Healthcare is paramount to improving productivity of the workforce.
The more healthy people are, the more they are enabled to participate in
economic activities. It is believed, thus, that Rochas Okorocha would
prioritize health policy reform within his economic agenda. 6 years
after being Governor of Imo state, what is Imo state’s healthcare
coverage policy? As someone with a penchant for naming all state
programs and reforms after himself, one is compelled to hear now of a
robust healthcare system in Imo state: ImoCare? RocheCare? NneomaCare?
Or FreedaCare?
Imo state’s healthcare system is not different from
other parts of Nigeria. Many issues over the years explain the lack of
quality and efficiency of the health sector in Nigeria. Most are plagued
by inadequate funding/financing models, weak governance and
enforcement, poor service quality and inadequate infrastructure.
In
other cases, household poverty and insufficient risk pooling contribute
to this pool of healthcare system inefficiencies. Others include a
highly inefficient and declining workforce owing to brain drain and
disparate wages among the workforce or even poor quality of health
staff.
In public or general hospitals, long queues, preferential
treatments and high-handedness of the few qualified medical personnel
are daily experiences of Nigerians. To compound these, it has taken
years to pass a national health policy that has not found proper
implementation.
Given these factors, Okorocha’s campaign promises for robust health
programs in Imo state were a welcome development. “Free Health For all”
“New Hospitals” projects were declared to fanfare and pomp.
Promised
basic health services include the treatment of aged citizens at no
cost, and the improvement of medicated services in the state. In most
states, these promises does not address the underlying problems of
healthcare system in Nigeria, stated above.
In Imo state, Okorocha
promised the upgrading of facilities and the considerable improvement
in basic medical services rendered by the general hospitals. Imo state,
however, like so most states in Nigeria, has no specific health policy,
besides the generic offers noticeable among all APC states.
In all
Local governments surveyed, the feedback from respondents posed the
same verdict: that healthcare services in the General Hospitals have
declined, with lack of sophistication of equipment, and expensive
out-patient services for citizens. Respondents also declared that “no
noticeable improvement in the employment of quality workforce or rapid
standardization of general hospitals” Some of these were confirmed on
visits to the Local governments.
Many pregnant and feeding mothers
complained bitterly of the quality of service and also of expenses
incurred during pre-natal check-up and diagnosis. In many cases, these
necessitated the decision to patronize private sector hospitals, leading
to an increase in out-of-pocket expenditure. This is worse when the
lack of consistency in salaries of public servants (who make up the
bulge of employment) in Imo state is added to the mix.
Rochas Okorocha, like many other governors in Nigeria, has no
specific policy objective for initiating “health programs” in Imo State.
Many General Hospitals visited are in dire shape years after Rochas’
election. Most users complain of little or no difference between
services offered and no difference in pricing for health services.
For
the gullible public, this strategy of “movement without motion” never
fails. Roads that lead nowehere, white elephant and phantom programs
that serve no specific economic purpose. It worked, and still works, in
Imo state.
Okorocha’s crave for political visibility is not lost
on the astute. His construction ventures in Imo must be portrayed as
“doing something”; construct buildings around the state, even if they
cannot be completed or if they are not viable. In 2014, Okorocha’s
establishment of new hospitals are not informed by any data but the
brash urge to throw money at problems.
Without any information on
revenue, or how new hospital projects will be funded, Okorocha announced
the construction of new hospitals across all the local governments;
whereas existing general hospitals have no access to basic clean water,
consistent energy, and an acute shortage of medical personnel.
Rochas
Okorocha started the construction of these new “world class” hospitals
in 2014. Many respondents saw it as a calculated move towards the 2015
election towards winning electoral votes within the state. These
hospitals were promised to begin functional services by 2015 January and
were constructed across the 27 local governments in the state. Till
date, none of the visited hospitals have been completed since 2014 when
their constructions started.
The decisions underlying these new hospitals are impractical,
wasteful, and are not based on sound policy qualities (e.g. technical
efficiency, equitable distribution of health welfare or allocative
efficiency). With high poverty, inconsistent wages, and an over-burdened
public health system, many Imo citizen are paying for their healthcare
in private hospitals at a high cost.
This is the summarized feedback from our visit around the state (all of them are not completed, unequipped, and abandoned):
– General Hospital Aboh Mbaise (Serving 3 LGAs)
– Njaba LGA (No Equipment, No Gate, Not Opened, Rusty, Bushes all over)
– Orlu LGA (No Equipment, No Gate, Not Opened, Rusty, Bushes all over)
– Nkewrre LGA (No Equipment, No Gate, Not Opened, Rusty, Bushes all over)
– A “joint” Hospital in Nwagele LGA being run by the Catholic Church, serving about 3 LGAs
– A “joint” Hospital in Isiala Mbano LGA being run by the Catholic Church, serving about 2 LGAs
– Ahiazu LGA (No Equipment, No Gate, Not Opened, Rusty, Bushes all over)
– Ikeduru LGA (No Equipment, Bushes all over and locked up)
– Mbaitoli LGA has NO General Hospital
– In Ahiazu LGA, The main General Hospital was demolished for a “Timber
Market” while the new hospital remains abandoned with rusty walls and
bushy environment.
Like other states, the main financial model for healthcare coverage
in Imo state is on out-of-pocket fees. The loss in social welfare owing
to the construction of these new but incomplete and unequipped
facilities have huge implications. If completed, perhaps a
community-based healthcare insurance partly funded by the state and
supplemented by citizens would have been a beautiful model worthy of
emulation. This will increase access, affordability (equity) and improve
quality (efficiency)
Naturally, Okorocha, like many other state
governors, are in that crucial position to lead sustainable development
projects that enrich future generation and not rob them. In fact, the
solid performance of many state governors would naturally reinforce the
need to implement decentralization as promised in the constitution. Not
so!
As
someone who does not believe in social or political accountability,
Okorocha’s health policy in Imo state has been, at best, vague. Given
limited resources, what is the policy criteria (efficiency or equity)
for setting up 27 new general hospitals? Who is designing them? Who is
building them? Who is funding them? Who will operate them? Would
upgrading the available ones be a more reasonable option? Is there
enough data available to justify the construction of new hospitals? Are
the services going to be subsidized? How will it be sustained? What is
the financing model?
Okorocha’s policies does not state how
efficient or sustainable the citing of 27 new general hospitals are.
What are these hospitals intended for: primary healthcare or specialist
centres? Who is the primary care provider: Government or Private sector?
How will they be sustained? Even when completed, what is the model of
running these 27 new hospitals? Are they built for private-sector
operations while the state at as regulator?
Like
most of his policy programs, the underlying guidelines for Okorocha’s
policy programs are not to correct inefficiencies, redistribute wealth,
provide jobs for the people, or advance welfare, or equitable benefit
distribution. In a nation where medical tourism account for about USD
$1billion, Okorocha’s hospitals and health reforms, and healthcare
policy would have been a shining example of how to design and implement
healthcare reform in Nigeria.
By indulging in repeated half-baked
and poor quality construction around the state, Okorocha’s
administration is robbing the state in terms of quality of work,
resources and effort. This is because most of these buildings have been
constructed without transparency, nor were the projects carried out by
due bidding or due process. Worse still, with limited state resources,
these projects are not completed.
Mr
Okorocha has wasted state taxpayers fund having spent hundreds of
millions constructing his “giant” but empty health centres across the
state with none duly completed (except the Airforce centre along Owerri
North). In short, Mr Okorocha’s health policies have been half hearted,
and mostly have been detrimental to hundreds of thousands of Imo
citizens.
A perfectly designed healthcare system with a carefully
crafted (equitable or efficient) policy would have shown and signalled
the seriousness of one Nigerian governor with the heart and will to
implement healthcare reform in Nigeria. At best, it would have projected
Okorocha as a forthright forward thinking beacon of hope in Nigeria,
especially given his ridiculous presidential ambition. An incapacitated
but honest president is much better than a brazenly corrupt and
incompetent Okorocha.
– Bamikole Adeleye is currently in Imo State on his Eastern Nigeria Governance Tour.
