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HEALTHCARE DELIVERY IN NIGERIA:
CONTRIBUTIONS OF NIGERIANS IN DIASPORA
ADDRESS TO THE CONVENTION OF NIGERIAN
PROFESSIONALS IN DIASPORA, AT PARIS, FRANCE
BY
PETER U. NWANGWU, M.Sc., Pharm.D., Ph.D
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INTRODUCTION
When I first received the invitation from your president to give this presentation, I
wanted to focus on the problems of healthcare in Nigeria; I wanted to examine those
problems by presenting perspectives on two crucial areas:
(a)
(b)
The problems of Quality of Healthcare, and
The problems of Accessibility to Healthcare
Problems with the quality of care would include evaluation of the adequacy of healthcare
facilities and systems, including healthcare policies at medical centers, adequacy of
standard operating procedures at these centers, adequacy of the level and scope of care
provided by physicians and nurses in light of current knowledge and accepted standards
of medical practice in current world medical literature.
Problems with accessibility to care would include evaluation of the adequacy of the
numbers of healthcare facilities and the proper distribution of these facilities to allow
easy and immediate access to a medical facility for every patient who needs one, the
affordability, and therefore the accessibility of quality healthcare to all patients, etc, etc.
On second thought, I considered that while such analysis would be an interesting and
stimulating perspective on healthcare in Nigeria, I felt that it could be too academic for
the purposes of this audience. My sense of this audience here today is a group of sincere
individuals who are truly interested in going back to Nigeria to solve some real problems,
or individuals who have the desire to go there but are frightened to death because they
don’t know where to begin or what to do when they get there. Therefore instead of
giving you an interesting academic discussion on the problems of healthcare in Nigeria, I
shall leave all that alone and recount for you my real life experience as a Nigerian in the
Diaspora who made sincere effort to make a significant contribution to the resolution of
healthcare problems in Nigeria.
BRIEF
SUMMARY
OF
MY
PREPARATION FOR THE TASK
ACADEMIC
AND
PROFESSIONAL
I had served as a professor of Pharmacology and Toxicology at St. John’s University,
New York, before joining the drug industry. I worked on 42nd street in Midtown
Manhattan in New York City at the world headquarters of American Home Products, a
multi-billion dollar conglomerate that included Wyeth Laboratories, and Ayerst
Laboratories. Before my days at St. John’s University I served as the Director of Clinical
Research at Florida A&M University in Tallahassee, Florida. My educational
preparation included two doctorate degrees – the professional Pharm.D or doctor of
Pharmacy degree in clinical pharmacy and biopharmaceutics which is the terminal degree
in professional pharmacy, and also the research Ph.D or doctor of Philosophy degree in
medical sciences, specializing in cardiovascular pharmacology. My master’s degree was
in medicinal chemistry and pharmacognosy, and also in pharmacodynamics and
toxicology. I earned my bachelor’s degree with honors in chemistry at the University of
Nebraska, Lincoln. I was therefore properly trained and experienced in all areas of
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pharmacy, and had a sincere desire to make significant contribution to healthcare in
Nigeria.
THE HEALTHCARE PROJECT FOR NIGERIA
It was while I served at St. John’s University, New York in the early 80’s that I became
especially troubled about the state of healthcare services in Nigeria. At first I felt quite
helpless about the scope and magnitude of the problem. But I eventually decided to
pursue an idea that I felt would make significant contribution to alleviation of the
problem. As you can appreciate, the key to making any significant and lasting impact on
the problems of healthcare in Nigeria is having a dependable source of large sums of
money – not just for the development of the proper healthcare infrastructure, but also for
the perpetual maintenance of the infrastructure. I decided to set up a modern drug
manufacturing company which will have the capacity to earn significant sums of money,
and the sensitivity to commit the profits from this enterprise to the development of the
healthcare sector in Nigeria.
I still have in my files copies of letters I received from four state Governors in the United
States expressing interest and outlining the benefits of locating the pharmaceutical
manufacturing plant in their states. I visited their respective states, but eventually
decided to locate the plant in Nigeria for only one reason: a local modern generic drug
manufacturing plant in Nigeria would make available to our people a reliable source of
affordable high quality essential drugs, which will markedly contribute to quality
healthcare in Nigeria by alleviation of unnecessary drug scarcity. Therefore, in 1986, I
resigned my appointment in New York and decided to commit large sums of money to
the development of a modern drug manufacturing plant in Nigeria.
THE NIGERIA EXPERIENCE
1.
When I arrived in Nigeria, my first task was deciding a location to site the
plant. My initial considerations included choosing a site near a seaport to
facilitate importation of raw materials, and ultimately exportation of some of
the finished products to markets outside Nigeria.
Other factors in
consideration included availability of trained and responsible labor force,
availability of power, clean water, telecommunication, and national
transportation network for distribution of finished products. I was quite
attracted to Lagos and Port Harcourt. I got my first shock when a reliable and
informed friend quietly said to me: “I understand the factors you are using to
select a site and they are sensible and legitimate. However, you must
remember that you will import a lot of raw materials, and that import license is
a very important issue. If you do not site your plant in the right state or
location you will never get the import license and hard currency you need to
purchase raw materials for your operations.” Several people confirmed his
assertion. Eventually the project was sited in Jos, Northern Nigeria, not
because the location we settled for has a seaport which we needed, but because
it offered the promise of import license through significant connections to the
government. We established our facilities. We had a nice and very modern
drug manufacturing plant. I was properly introduced by a good friend in Jos to
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several key people in government, especially several key ministers from
Langtang.
2.
National distribution infrastructure for pharmaceuticals, such as wholesalers,
was very poor and inefficient. Therefore, selling to the federal government
was attractive at the time. We put together a proposal for the ministry of
defense. Fake drugs were rampant in Nigeria. We therefore proposed to
manufacture private label products for the ministry of defense which will be
supplied to the army, navy and air force. The first product was an analgesic
branded Defadol. Benefits outlined for the ministry included:
(a)
The product will be sold only to the defense ministry. So, if it was seen
on the market the ministry would have legitimate grounds to arrest such
sellers. This would cut down on pilferage and diversion which were
rampant problems.
(b)
Since the product was a private label brand made exclusively for the
defense ministry, there will be no fears as to the quality of the product,
which was significant in view of the fake drug crisis in Nigeria at the
time.
Through a very elaborate process the proposal was approved by the director of
medical services, the quartermaster general, and the defense minister. Before
signing the contract the defense minister asked the ministry of health to
analyze samples of our product and advise them if they should purchase the
products. The analysis showed that the product was above reproach, and so the
health ministry wrote a good letter of support for the product advising the
minister of defense to proceed with final approval of the contract. The contract
was therefore approved by the defense minister.
3.
After the minister approved and signed our contract he passed it down to his
permanent secretary for implementation. That was when our nightmares
started. To cut a very long story short, our contract sat there for months
because we refused to bribe anyone, specifically the permanent secretary. We
were advised to bribe the man by some people who knew him well; otherwise
the project would not move forward. My position was that the project should
stand on its merit, that the permanent secretary must do his job and implement
a project that had already been approved by his boss. Little did I know that my
firm position against bribery would cost me 18 months. The minister knew
what was going on. He supported my position. He was embarrassed by the
events. Eventually the minister through approvals by the president negotiated
removal of the permanent secretary; he was moved to aviation and a new
permanent secretary was appointed for defense. The project was finally
implemented. We manufactured and delivered the products, and submitted our
invoice.
4.
Getting paid for the product was another hell. Just signing the invoice and
submitting it to the defense ministry was like pulling a tooth. Apparently we
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were supposed to bribe someone for that. We knew the person we were
supposed to bribe. We were repeatedly advised to bribe him, but we were not
interested. It took at least two months for him to simply sign our invoice
because we were unwilling to pay anybody. After the invoice was signed and
submitted we were told there was no money to pay us for that quarter. Fourty
companies had already been short-listed for payment that quarter. Total sum to
be paid amounted to over 40 million naira, but the total quarterly allocation
released to the defense ministry by the government for payments that quarter
was only 10 million naira. Our company was not among the 40 companies
short-listed for payment that quarter! I will not bore you with details of how
we eventually got paid, how long it took to happen, the incredible costs to the
company in accumulated interests on our working capital credit line, the
opportunity costs, and the frustrations we endured. But I was consistent in
refusing to bribe anyone as a precondition for them to do their job. We were
finally paid. After we were paid, we chose to go back and express gratitude to
several people for the services they provided. That shocked many of them
because according to them, we had no reason to come back to express such
gratitude for services already rendered.
Although the original contract was for five years, I was so discouraged and frustrated by
my experiences that I decided to return to the United States after the first supply of
product.
THE LESSONS FROM MY EXPERIENCES
1.
The most important lesson I learned from my experience is the problem of too
much reliance on government contracts. In retrospect, I should never have gone to
the government for anything. If I dealt strictly with the private sector on a cashand-carry program, the outcome of my experience may have been different.
2.
I returned to Nigeria recently for the first time after leaving there out of frustration
12 years ago. The second lesson from my experience came to me during that visit.
I wished I didn’t leave; I wished I stayed. For two reasons:
3.
(a)
Indians, Lebanese and Italians were all over the place abusing the country
and the resources of the country. They have no real vested interest in the
country, but they are willing to stay in the country. They will bribe
everyone for everything, inflate their contract price to recover their bribery
costs, and immediately repatriate their profits out of Nigeria regardless of
the hard currency cost, and without any consideration whatsoever for the
hard currency burden of their actions to the economy.
(b)
When you leave Nigeria, in some ways, Nigeria leaves you. It’s like you
have to start all over again from the beginning every time you leave that
country for a prolonged period of time.
Do I regret not bribing people to facilitate our project? No, absolutely not.
Clearly if I elected to bribe as required, I would not have been frustrated the way I
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was. I had excellent contacts and a very good project that would have been
extremely successful, and by today I would have made the financial adventures of
the generals in that country seem like a child’s play. I stand here today to testify
to you that no one needs that type of wealth. I have my good conscience, and I
can tell you that it is worth more than the entire Nigerian national treasury. You
have a choice, not to be part of the decadence.
Here is my hypothesis on what I think is the problem with Nigeria and most Nigerians
everywhere. We are a country of very insecure people. In our incredible and intense
search for acceptance, emotional and psychological security, we go to any length to look
better and be more powerful than the Akpans’ next door. We want more money in our
bank account than the Akpans’ even if we have to take a bribe, steal, push cocaine or be a
419. Because of our insecurity we have to show off our wealth so we can be seen to be
wealthier and more powerful than the Akpans’. We must be called Engineer that,
Architect so, or chief that, because we have a need to assert superiority over the common
Mr. Akpan. This sad emotional insecurity problem has plagued our nation for too long,
and has created a country of insane people. If we do not address that simple but profound
national problem of emotional insecurity through proper dialogue and education, we will
remain a country of insane people. We need to understand that there is nothing wrong
with being ordinary or simple. It is perfectly okay. As a matter of fact it is wonderful to
be ordinary. And let us begin with ourselves here in the Diaspora. I look forward to the
day when a Nigerian will say, “It is okay for the other guy’s idea to be better than mine.
That’s wonderful, he is a really gifted and profoundly intelligent guy – and I just love to
learn from his profound wisdom and listen to him speak. He is more qualified to be our
leader, and how I love to work with him, support his ideas and do whatever he wants me
to do to help this organization grow!” That mindset and disposition is the only way to a
new and prosperous Nigeria. A lot is at stake for everyone in the development of Nigeria
into a safe, hospitable nation with basic amenities and functional services. The country is
losing the services of many good Nigerians driven out of the country and scattered all
over the world against the deepest desires of their heart. Increasing numbers of Nigerians
die and are buried outside their fatherland against their will; some of them born outside
Nigeria, die without the benefit of stepping their foot on Nigerian soil for even one day.
In closing my presentation, I want to tell you about Nigeria from the eyes of my children
when I took them there from America 14 years ago. My youngest son at that time was 2
years old. He saw some chickens walking around in the compound and was so utterly
captivated by this sight. He asked his mother, my wife, if he could catch the chicken.
His mom said, “By all means, go for it”. This child spent half of the day diving after
these chickens and having incredible fun trying to catch them. Towards the end of our
visit to Nigeria, my family and I were all sitting around talking one day and I asked them
a simple question. “Nigeria and America, which one do you like more?” My first son
who was seven years old at the time was the first to answer. He had a funny smile on his
face, and then he answered, “Nigeria”. Out of curiosity, I asked, “Why do you like
Nigeria more than America?” His answer was simple but profound. He said, “Because I
can pee anywhere I want.”