Clinical Governance - HEALTH CANNOT BE LIKE ‘CASH & CARRY’ BUSINESS – NEVER WORKS LIKE THAT!! - Health Resource International West Africa (HRI)


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Wednesday, 5 July 2017


Dear All,


HEALTH CANNOT BE LIKE ‘CASH & CARRY’ BUSINESS – NEVER WORKS LIKE THAT and we have had to say that to Governors and Health Planners! The evidence is abundant in the
performance and outcome in countries that have a social safety net and underpin it with Universal Health Coverage (UHC) that guarantees that every citizen has health care at the point and time of need irrespective of whether they can pay / or have the money there and then. These countries are many the UK, all of Western Europe, Australia, Canada, Japan. 
Notice that the exception is the richest country in the world and which spends the most on health and is not in the list: that is America. And the reason is simple America treats Health like a business which is why it is the only G7 country without Universal Health Coverage. And see the upheaval in America’s health system.

Source:‘Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally’

Inspite of the socio-economic challenges of Nigeria, for some reason that is still not clear, and inspite of all the external evidence, some Nigerians want to copy the American system, including some health professionals and planners. 

Ofcourse, 'there is no free lunch', therefore health care has to be paid for, but illness should not be a cause of poverty, rather because everyone needs care at some point in their lifetime, and no one can predict when that will be or the severity of it, or how it will come, the countries that have achieved UHC devised a system that ensures that every citizen can receive health care when they need it: these countries do it by mandatory health insurance without middle men/companies whose sole aim is profit for shareholders. The insurance service pays the provider directly because in those countries every citizen is covered. When a citizen falls ill or needs elective care they approach a provider who delivers the care and claims payment from the National Insurance service. No middle man whose only objective is profit making for his / her shareholders!. This is not rocket science and does not need re-inventing. It only needs the Political Will and Courage to establish. And the expertise for doing so is abundant in Nigeria.

Private health care can be run as a business, 'cash and carry' but not Government / Public health system. Government health system is run as a not for profit ‘business’ so that the money collected from various sources including the pre paid insurance, special levy on some consumer items like tobacco and alcohol, mega industries like Mobile phone companies, oil & gas, etc is used to deliver care under a UHC provision and re-cycled into the health system and not huttled away into shareholders dividends!. This is easy to do, once there is political will and courage.

Imagine how difficult President Trump is finding it to ‘repeal & replace’ Obamacre which was a genuine effort towards giving Americans UHC, even though his Party controls the Congress and the White House. The Republicans in the same Party as the President have stalled his efforts until they can produce something better than or equal to the benefits of Obamacare: Political Will and courage in action. Putting the health of Americans first!.

Recently the Nigeria House of Representatives held a public hearing on the NHIS – our fingers remain crossed in the hope that they will do the right thing: put the interest of all Nigerians first, including themselves. Every human being shall need care sometime / some more than once. If there is no UHC, no matter how rich or priviledged the person , he/she cannot dictate how or when that time will be!!.

There are good reasons why in the countries that have achieved UHC ( and surprisingly in America as well) individual health practitioners do not establish hospitals – simply because it cannot be run like a profit making business 'cash and carry' supermarket or fast food outlet! In these countries Government delivers UHC but Big business/companies set up private hospitals where health professionals deliver care to patients who are covered by insurance!. It is good for patients, good for the professionals who can practice ethical, patient centred care, and good for government / and business!. Everybody is a winner!!.

These are the countries that give Aid to Nigeria’s health system to survive. If they ran their own health systems as ‘cash & carry’ business, we wonder if they would give Nigeria and other LMICs Aid!.

Nigerian's solution to funding UHC is in running an effective and efficient National Health Insurance scheme, mandatory to all who can pay and supplemented by other special levies, making provision to cover those groups who cannot pay. The more it is delayed the longer its poor health indices will continue.

Joseph Ana.

Africa Center for Clin Gov Research & Patient Safety
@ HRI West Africa Group - HRI WA
Consultants in Clinical Governance Implementation
Publisher: Health and Medical Journals 
8 Amaku Street Housing Estate, Calabar
Cross River State, Nigeria
Phone No. +234 (0) 8063600642

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