By Cosmas Omegoh
Opposition has continued to mount against the Federal Government’s proposed concessioning of 22 Teaching Hospitals across the country.
Some people see the idea as a clear attempt to deny the people healthcare services, wondering what will remain if the Teaching Hospitals are sold.
The idea from the beginning
Sunday Sun learnt that the Nigerian Medical Association (NMA) had tried to convince the Federal Government to run the Teaching Hospitals as commercial entities since they are being run with insufficient funds to make them viable.
On August 1, 2022, for instance, NMA President, Dr Uche Ojinma, reinforced the proposal.
While speaking to News Agency of Nigeria (NAN), he recalled that the idea had been on for over the past seven years.
He said: “As far back as 2014, we wrote a compendium on how to fix these Teaching Hospitals and public hospitals and there are two options if the government wants to fund it properly.
“We can go for graded privatisation where they sell 51 per cent of the shares. Of course, they should fix it up a bit so that it could fetch some money.
“They get a core investor or sell 51 per cent of the shares to the core investor; if the government does not want to leave totally, it can keep a certain percentage, maybe 30 per cent so that with that they can still moderate the price so that we don’t go for full gains to the detriment of the people.
“Then the remaining 19 per cent should be sold to the workers to retain the hospital so that they know they have a stake in this business and they will give their all so that is not all about salary.
“So, if you privatise these hospitals and you channel the money you would have budgeted for them every year for the next five years into the National Health Insurance Authority (NHIA) to capture more people under that, it will make it easier for them to assess those hospitals.
“With this, it will be easier for the people to get treatment and if you do that and personnel are well paid, everybody knows you are here to do your job; the major shareholder can decide that he wants to buy automated equipment, you cannot stop him.
“However, as it stands today, in Nigeria right now, the way we are running it, healthcare delivery is a social service and not a profit service.”
Labour against idea
Right from when the idea was mooted, labour unions had rejected it, insisting that they would do everything they could to make it stillborn.
According to the Trade Union Congress (TUC) President, Mr Festus Osifo: “As TUC, we take a complete exception to this.
“The NEC of TUC frowns at this because the privatisation that was done in the past, where has it led us to? Nothing meaningful has ever come out from the previous privatisation processes, especially the power sector.”
Similarly, the Nigeria Labour Congress (NLC) has expressed its own contempt for the idea.
“We debunk the lies being persistently told to Nigerians and the master profiteers of privatisation that the government lacks resources to modernise the health sector and provide quality healthcare service to Nigerians. This can only be a ploy to further exploit Nigerians while increasing the wealth of a few.
“Indeed, this fact of government capacity to fund the health sector is further provided by the National Bureau of Statistics. In its 2020 report on social statistics in Nigeria, the NBS said about $32.1 million and N179 billion were recovered from stolen public funds between 2017 and 2019. Between 2020 and 2022, more than N200 billion have been stolen and all these publicised thefts are a fraction of the leakage that is daily going on in the oil and gas sectors.
“On the challenge of paucity of funds which incidentally is not peculiar to the health sector alone, the government needs to be sincere, willing, and decisive in addressing corruption and leakages in the system,” it said.
Health key to social service
According to the NLC, “health and education are critical human resources that facilitate development and their performance is a key indicator of a responsive and responsible government that is accountable to its citizens.”
The NLC in a memo it sent to the Committee on National Health Reform signed by its President, Comrade Ayuba Wabba, reminded the government that “we are of the strong conviction that human beings are at the centre of whatever makes meaning to life, and must, therefore, be the core consideration of policies and action to which they are beneficiaries.
“This means that changes or development of policies and programmes that are expected to be beneficial to people must undergo critical impact analysis such that it leads to a progressive outcome rather than a tendency to further deepen the social inequality divide and poverty.”
It further noted in its memorandum that “with much appreciation of the desire to make health services accessible and available to all, we are concerned that the timing of the plan for the implementation of a new health sector reform programme for the country comes at a time when the current administration has less than eight months to conclude and bearing in mind the legislative and administrative process that is required to conclude any policy that must pass through universal standard test.
“The possibility to rush through the process before the expiration of the current government will very likely exclude key stakeholders consultation and impact analysis as is evidenced in the gap from the terms of reference and the poor stakeholder consultation.”
In the meantime, health sector unions among them the Medical and Health Workers Union have separately condemned the concessioning idea.
Speaking to Sunday Sun, Comrade Auwalu Kiyawa Yusuf, general-secretary, Medical and Health Workers Union said: “Our reaction is completely not in favour of this government initiative, and we will do what we can to see that it doesn’t see the light of the day.
“In an attempt to do that, we have made our position known in the Memorandum of Understanding we submitted to the Federal Government committee headed by Vice President, Prof Yemi Osinbajo. We made it very clear that we will never allow that to happen.”
He refused to comment on how the proposed privatisation would affect his members, preferring to say: “To be candid, we are not even praying that it gets to that stage. That is why we will ensure that that the proposal doesn’t go too far.
“How can the government be scheming to privatise the health institutions which are the only thing the common man is benefiting from this present government? We get the feeling that assessing health services might soon be a story to the common man in this country.”
He cited the situation at General Hospital Gwagwalada, saying that is what to expect in the coming days.
“The other time, there was this partial concessioning of the General Hospital Gwagwalada. I can tell you that those who are visiting the facility for a case as simple as malaria fever now pay nothing less than N50,000. So what will happen when the facility is fully privatised? It will not only be out of reach for the common man, but well-meaning Nigerians.”
Health services and government
Comrade Yusuf questioned the existence of the government if it does not provide health care service to the people at the tertiary level.
“The basic role of the government,” he said “is to provide social service such as healthcare, education among others.
“If they go ahead to private healthcare facilities, it means that healthcare delivery will be zero to the common man. We should not be praying to get to that stage; we will insist we don’t get there.”
A social commentator, Tajudeen Olawale, condemned the government for considering the concessioning idea at all.
“What is left now is for them to charge us for the air we breathe.
“If they take away healthcare services, what else is left; what will be the role of government then?”
A lawyer, Chief Goddy Uwazuruike, described healthcare as a “social service, a “social contract and an essential part of government service,” warning that “it must never, never be commercialed.
“If it is commercialised it will never be for everybody. That is why if an individual does not pay, a government hospital cannot turn him away.
“So when healthcare is privatised, the essence of hospital providing social services is gone. That is why it is shocking that anyone is looking in that direction.”
He warned: “When health services are taken away, the government will create a social disconnect.
“It is a disaster socially to take away health service from the populace. That is why there is an ambulance; when a sick person is taken in an ambulance the government pays. An ambulance is a primary part of that social service. No one will tell you to pay before you are taken into government ambulance. When one is asked to pay, it is no longer a hospital service.”
Asked whether anywhere overseas, government commercialises health service he said: “Not to my knowledge, even in USA that is the most capitalist of all countries.
“That is why when a anything happens, you call an ambulance and it rushes in. It is the state that pays for the service. Even a homeless man who has no address is still entitled to an ambulance service. You cannot tell him to pay first before he is carried into an ambulance. That is why an ambulance is a major symbol of that social service.
What the proposal tells everyone
Chief Uwazuruike said that the proposal is a clear sign of stress and failure. Hear him. “It tells us about failure of government. Any government that fails to offer social service in health has really failed.”
How govt can improve healthcare
In Comrade Yusuf’s view, rather than comercialising the institutions, the government should consider improving the primary healthcare delivery system. “If we have that, I can assure you that over 60 per cent of the cases going to the middle level and tertiary health institutions will be taken care of by the primary healthcare system.
“If you go to the tertiary healthcare facilities, over 50 per cent of those admitted are cases of malaria and typhoid fevers. These are cases that ought to be treated at the primary level.”
He wants the government to improve its yearly budgetary allocation to the health system saying: “If you take a look at the previous years, the health sector was given almost 20 per cent of the allocation. In some countries, health is given almost 40 per cent of government budget. So, government must do this.”