governing the conditions of their
service."
Bureacracy he argues rightly is an important institution
which performs most of the day-to-day work of government.
It is the bureaucracy who controls the personnel, money,
materials and legal powers of government, and it is this institution that
receives most of the implementation directives from the executive, legislative
and judicial decision-makers, he affirmed.
The author said something of interest to us in this
piece when he reminds us that it is a question of controversy whether the
bureaucracy is strong enough to dominate the political elite or vice versa.
He then added that however, bureaucracy has never been a
popular word. It is said to be afflicted with excesses of red tape, tedious
rules and an attitude of unresponsiveness.
Despite its maladies, it is important because
implementation is the continuation of policy-making through means, he averred.
These basic foundations is necessary so as to properly
focus on the thematic area of our piece which came about by a certain news
story in The Guardian few days quoting the health minister as planning to
import medical doctors to Nigeria as a way of checking medical tourism.
This news story instigated and ignited a groundswell of
disturbing signals in the organized human rights community particularly because
if it is indeed true that after over half a century that Nigeria became an
independent nation that we are still relying on foreign medical doctors to work
in our public health institutions and indeed the bureaucrats in this government
would come up with such a weird public policy, it therefore means that Nigeria
has returned to square one.
The HUMAN RIGHTS WRITERS ASSOCIATION OF NIGERIA
therefore undertook an interface with the Health minister Dr. Osagie Ehanire
and his minister of state Senator Oloruninmbe Mamora to hear from them the
real position and also to demand accountability from them on what the Federal
government has in the pipeline to ensure the delivery of the right to
qualitative healthcare to Nigerians.
From the totality of what the two ministers told us
during the two hours meeting, there is nothing that shows that President
Muhammadu Buhari’s administration is planning to impart foreign doctors. Here
are their words so you judge for yourself.
The Honorable Minister of Health said thus: “As you know
we are in the period of budget defence and the various committees of the house
invite all the Ministers to come and make submissions to them and while we were
having the submission with the committee on Diaspora, Diaspora are those
Nigerians who work outside the country and some of them do come here. The
doctors and nurses and pharmacies among them gather to work here, we cooperate
with them and they corporate with us. And in the course of asking about
diaspora doctors and about medical tourism, the committee members asked those
questions, we answered that yes we do work with the Nigeria diaspora doctors
they come from abroad for 2weeks, sometimes 3weeks, 4weeks, one week depending
on how much time of leave they have, because they are working over there. So
they use their leave to come home to work. As far as medical tourism is
concerned we need also to improve our health delivery by looking for people who
have experience from outside the country who have perhaps retired and who are
looking for somewhere to volunteer to spread their experience and their
knowledge. If they could come here, work in our teaching hospitals to also
share their experience. Because there are some very experienced people who have
worked retired and some of them are still strong and they don’t know what to do
want to go volunteer and work somewhere else to share their experience among
those who are coming up that we shall also be happy to engage those in fact we
are in discussion with some of the embassies to see if they can help us to find
some of those people and perform particularly difficult operations which we are
not able to do here. They are such operations that we don’t have either the
equipment or maybe because the expertise or maybe very seldom operation where
in some cases we actually infact justifiably have to send few cases abroad
because we cannot do it here, so they can come and share their experiences with
us. That’s what we said, and then the next thing was that it took a different
turn that we are importing doctors.
Well first of all, let me tell you that Nigeria doesn’t
have money to import people because it’s difficult not paying salaries here so
where are we going to see the money to go and import doctors from American or
from anywhere, do we have the money? There is a lot of expenses here that the
government has to meet and you hear sometimes doctors and workers go on strike
because of their salaries are owed here. Is that the time to be importing
doctors?
It does not make sense; we are talking about people
volunteering. What we want to import is not doctors but we want to import their
knowledge and skills. Who would come here volunteer to work in may be in
UBTH, Lagos Teaching Hospital, LUTH, National Hospital, Ahmadu Bello
University, and University of Nigeria Nsukka, Ibadan and these experienced
Professors from abroad, from America, Germany, Uk, England, France will just
work for about 2, 3 months to take care of them they are volunteers because
they have their pensions, and there is nothing they are looking for again other
than to find a way to also share their experience and give their experience to
our own expertise so that they can be stronger and better. That is the story we
gave to the committee that’s it and it started going a different way so we
called them and said this was not what happened and as far as am concerned my
door is always open l talk to people who always come and ask for interviews who
we give them interviews, so if you have been able to make a phone call or ask a
question you would have been given a scenario of what happened , the point is
that we don’t even have money to pay the salary of any expatriate coming.
Nigerians won’t even have the money and that was not the thinking or even the
words that were used. The words that were used are that we are looking for
volunteers. Do you pay for volunteers? No you don’t and that the volunteers
will come and they must be experienced not just any other person who will be
able to add value so that people will have more confidence in this system and
they would not want to go and get treatment outside. That is the way the story
went. So for those of you who have heard now yes.
1-it is not even on our budget to be able to bring
foreign doctors to come. If it is not in the budget so why will anybody say
they are bringing doctors.
2-Secondly, we need their knowledge, we need their
experience, we need their expertise and some of them have also learnt, I mean
they have new technology that they can also show us here because medicine is a
science that is constantly improving and changing. And those people who are
retired and they have all this knowledge and expertise can come here and show
us the latest in approach to treatment, to operations and to managing patients,
so that was the story and now you know it.
We agree with you that the health sector in Nigeria
requires repair that is what the president has been saying over and over again
that he took over this country in a very difficult time where people in the
past government believes that when you talk about health, you build big
hospitals inside the city that everybody can see and say this man is working.
But in the village where nobody there is nothing. So since president Buhari
came, his idea is to balance this thinking if you are in the big town, ok you
can have big hospital, if you are in the small town then you can have small
hospital. So that’s why we are developing primary health care so that you can
give health care to people in the rural area also, in the village, in the
remote areas in hamlets even if it’s just a small primary health care with 5 or
6 people, they can have something and his policy is to have at least one
primary health care centre in every ward if the ward is big or population is
very big you can have two or even three but you must have one minimum in every
ward that will give about nearly [10,000] ten thousands which we have been
working on, infact one group just left before you became an NGO that receives
support to help us with this primary health care centres. Since we announced
it, many foreign friends have been very happy they said yes now you are doing
something about the poor people we will support you. So this particular group
has renovated about 1,000 one thousands primary health care centre in Nigeria.
And that’s exactly the kind of example we are looking for so when we are
talking about foreign people well, they can help us in many ways because some
of them have money, the expertise, the technology and what this people are
doing now helping to renovate and take health care to the rural areas. We have
done more than half or about half of the number we are looking for. And we are
also going to continue those health care centres. You asked a question about
who is in charge?
Well Nigeria operates according to constitution. Who is
in charge of primary schools? It is supposed to be local government. Who is in
charge of secondary schools? It is supposed to be state government. And who is
in charge of University? It is supposed to be the federal government. That is
the way the constitution actually divides it. And in the same thing, in health
care local government is actually supposed to be responsible for primary health
care but they are not strong you are correct. They are not strong and the
general hospital does actually what the state government should be doing but
what the federal has to do. And you said the only ones working are the big
hospitals in the city, the teaching hospitals you are correct. So the result is
that anyone who has transport fare coming from the village, coming from
everywhere and crowding the teaching hospitals and federal medical centres.
They have to do all the out patients, treat everybody cough, catarrh, backache
and waist pain which normally can be taken care of at primary health care
level. Malaria, waist pain, even deliveries, many deliveries, diarrhea,
stooling, all those are things that can be done in primary health care so that
people will not waste their transport fare and those who have no transport fare
and those who do not have transport fare will not lose their lives. That is why
we are taking health care to all rural areas .If we have primary health care
centre, you can also have health posts in different villages where people can
at least get advice or get a few tablets for their ailment that is the plan and
for the secondary level, the general hospitals again, the states were not really
doing that. Some of them were building big hospitals like tertiary, which the
federal government has already done. So that is the area we should believe the
private sector will be very important because those doctors who are building
their own hospitals may be 20, 40, 50 beds and they are able to perform some
operations and employee other doctors, they are now like general hospitals
.Some of the private hospitals so those ones will fill in gap for the secondary
health care part of it and then be able to have a place where the people who
cannot be treated in the primary health care can be referred to. As you know we
are also working on National health insurance scheme to be able to have people
contribute maybe when you begin to hear of it you will join too because
you are supposed to contribute Health Insurance Scheme when you are well so
that you will make it a monthly contribution, so that any day you fall sick
nobody will ask you to come and pay money again because you already have a card
that says you are a contributor and being a contributor is like being a member
of a hospital where you can go and get treatment because you are paying. It is
like a membership fee which is what they do all over Europe they do it in many
of those countries and we should be doing it here too. The law is about to be
passed out to allow the National Health Insurance Scheme to expand and make it
mandatory for people to join so yes I agree with you that there is a right to
health, but to have the right the right to health you must have the health
facility there, and it’s the Federal Government that is now going in to put
money and put resources for Primary Health Care because at the end of the day,
the federal government feels responsibility for all citizens we won’t say we
are sorry, local government take care of yourself because local government, the
constitution has left them weak and unable to do those things that are expected
of them. As equipment concerned well people stay outside and say the hospital
has no equipment nobody has really gone to examine, have you gone there to
examine? NO you haven’t. The point is that yes it is true that they are some
that they don’t have the equipment they want, there are some of that have
equipment that are in need of repair, but there are good number that have good
equipment, equipment that work and are functioning. So those ones too we expect
better performance from them. While we are trying to have a better strategy for
either repairing our equipment or how to buy equipment because yes equipment
are extremely expensive we don’t make them. They all have to be important and
some of them are millions and even millions of dollars and to have them is not
easy at all, so we are in need of a strategy to be able to get all the
equipment that we need perhaps helping the private sector, everybody has money
for example, if you have money and you want to invest money in the health
sector, we encourage you to come, you can build an x-ray centre in the hospital
and you can be charging that’s private sector joining where government cannot
supply the whole of 36 states the whole of 774 local government and the whole
9,844 wards federal government alone is not able to take care of all of those
so we are looking for participation from private sector which are very much
interested in. As far as complain about service is concerned , most
hospital who have servicom points where you can go and complain if you
have any issue that didn’t appeal to you, you make your complain, I myself
received petition when people have been to hospital they were not
happy.
They write letter complaining to me, i will investigate
if a doctor didn’t treat them right or the nurse abuse them they will set up a
committee to go and find out and then discipline the person, so yes complains
we are waiting. Infact we welcome complain so that we can correct people
who are not doing the right thing. If you keep quiet, we will never know who is
doing it well and who is not doing it well, so for interface, you can interface
with us, anybody here that you know. But the chief person here is the deputy
media director who has her own team, she can speak to you anytime. Infact she
brought somebody to interview us this morning, so you are not blocked off. That
we are attending only to doctors, that is not true we attend to anybody who
wants to know because it is the people’s ministry, we just work here and it’s
yours. So that’s the way the story went about importation of Doctors as you
said just now let me repeat:
A. We didn’t have in our budget to import anybody, so
nobody could be importing a doctor and secondly, we didn’t need to import
anybody and thirdly, what we want to import is skills and knowledge from
volunteers. Volunteer because we know we cannot pay them. We can’t pay so, it
is only people who are interested who have these knowledge and skills from
outside the country, from modern world and they want to help us. We appeal to
them that come if can spend about three (3) months, six (6) months we can
give food and water and a place to stay and they teach our experts to know more
and have more skills.
The Honorable Minister of State added the following:
“Comrade let me thank you and your team for finding time to see us. I will say
without mincing that every expectancy in respect of the news that was very
unfortunate because nothing was said that way to even be misconstrued in that
regard by anyone not the minister, not myself not anyone that had privilege of
making any comment on that day.
And the question to ask is, if truly that kind of thing
was even contemplated and shared. That was a major news item why is it that
it’s only just one paper that carried it, in front page? That’s the question.
Such a news item that carries such weight, if it was true why would it be that
one paper would carry it. Not a side news but front page headline. I felt
disappointed really, I must be frank because a number of my friends locally and
internationally called me and were asking .So no iota of truth in that
publication and its quiet unfortunate coming from that stable. So we must
think. Even if we make mistakes we must be ready to accept our mistakes but it
should not happen. The constitution gives a specific room to media as partners
in governance process but every right I must say, every right has a commensurate
responsibility attached to it.
There is no right that is absolute, every right is
qualified and has responsibility attached to it even the right to health that
you are talking about. We have a righto health but if you continue to abuse
your health, through alcohol abuse or cigarette smoking and all that, I mean
nobody would but you would just be told these things are dangerous to your
health. But if you fail to do what is right, in terms of responsibility that
you have then there is a limit. So am saying that as much as we
appreciate and welcome journalist, media people as partners for good
governance, we need to be careful with what we push out and as you said in
regards to that first news going out there, a lot of people may not even get to
read the re-rejoinder, and they will just go on . It’s unfair we shouldn’t and
whoever wrote that story had the opportunity to cross check. I always say, the
basic principle of justice is to hear from the other side.
That’s the basic concept of justice so please I’m happy
that you are here by virtue of what you do as the Guardian of Human Rights. I
think our own right at the Ministry too has been violated through that
publication. That’s the truth it’s not fair, if we are wrong we would apologise
so i don’t know what the motive could have been but I must say that it is not
right. Then the other thing is that the current leadership in this Ministry
will engage you on regular basis so that you can have the opportunity to
issues that bothers you particularly that has to do with national interest
which we are all here to protect so we will have regular engagements as much as
time permits .
So that issues that have to do with health can be
discussed and you can have the position of the Ministry. That’s what we intend
to do and that would be established in due course. And finally is to say that
we have never claimed that we can do it alone as officials of the Federal
Ministry of Health so we welcome this partnership as much as possible we will
also try to be proactive so that we can all be on the same page on issues that
concerns health in our country.”
*Emmanuel Onwubiko heads HUMAN RIGHTS WRITERS
ASSOCIATION OF NIGERIA (HURIWA) and blogs @www.emmanuelonwubiko.com, www .huriwa.blogspot.com,www. thenigerianinsidernews.com.