…Case for Specialised Medical Universities
By Prof Friday Okonofua
Continued from last week
Distinguished Guests, Ladies, and Gentlemen, the purposes of this memorial lecture are to first identify the major challenges in the delivery of comprehensive and high-quality health care services; and next share my firsthand experience of developing a non-traditional health sciences educational curriculum at UNIMED to address these challenges. In Nigeria, changing established dogmas and doctrines concerning the training of healthcare professionals is daunting and certainly not a tea party. As such, I will highlight in this presentation some of the difficulties experienced in this process, and also share what we have done to confront these challenges.
Prof. Friday Okonofua,
Challenges within Nigeria’s Health Care Delivery System
It is now well known that Nigeria has one of the most difficult and obstinate health care systems in the world. Not only does the country have extremely high rates of communicable and non-communicable diseases, but it also has some of the highest disease-related morbidity and mortality in the world. In 2001, the Health and Development Dialogue (Health Development Dialogue, 2001) described the Nigerian health care systems as “sick, very sick and in urgent need of intensive care¨. It is blind, lacking the vision of its goals and strategies; it is deaf, failing to respond to the cries of the sick and the dying; and it is impotent, seemingly incapable of doing things its neighbouring states have mastered.¨
Similarly, the World Health Organization summary index of performance of health systems released in 2000, placed Nigeria in the 187th position out of 191 countries surveyed, and described it as “dysfunctional, ineffective, under-capitalized, costly, and inaccessible.” (WHO, 2000). Since these periods, nothing substantial has changed. Our healthcare challenges continue to be compounded by the absence of coherent national health policy and health reform agenda, inadequate healthcare financing mechanisms and the lack of a political will for addressing the problems of ill-health and poverty in the country.
Not only are the numbers of healthcare professionals in the country clearly inadequate, but we are yet to chart a clear vision for the nation’s healthcare system. The challenges within the Nigerian healthcare system are too many to enumerate here, because of time limitation, but a short list will underscore the scope of the problem. The challenges include the following:
- Shortage and uneven distribution of manpower
- Disproportionate on cure of disease at the expense of preventive care
- Limited physical infrastructures and inequities in healthcare delivery
- Inadequate funding of healthcare
- High cost of medical equipment and pharmaceutical products
- Delay in the implementation of the national healthcare insurance scheme
- Endemic corruption within the system
- Incessant labor strikes and inter-professional conflicts
- Poorly developed emergency response system and
- Ineffective leadership at the Health Ministry
These challenges are too familiar, but they can be overcome with the right leadership and implementation of a dynamic medical education curriculum that is responsive to the problems within our healthcare system. The first medical school in Nigeria was established in 1948 at the University College, Ibadan, and it adopted the University of London medical curriculum, which subsequently was transplanted to the other newly created medical schools. For over six decades, no concerted effort has been made to align the contents of our medical curriculum with emerging global standards despite appeals from several quarters. Meanwhile, our healthcare system continues to crumble.
Unfortunately, healthcare professionals in Nigeria must share part of the blame for the failure to propel our healthcare system forward in dynamic ways to ensure sustainability, intra-and-interprofessional cohesion, commitment and increased funding for the health sector. Healthcare professionals in Nigeria usually think most of themselves and the benefits that may accrue to them rather than the broader and more comprehensive ways that will systematically improve the health sector. The failure to teach