By Eze Onyekpere
It is a fundamental aphorism that leadership and governance are critical factors for the success of any organisation, institution, entity and sector. The health sector is not exempted from this aphorism. The leader leads, sets direction, is instrumental to policy formulation and implementation, and his behavior, attitude and responses to challenges set the direction of institutional governance. In democratic settings, leaders, including presidents and governor,s are elected and derive all their powers and authorities from the people, who are deemed to hold sovereign power. Appointments by the president or governor into different positions are legitimised through the initial mandate given to the office holder.
During electoral campaigns, candidates for leadership propose ideas, strategies and methodologies for realising different components of societal goals, resolving social conflicts and addressing the developmental priorities of the people. One of such priorities is healthcare. They sell themselves to the electorates as having a stake in their affairs; essentially, candidates state that they are stakeholders in the developmental process. In the health sector, the president, governors, ministers, directors-general, executive secretaries, etc. propose that they are part and parcel of our health experience; that what concerns us concerns them; and that they propose to lead us in accordance with fit and good practices and under the rule of law. The health sector, like any other sector, is guided by various national, regional and international laws, policies and standards; hence the rule of law is central to the management and improvement of the sector and the improvement of our health indicators. Thus, the leader as a stakeholder is a minimum requirement for the leadership of the health sector.
The Cambridge Dictionary defines a stakeholder as a person or group of people who own shares in a business; a person such as an employee, customer, or citizen who is involved with an organisation, society, etc. and therefore has responsibilities towards it and an interest in its success. The last part of having an interest in the success of the sector is interesting, as well as intriguing. It means in fact that the leader would normally use the same health facilities available to the people, would do everything possible to improve services and standards, etc. In accordance with the presidential oath, public officials are to discharge their duties to the best of their abilities, faithfully and in accordance with the Constitution of the Federal Republic of Nigeria and the law. The legal angle brings to the fore one of the central challenges in the Nigerian health sector. It is the challenge of due and undue medical tourism. It is estimated that Nigerians spend over $1billion on medical tourism every year.
It is imperative that Nigerians should know that one of the goals of Nigeria’s health policy is to discourage medical tourism, as it seeks to build local capacity for the management of almost every ailment. Discouraging medical tourism starts from expenditures derivable from the public treasury. The National Health Act states in section 46 that: “Without prejudice to the right of any Nigerian to seek medical check-up, investigation or treatment anywhere within and outside Nigeria, no public officer of the Government of the Federation or any part thereof shall be sponsored for medical check-up, investigation or treatment abroad at public expense except in exceptional cases on the recommendation and referral by the medical board and which recommendation or referral shall be dully approved by the Minister or the Commissioner as the case may be”. The jury is out on whether this provision is followed in practical terms, as it seems that most of our laws are obeyed in the breach.
The disadvantages of our leaders running to foreign hospitals to manage their ailments are legion. The first is that by unduly seeking medical treatment abroad, especially without following due process as stated in the National Health Act, the leadership removes itself from holding a stake in the Nigerian health sector. Getting good treatment for this crop of leaders is no longer subject to the quantity and quality of prevalent services in Nigeria. And as a human being, with a natural inclination to selfishness, the drive and urge to improve the system for the bulk of the population will be reduced. Any claim to being a stakeholder by such leadership will be anchored simply on the fact of the position they occupy. Thus, the stake held is a retrogressive stake which seeks to draw back, rather than being a dynamic relationship that improves the beneficiaries. It is therefore asserted that no one should lead a sector that he has no stake in.
The second disadvantage, which is the direct result of this leadership attitude, is that the health sector will be perennially underdeveloped since the individuals who are supposed to take action for its development will have no interest in taking targeted and concerted steps for its development. Thus, the state obligations to respect, protect and fulfill the right to health will be left in limbo. These obligations are contextually and geographically bound within the territory of the state – where the rights of the majority are to be realised. The third disadvantage is that unduly seeking medical treatment abroad fritters away the available but scarce foreign exchange and puts more pressure on the naira. This is most regrettable when public funds are involved. Such an exercise cannot in any way amount to the dedication of the maximum of available resources for the progressive realisation of the right to health.
The fourth disadvantage is that it creates jobs and economic opportunities in the countries of destination. The doctors treating Nigerian public officers will be paid handsome fees, while Nigerian medical personnel remain poorly paid. The earnings of these medical personnel will be taxed by their governments and this increases public revenue to be deployed for the common good of these countries, while the Nigerian public purse continues to diminish. The fifth disadvantage is that as a people left behind in time and space, we are delaying the start of our “meet up or leap frog race” and the longer the wait, the more the idea of meeting up begins to solidify into impossibility. The earlier the race starts, the better.
In conclusion, it has become pertinent for stakeholder-leaders to emerge in all sectors of Nigeria’s economic and social life, especially in health care. Our hospitals, health institutions and the services they render will automatically improve the day our president, minister of health, other ministers, permanent secretaries, members of National Assembly, judicial officers, etc. begin to fully patronise our local hospitals without the option of running abroad.
Eze Onyekpere is the lead director at Centre for Social Justice.