Events in Health Care

I have posted substantively in a while.

The University of Benin Teaching Hospital performed the first stem cell transplant in Nigeria. The patient was a 7-year old with sickle cell anaemia, and the donor was his 14-year-old brother.

This is wonderful news, and I wish the child a full and complete recovery.

The cost of the surgery seems rather prohibitive for most Nigerian families. I like the underlying idea behind the newish the National Health Insurance Scheme, though it comes with the usual problems with government bureaucracy and the usual unclear policy direction. It is not likely to have the resources to support even a basic level of healthcare for the majority of Nigerians, but it is a platform from which a this level of care for the majority of Nigerian citizens.

Lagos State has its own public Health Insurance scheme. It began with a pilot project back in 2008 which has been since been expanded . The Lagos State government nevertheless admits the reach of the scheme will be far from universal, given that the majority of the state's population is in low-income, "informal" employment not covered by the scheme

Having said that, we have to think carefully about how to advance these programmes and in what direction. I am not being cynical. Let me explain myself.

There is this thing we do in Nigeria and in Africa. If we see that Europe is rich and has a European Union, we rename our non-functioning continental organization "African Union". If Europeans create a single currency called "euro", we start advocating a single African currency called "afro". If Europe switches from three continental club championships (Champions Cup, Cup Winners Cup and UEFA Cup) to two continental club championships, we follow suit, and we copy the names they use.

Rather than think about what works for us, we have become shallow mimics of what we see other people doing, creating an endless series of facades designed to look like something without actually being that thing -- and I say this without delving into the question of whether the things we are mimicking are relevant to Nigeria/Africa in the first place.

Coming closer to home, the USA has an FBI, so Nigeria creates an FIIB. The USA has an FDA, so Nigeria creates a NAFDAC. Ex-dictator Ibrahim Babangida named his two artificial political parties the Social Democratic Party and National Republican Convention, which were alleged to lean a little to the left and right respectively, like the USA's Democratic and Republican parties.

So here is my problem. Changing the name of the "Organization of African Unity" to "African Union" and mimicking all the unnecessary institutional structures of the European Unions has not in any way, shape or form advanced the continent's strategic interests. I could say the same thing for the other mimicries.

I get the impression that the inspiration behind our relatively new National Health Insurance Scheme (NHIS) was the United Kingdom's NHS. I worry that an official or politician, desiring to seem like he was doing something about the issue, just created a new agency/bureaucracy with a name that he or she is familiar with from his or her days as a student in the UK.

This is not to say that it cannot be made to be successful, but that I am not aware of any national debate on what our public health insurance scheme should be, who should or shouldn't be covered by it, what should or shouldn't be covered by it, should it be state-based or federal or both (and if both, who handles what), and most importantly of all, how we should fund it long-term.

I do not think a Nigerian "NHIS" would succeed in the short-, medium- or long-term if it is designed to be a simulacrum of the British "NHS", but that is a conversation/argument to have if and when our country actually gets around to deciding properly how to handle it.

To be honest, those countries that have generous welfare states have never really been able to afford it, regardless of what their politicians have told them over the decades. The conditions that allowed them to act uneconomically are coming to an end and will probably never return.

This something no one really thinks about. When Imo State Governor Rochas Okorocha announced a scheme to begin making stipend payments to schoolchildren in Imo State, he was roundly praised. I am too lazy right now to find the links, but I do believe Okorocha has either implemented or is planning to implement free healthcare and free education up to secondary school.

These popular and populist measures always earn politicians praise as "achievers" and "action governors" who have "pro-people" policies. Nobody pays much attention to the fact that the state's public debt starts to sharply rise, that spending on other vital areas (like roads, particularly in the Southeast) get squeezed or wiped out, or that projects begin with great fanfare but are then abandoned because funds run out.

Understand me. I am not saying this is a bad thing per se. Brazil's Bolsa Familia has not only raised living standards, but has kept a lot of children in school who would otherwise have dropped out (something Imo State has to worry about). But on the other hand, Brazil is a subcontinental country with the world's 10th largest GDP and is fast rising higher up the GDP list (it will overtake the United Kingdom in the near future). Where Brazil's richest state, Sao Paolo, has a bigger GDP than all of Nigeria, Imo State is not even Nigeria's richest state....

.... and most of our 36 states are already committing a problematic proportion of their revenues to servicing ever-growing (and unmonitored) debts.

Improving social welfare in Nigeria will be a complex task that involves balancing what we want to do against what we can do.

Unfortunately, there is not much debate about this in our federal republic. I keep coming back to my disappointment with the fact that the 2011 Presidential Election was deciding based on nothing more complex than whether you thought it was (vote Buhari) or was not (vote Jonathan) still the North's turn in the North/South Rotational Presidency system. Ours is a three-tier federal system, so this was neither the only electoral race nor the only "issue" at stake at the polls, but it is a good indicator of the level of the "debate" surrounding the election.

And no, I am not suggesting that we Nigerians are not interested in the important, substantive issues. Quite the contrary. Start a conversation with a group of Nigerians on the substantively important issues, and you will get a myriad of very serious opinions on the way forward. You will not agree with all of the opinions, but that is (supposed to be) the nature of democratic politics.

What annoys and flabbergasts me is the fact that our politics has NEVER reflected our debates and discussions on the vital issues facing the federal republic ... and the the fact that we the people are actually quick to drop our concerns to rally behind the divisive laagers the politicians stoke.