· Introduction
·
Factors driving
Nigeria contribution to medical tourism
in India
·
Traditional
medical practices in Nigeria
·
Nigeria cultural
practices and health
·
Some harmful
cultural practices in Nigeria
·
Traditional and
herbal health care in Nigeria
·
Reference
Health Theory and practice in Nigeria
Introduction
International health partners is a group of partners committed to
improving the health of citizens in developing countries. Partners work
together to put international principles for effective aid and development,
cooperation to practice in health sector. International health partnership began
on 5th September 2007 with 27 developing countries, government
partners, civil society, organization and non-state actors. Currently there are
59 signatories improving health. Health service is a complex task in any
country, it involves government health workers, civil society, parliamentarian
and other stake holders.
In developing countries money for
health comes from both domestic and external resources. This simple means that
government must also work with range of international development partners. International
health partnership mobilizes partners to support comprehensive country-led
health strategies in a well coo-ordinate way. Many principles were adopted and put
into practice in the health sector to bring about effective health delivery.
The international health combined these principles and put them into practice
in the health sector to encourage wide support for single national health plan,
evaluation monitoring with strong emphasis on partners holding each other to
account.
These principles aims to build
confidence between government, civil society, development partners and others
whose activities affect health.
The partners are increasing in
number using different funding streams and have diverse bureaucratic demands.
In
2005, Paris declaration on aid effectiveness set out Principles for making aid
more effective using GAVIS approach.
These
principles include:
1. Principle
of ownership: GAVI provides supports to expand Access to immunization plans.
This accessibility enable country to better plan and increase the value of the support.
2. Principle
of alignment GAVI providing support for countries own priorities asset out in
their national health and immunization plan.
3. Principle
of harmonization: By producing resources at the global level, GAVI also support
hamonization efforts through international health partnership, support working
with national health sector.
4. Principle
of mutual accountability and managing for result. GAVI brings together its
partners in the alliance board which hold all parties to account for their
respective responsibilities.
In 2011, the busan high level forum
on aid effectiveness came out with emphasis on considering domestic and
external resources together. The international health partnership put these various
principles into practice in health sectors and accelerate progress towards
millennium development goals.
IHP+ achieve results by mobilizing
national government agencies, civil society and others to support a single
country.-lead national health strategy or plan, a single monitoring and
evaluation framework and strong emphasis on partners holding each other to
account. IHP+ is about people and organization at local, national global levels
uniting for a healthier future.
The high patronage of Nigerians to
procure medical treatment in India and other developed countries speaks
eloquently of the decadence in the health care policy, governance contributions
to global medical tourism at the experience of developing local capacity and
knowledge to deliver quality and ever affordable health care to the Nigeria population?
Nigeria healthcare policy,
governance and practice could be classified as under developed rather than
decadent. Nigeria health policy since 1960 has remained statistic apart from
introduction of primary healthcare policy in the 1980’s and the Nigerian
national health insurance policy in 2005. Implementation of both policies have
been abysmally poor and so they have not made any impact.
Nigeria’s health governance since
independence remains the same. Government provides free or subsidized health
care in competition with private providers who charge money for health care.
There is no integrated health system that is all embracing where government and
private providers work in synergy as is done in many developed and developing
countries. In Nigeria, over 90% of common folk go to government hospitals for
free or highly subsidized medical care. How ever, statistics show that not more
than 10% of doctors practicing in Nigeria are employed by government. Free
healthy care is therefore unacceptably cumbersome. Patients may line up in a
government hospital from 9 am to 4 pm before they can see a doctor for
diagnosis and treatment. This is because there are many Patients and very few
doctors. There may be over 120 patients and only 2 or 3 doctors available to
see them. In contrast, doctors working at the surrounding private hospital may
be quite idle with very few Patients to see.
In our healthcare practice, Nigeria
is still in stage one healthcare development with practice characteristics of
the 19th or 20th century health system.
Stage one healthcare development is
characterized by highly fragmented delivery system with physicians hospitals
and other health care organizations functioning autonomously. Patients rely on
physician training and experience to make best decisions. Patients roll is
passive and they have no control over treatment decisions. Information
technology and tools are entirely absent.
Medical practice in many developed
and developing countries is now in stage 4 healthcare development which is the
health system of the 21st century. In stage 4 health care practice,
health care organizations have the characteristics of high performing
organization and focus on six aim for improvement; safety, effectiveness, Patients
centeredness, timeliness efficiency, equity.
Patients have as much control as
they want over treatment decisions and services are coordinated across practice
with generous use of information system. A lot of hard work will need to be
done to move our care system to stage 4. It will require training and retraining
of our medical practitioners, our nurses and other health workers, healthcare
administrators or and educating the populace. According to criteria stage 4
health practice, health care should be:
* Safe: Avoiding injuries to patients from the care
that is intended to
help them.
* Effective: Providing services based on scientific
knowledge to all who can benefit.
Patient-centred: Providing care that is respectful of and responsive
to
individual preferences, needs and value
Timely: Reducing waits and undue delays
Efficient: Avoiding waste of supplies, ideas, energy.
Equitable: Providing health services that does not vary in
quality because of
personal characteristics, gender, ethnicity or
socioeconomics status.
Our
health system should be geared toward meeting the above criteria.
FACTORS DRIVING NIGERIA’S CONTRIBUTION
TO MEDICAL TOURISM
The
1st factor is patients choice: Rightly or wrongly, going to India
has become a fad among Nigerians who can afford it. Even those who cannot
afford it beg for money. This is the nature of health seeking behaviour of
Nigerians today. All over the world, health seeking behaviour has not always
been rational or based on doctor’s advice. Booter and Bachuk in USA reported in
1972 that in United State of America, more patients tended to consult lay
persons in kin and friendship network than to consult medical person when about
to decide how to seek medical help and that they lay person tend to provide
advice based on their specific knowledge of bias.
In a study in Igun in Nigeria, most
persons sought the type of treatment they need for their illness usually on
advice of friends or neighbours. Social network therefore has a powerful
influence on health seeking behaviour and that is what is partly driving the
India fad. Many Nigerians believe India is place to for specialist treatment
and usually advise their friends or neighbours to do so.
The second is doctor factors: Many doctors in Nigeria needs re-training to upgrade
their practice from stage to the current 21st century stage 4 health
system. Many doctors should be taught to know when to refer patient to other
experts and where the experts are in Nigeria, some doctors refer directly to
India instead of Nigerian experts, partly because they do not know them and
partly because they are given generous incentives to do so by way of
commissions from the Indian hospitals. On the one hand, there may be probably more
Nigerian doctors practicing abroad than those working in the country, and we
have issues around inadequate knowledge and skill by practicing Nigerian
doctors in the country. It is true that more Nigeria doctors are practicing
abroad than those working in Nigeria. If all this Nigerian were to be working
in the country, many people from other countries in Africa would have been
coming to Nigeria on medical tourism. Many of these Nigerian doctors abroad
have world class knowledge and skills.
The answer is obvious, practice of
medicine is not rewarding in Nigeria. Most doctors employed in government
services are poorly paid and as a result of this, medical Professionals would
prefer displaying their talent abroad for better payment.
Equipment shortage: some has link the poor health services to equipment
shortage. Though this may be a contributory factors but equipment shortage is
not the problem in Nigeria. The weakest link in our medical system is
availability of skilled medical experts, and then give the experts the
equipment they need and pay then well.
At present, Nigeria governments and
Nigerians political elites have no respects for skilled Nigerian professionals
and little interest in training highly skilled medical experts for Nigerian
health system. They undervalue highly educated professions hence many of them
are out side Nigeria.
The various government (Federal,
State and Local) play a dominant role in health care provision in Nigeria. Since
they promise to provide free or subsidized health care fore the ordinary
Nigerians who cannot afford private clinics or hospital. These government are
therefore partly to blame for the state of health care in the country.
The near collapse of our healthcare
is as a result of poor financing of the free health care. The better option is
to have a health financing arrangement that takes care of every one. This can
be done with a credible health insurance system where all workers are covered
and self employed or unemployed persons covered by a community health insurance
system where people pay premium and government subsidizes the premium of those
who are poor and unemployed.
This will make health care a viable
business where both private providers and government institutions work in
synergy as partners. As at now, many state governors are not interested in the
national health insurance system and those who entertain the idea of community
health insurance want to run it themselves the way they are running their free
healthcare system. Health management organizations (HMO) drive the Nigeria
health insurance system in Nigeria.
Insurance is about pulling resources
of a larger number of people together to give a cover to those of them who
might be ill. By actuarial principles, the larger the number in a group the
smaller the viable premium each may pay. An individual who insures for N1,500 a
month may use up over N5,000 just one illness.
Continuing professional development and medical
education of Nigeria health professionals to keep abreast of current
development in medical practice are coupling necessities. As earlier pointed
only the weakest link in provision of quality health care in Nigeria is the
knowledge of practicing health professionals, and not necessarily availability
of sophisticated equipments.
Nigeria developmental finance from,
Nigeria operating 19th century health system by Mustapha Danes,
2012.
Traditional medicine practice
This is yet another type of health practice in Nigeria
apart from the orthodox medical practice. Nigeria is formulating a new health
policy to integrate traditional medicine practice into orthodox medicine
practice as a part of the strategies to scale up health care delivery in the
country. Government is working with the traditional medicine practitioners to
standardize the traditional medicine practice in the country. Government saw
the need to train this group on anatomy, physiology, pathology and therapeutics
for them to fit in into achieving effect health care system.
Nigerian Cultural Practices and Health
The cultural practices of a people not only affected
their health but also affect all their affairs including health and disease. Man
living in an interactive society is affected by what happens in his environment
and how he reacts to it. i.e, the deterrent and determinants of health and
disease in a community cannot be completed unless the cultural practices of the
people are considered. Many cultural practices have helped to perpetuate health
problems in Nigeria. However, not all cultural practices and beliefs in Nigeria
are bad. Many have and withstood centuries and actually promote health. But
there are some cultural practices which encourage disease prevalence and
propagation. Most of these negative practices are due to ignorance and
non-availability of better alternatives. Efforts should be made to encourage
those practices that promote health through provision of information and better
health care services.
Some of the Nigeria health practice
which promote health includes:
- The
common practice for mothers to breasted their children for a long time. It is a
good practice because breast milk is better then any other food a child can receive
within the first 6 months to one year.
- Also
the common practice in Igbo and eastern Nigeria for women who have just
delivered to be placed on special diet. This they believe helps the woman to
regain lost nutrient during pregnancy which is fact.
Sexual abstinence during lactation
is also widely practice among the Igbos because of the belief that a women is
not fully pure at this time. This practice helps in child spacing and family
planning.
Also among the Ibos, the Binis, the
Ijawse and several other ethnic groups in the southern Nigeria, it is a common
practice for people to Embark on wrestling combat when it is not farming
season. This promote physical activities and health.
Environmental Sanitation: This is practiced virtually in every Nigeria society.
Early morning sweeping of the house and compound by both men and women is
encouraged.
Some harmful cultural practices in
Nigeria
In the western part of the country,
it is common practice to use cow dung to clean umbilical cord. This is a dangerous
practice which infect the neonate cord and result to neonatal tetanus.
Also in typical Nigeria rural society children are
usually not given food like egg for fear of becoming a thief. This deprive
children the essential food they need and may lead to malnutrition disorder.
Female and male circumcision is practiced not only in
Nigeria but also in about 26 countries of Africa.
Scarification and tribal marks are practiced commonly
all over Nigeria especially in the southwest and northern Nigeria. This how
ever expose them to infections like tetanus etc if not done in clean
environment.
Traditional and herbal health care in
Nigeria: Contribution by Ndubusis S. Debe January 24/2011
Traditional medicine also known as indigenous medicine
and comprises of medical knowledge system that developed over generations
within various society before the era of modern medicine.
This
practices include: herbal, traditional Chinese medicine Islamic medicine,
acupuncture, Traditional African medicine etc.
WHO define traditional medicine as: “the health practices, approaches, knowledge and
beliefs incorporating plant, animal, mineral based medicines, spiritual
theories, Manuel techniques and exercise, applied singularly or in combination
to treat, diagnose and prevent illness or maintain well-being.
In some Asia and Africa countries,
up to 80% of the population beliefs on traditional medicine or practice for
their primary health care needs. When adopted outside of its traditional
culture, traditional machine is often called complimentary alternatives
medicine.
Nigerian people and even the
government have equally got the awareness of the role and need for alternative
means of health care for the people.
REFERENCES
Aid effectiveness: GAVI applies the principles and as
set out in pari declaration on AID effectiveness and the Accra for action –
Google.
Britain launches global health care plan for poor
countries ABC News (Australis) September 6 2007.
Brown launches global health plan: Associated press in
the Hindy, September 5, 2007.
Bobby Ramatant, September 11th 2007. Asian
Tribune International Health partnership to strengthen health system.
McCoy, David (2011) The HP+: A welcome initiative with
an uncertain feature. Global Health and development guiding principles.S
Ndubisi
S. Dube, 2011. Traditional and herbal health care in Nigeria.
Mustapha
Danes, 2012 Nigeria operation 19th century health system
Onyeabochukwu Duke Augustine. Cultural practices and
health: The Nigeria experience. Department of median and surgery university of
Nigeria Enugu Campus.
Principles
of international health-Google.
International
health partnership.
- IHP+
The international health partnership
- Global Health and development-about
the Alliance-GAVI Alliance
- Global health and development guiding
principles.