Unfortunately, the health sector is among the least scrutinised for financial mismanagement in Nigeria. Maureen Lewis, a non-resident fellow at the Centre for Global Development, wrote a comprehensive brief on healthcare corruption and governance woes in developing countries. While his paper touched on many key issues, corruption in the Nigerian health sector has several peculiarities which need addressing.
Since the current administration has been living up to its anti-corruption brand, it would do a great service to the Nigerian people by designing sustainable systems which can significantly reduce corruption in the health sector.
Rather than merely increase hospital funding simply because it is easier to accept the logic that greater health funding is necessary, the Buhari government should focus more on curbing and checking corruption while improving efficiency of the current structure. Some of the key elements of corruption in the Nigerian healthcare industry are summarised in subsequent paragraphs.
Why are even “common” medications out of stock in pharmacy departments of public hospitals? Contrary to the principles of pharmaceutical needs assessment, hospital management –without the know-how or due to bribery and kickbacks- award supply contracts of drugs in quantities and mix which do not reflect the spectrum of diseases and conditions being managed and the demography of patrons in the health facility.
Apart from shrinkages due to lack of inventory automation, the hospital management often mismanage the statutory Drug Revolving Fund that is supposed to be used for the procurement of essential drugs for patients. Pharmaceutical suppliers refuse to release more drugs because of a backlog of debt the hospital owes them. Also, cases of shady and shabby procurements of medical equipment are rife. The government is billed the cost of new and latest equipment, while hospital management procure used and out-dated equipment. Go to the back end of the hospital to see theft of diesel and petrol meant to power intensive care unit, theatres, radiology department etc., thus inflating the running cost of the hospital.
It is not unusual to find that several cases of resident doctors’ strike are due to their allowances/salaries being embezzled or denied by sitting medical directors. How can we hope to grow a sustainable and efficient healthcare system when health ministers, directors of departments and agencies as well as those involved in the execution of various health projects (vaccines, malaria control, etc.) help themselves to a significant percentage of budgetary allocation and contracts –and even helping themselves to funds donated by international health agencies such as UNICEF, WHO, PEPFAR, GAVI etc.? Indeed, development assistance for health has become a big opportunity for our health authorities and cronies to enrich themselves.
Similarly, Nigerian volunteers who traveled to Liberia to help fight Ebola complained upon their return that the Director General of the Nigerian Centre for Disease Control Professor Abdulsalami Nasidi embezzled the 28 million naira which was supposed to be disbursed to them as their welfare package. Recently, concerned individuals have blown whistle that the billions of naira donated to fight the short-lived Ebola crisis in Nigeria last year was misappropriated by the Rapid Response chief of the Federal Ministry of Health. Moreover, Nigerians need to know that the power tussle between the NMA and JOHESU has its roots in corrupt use of money and abuse of the privileges of office by health authorities such that JOHESU desires more stake in the power arrangement.
Cases of embezzlements and maladministration of hospital funds and materials, foreign health assistance on HIV/AIDS, tuberculosis, malaria etc. are rife and abound in the newspapers.
Early in March 2014 during the Presidential Summit on Universal Health Coverage, the newly appointed Executive Secretary of National Health Insurance Scheme (NHIS), Dr Femi Thomas said he had uncovered 100,000 fake patients on the NHIS scheme.
Early in his administration in 2011, the governor of Oyo State (South Western Nigeria) Senator Abiola Ajimobi was reportedly shocked on uncovering the number of ghost doctors, nurses etc. on the state pay roll.
Also, in the course of writing this article, a medical officer working in one of the public hospitals in Nasarawa reported signing against the name of a ghost worker who earns more than double the salary he is paid on the payroll. The hospital management are usually privy to such sharp practices, leaking public funds to their insatiable private pockets. Yet same hospitals lack the most basic items such as cannular, gloves, needles & syringes etc. would often lament it does not have enough health professionals when the huge amount of money they embezzle every month is enough to recruit additional health workforce and re-stock the hospitals.
If all the three tiers of government (federal, state and local governments) should take a stringent stock and an investigative audit of members of staff, the number of ghost workers as well as those who illegally collect triple (and more) salaries will be frightening. Such exercise and system cleansing can potentially help the government recruit more health professionals and free more funds for significantly improved healthcare delivery even at the current rate of spending. And such system audit should be carried out.
One way is to ensure that those to be appointed as medical directors are competent and do not have not pay their way into the office with huge sums of money. Also, central professing and payment of salaries initiated by the Jonathan administration must be sustained and applied to all health workers on the pay roll of the federal government without exception.