Healthcare and the Political Discourse

First the good news.

The federal Minister of Health just commissioned a fantastic new ₦100 million accident and emergency spill over ward, expanding the facilities at the Lagos University Teaching Hospital (LUTH).

Alas, the Minister went a step further to promise that pregnant women and children below five years would henceforth get free medical treatment in Nigeria. He assured his listeners that the federal government was providing the states with enough funds to make this happen.

Every one of our federal and state governments over the decades have made promises like this. The promise of uninterrupted electricity supply is perhaps the most famously repeated of them.

What we need in our political discourse is a mature discussion of what we are going to do, and of how we are going to do it.

The minister needs to tell us (a) how many pregnant women and children under five are treated in the hospitals every year; (b) how many are unable to go to hospitals, particularly in the severely under-served north-western and north-eastern parts of the country; (c) what it will cost to give them all free and accessible healthcare; and (d) how much money the federal government has given the states, so we can see if it matches the financial need thus established.

If the government does not give us this information, then university researcher should. We can't make decisions on things if we have nothing but empty rhetoric on which to decide.

Before you get on my case for "unnecessary negativity", read this story about healthcare in Benue State. The situation is not "good" in any part of the federal republic, but it is worse in some places than it is in others.

If we do not have the basic infrastructure of healthcare already set up, then even if we did allocate the necessary funding for "free" care to the states, there would be little or no capacity to put the funds to good use.

Adding the =N=100 million wing at LUTH is positive, but given the fact that we need to expand facilities and staffing all over the country before we can effectively start a "free" care programme, perhaps the Minister needs to handle that part of the equation first before promising something he knows he cannot deliver.

To be honest, the total budget (federal and state combined) for healthcare in Nigeria is TOO SMALL to expand facilities and staffing, or to pay for "free" care. And because our economy/GDP is too small relative to our population, and the combined federal and state budgets are consequently too small to fund public services for that population, I cannot see where the Minister is expecting to find the extra money for this.

Before you attack me for criticizing his "good intentions", remember that the paucity of funds has meant most "free" government programmes are never as "free" as advertized. The executives, ministers and technocrats usually continue using the word "free", even as the civil servants and administrators who actually deal directly with the public ensure that you cannot access the "free" service without paying one or other fee. It is not always about corruption; the doctors and nurses might insist on fees because their hospitals are under-funded and under-resourced to begin with, and would remain so even if you paid those fees.

Our political discourse is seriously limp. These are the sorts of issues that should be discussed aggresively.

There is always more than one side to an issue, and so long as we never debate which is the best way forward, we will continue to have sub-optimal outcomes.

I am still waiting for someone to ask whether it was wise to spend US$26 billion on cancelling our debt ($12 billion) and shoring up the value of the Naira ($14 billion between October, 2008 and April 2009), when our economy continues to suffer from a massive deficit in electricity generation.

Our debt-per-capita was never particularly large by global standards, but was only unmanageable because our GDP was too small (with effects on government revenues, and on broader societal welfare). With a bigger GDP, our required payments of $3 billion in interest would have been very manageable. But how do you grow your economy when you do not have sufficient electricity/energy/power?

Likewise a fall in the exchange value of the Naira relative to world currencies should have been a boon for export-oriented industries, if our economy was diversified and structured to take advantage of such opportunities. But our economy is incapable of taking such advantage, in large part because of structural weaknessess, perhaps the biggest of which is our MASSIVE ELECTRICITY DEFICIT! What the CBN saw in currency depreciation was a difficulty to IMPORT, and hence Professor Soludo poured billions into protecting the Naira.

There was a mini-Oil-Boom in the first decade of the 21st Century, a boomlet that expanded our currency reserves to over $60 billion. Of this sum, we have paid out $26 billion for debt cancellation and currency defense, only to find ourselves with a LOWER electricity output than we started with, and thus with less of an opportunity to defeat poverty and enshrine rapid growth.

I know it is not easy.

I am not saying I could have done better.

I am just saying our political discourse needs to improve, and our decision-making needs to be based on a higher quality of substantive information. We waste so much energy fighting each other over irrelevant rubbish, while important things just happened sub-optimally, with no one giving it much thought.