The right to the highest attainable state of physical and mental health is one of the most fundamental of the human rights recognised in modern jurisprudence. Its link with the right to life makes it extremely important for respect, protection and fulfilment in line with state obligations under national and international laws. It is imperative to state that the inextricable link between the rights to life and health is demonstrated by the aphorism that the easiest way to deprive a person of his life is to deny them of health supporting conditions to the point of abrogation. Thus, an untreated malaria, typhoid or cholera, seemingly common ailments, can lead to the deprivation of the right to life; the right to life being the fulcrum upon which other rights revolve. Human rights consist of two words being “human” and “rights”. Take away the right to life (health which is human) and there will be no human left to enjoy the rights.
Nigeria’s health sector over the years has witnessed a myriad of challenges. These challenges include poor financing, inadequate number of health personnel per capita, poor support infrastructure, dearth of equipment, little or negligible investments in research, etc. All these lead to poor health outcomes and results and very limited availability of quality services. One of the most perverse of these challenges is funding. Government at all levels in Nigeria has not prioritised funding health care and with diminishing public resources, the funding has continued to decrease.
The state of our hospitals and health facilities was once described by some military adventurers as mere consulting clinics. That was over 30 years ago. Since then, things have further deteriorated leading to the challenge and difficulty in finding the right description for the state of our health facilities. The facilities to treat many common ailments seem to be lacking and where they are available, the human factor of managing and organising them seems not to be at its best. Medical personnel complain of being poorly paid and motivated; strikes come and go but they are merely suspended and not totally called off. Medical personnel find it difficult to give their full and best attention to patients and service users.
The outcome of the foregoing is that thousands of Nigerian doctors and other health professionals, trained locally, have left the country to seek greener pastures and to work in environments that have good and functional equipment to support health care delivery. Beyond making more money, the joy of a health professional knows no bound when he is able to save lives and he is saddened when lives are lost; not because of his incompetence or lack of knowledge but the fact that poor support equipment and infrastructure facilitated the deaths. Also, many Nigerians who can afford to pay for health services are voting with their feet, leaving the country in droves for medication in other countries. Political office holders attend hospitals outside our shores at the public expense while fairly well-to-do Nigerians and the middle class attend these offshore hospitals at their own expense thereby increasing their out-of-pocket expenditure for health. Thus, public confidence in the domestic health system is at the lowest ebb. By several accounts, According to Ebun Bamgboye, clinical director, St. Nicholas Hospital, Nigerians spend at least $1 billion every year for health and medical tourism abroad, thereby depleting the country’s scarce foreign exchange, putting undue pressure on the naira whilst denying the health sector of jobs that could have been done locally. The government also loses the tax that could have been paid by practitioners and hospitals who would have performed these health assignments locally. The spin-offs and connected economy of health/hospital support services also lose out in this equation.
Thus, with medical tourism, the economy and the right to health come under severe stress. Enter the Health Bank of Nigeria. The idea of a health bank is to deepen health financing and to provide funds for the health sector beyond budgetary allocations and money from the health insurance scheme. The bank is to focus on funding for the development of hospitals and other health institutions and their supporting infrastructure needs; human resources for health in terms of giving out student loans for the acquisition of rare and advanced competencies in the medical sciences; health infrastructure funding and for research on key tropical diseases and medical conditions prevalent in local epidemiological analysis, etc. It will sustainably fund the acquisition, maintenance and management of state of the art hospital equipment found in climes where Nigerians frequent for medical tourism.
The health bank will give out single digit interest loans or loans at rates below that which is available in money deposit banks. The loans will be long term in nature with a long period of amortisation. Thus, it is a development bank. Essentially, the bank will not be set up for profit but for the furtherance of the rights to life and health. However, it is not expected to be a loss-making enterprise. It should be self-sustaining and earn income and profits at a rate slightly below the prevailing market rate.The initial capital will be subscribed to by the Federal Government through the Central Bank of Nigeria and Ministry of Finance. Regional and international development banks such as the African Development Bank, the IMF and World Bank, etc. can also be called upon to subscribe to the share capital or provide soft long term loans for on-lending by the bank. Innovative ideas to raise funding for the bank will include specified transfers from the health insurance scheme after it has been made compulsory and universal, investment of one per cent of the profits of regular money deposit banks in the bank for a period of not more than five years from the date of its commencement.
There are similar models in the Bank of Industry and the funds for medium and small scale enterprises; the special funds set up by the Central Bank of Nigeria in agriculture, the bailouts for private companies, etc. However, the difference is that the health bank would learn from their challenges and devise strategies that make the business of health developmental. It will be run by experts and experienced personnel who understand their historic role in improving the health of fellow Nigerians.
If the health bank is established and run properly, coupled with improved budgetary allocation to the health sector, whilst health insurance is made compulsory and universal, there will be a pool of funds that will adequately take care of the physical and mental health of Nigerians. Well-equipped and functional hospitals paying competitive salaries will reverse the loss of the brain drain in the health sector. This will attract back Nigerian health practitioners who have left our shores. It will also reverse the foreign currency loss occasioned by medical tourism.
If we get our acts right, it may even open the way for us to become a medical tourism destination from our neighbours and other African countries.
Eze Onyekpere, Punchng.com