1) A strong, efficient, well-run health system.
Roemer (1991) defined a health system as“the combination of resources, organization,financing and management that culminate in the delivery of health services to the population.”{1}
An efficient health system should be able to provide comprehensive health services to its recipients including primary health care services on a properly "balanced":
a) Resources: These include hospital equipments, consumables, personnel, hospital buildings, and other hardware used in the hospitals etc.
b) Financing: The cost of hospital resources, cost of health care providers, cost of training health personnel, salaries, allowances, cost of oversight, and other financial transactions in the organization and management of the health system etc.
c) Organization: Policy making, regulations, gate-keeping healthcare finance, distribution and maintenance of hospital resources, Health care providers, Health management Organizations, Ministry of health etc
d) Management: Managing hospital resources, managing information, managing organization etc
2) A system for financing health services: Financing of health care services is known to influence efficiency in health service provision. Health services are financed either through government budgetary allocations, through taxation, through payroll contributions, through voluntary contributions to have a pool of health fund. Health services can be financed by "fee-for-service" (or out-of-pocket) method.
The goal of universal health coverage is to remove "out-of-pocket" method as a form of financing health services.
Health care funding systems have various effects on cost of running health care services, equity and access to health care services and patient’s choice and power. World Health Organization (WHO) 2000 report on ranking of national health system performance done in 1997 put Nigeria in 187th position out of 191 member countries. Nigeria needs a health care funding system that can sustain and improve health care service delivery to the whole population irrespective of patients’ financial status. {2}
The 2014 National Health Bill captures the Nigerian method of financing health service thus:
[Section 11. Establishment of Basic Health Care Provision Fund.].
(1) There is hereby created a Fund to be known as Basic Health Care Provision Fund.
(2) The Basic Health Care Provision Fund shall be financed from-
(a) Federal Government Annual Grant of not less than one per cent of its Consolidated Revenue Fund.
(b) grants by international donor partners; and
(c) funds from any other source.
The Nigerian health care funding system is still evolving despite the numerous challenges facing the system. Amongst the challenges are shortage of manpower, poor implementation of good programs, poor funding and lack of political will on the part of government (Kumar, 2007).
3) Access to essential medicines and technologies: Access to essential medications involves the production, distribution and consumption of "medicines" prescribed by a healthcare expert for either curative and/or diagnostic purposes without hitches. The success of universal health coverage is predicated on how easy prescribed "medicines" can reach an ill individual for consumption. NHB (National Health Bill 2014) captures the importance of access to essential "medicine" thus:
[Section 11. (3)]
(b) 20 percent of the fund shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities.
Section 39. Part IV [National Drugs Formulary and Essential Drugs List and Safety of Drugs and Food Supply].(1) There shall be a compendium of drugs approved for use in health facilities throughout the Federation- (in this Bill referred to as the "Essential Drugs List") which shall be under the periodic review of the National Drugs Formulary, and Essential Drugs List Review Committee.
(2) Indigenous and local manufacture and production of as many items in the formulary as practicable shall be encouraged.
Section 2.[Functions of the Federal Ministry of Health]
(1)The Federal Ministry of Health shall-
(I) promote availability of good quality, safe and affordable essential drugs, medical commodities, hygienic food and water; and
(m) issue guidelines and ensure the continuous monitoring, analysis and good use of drugs and poisons including medicines and medical devices.
Technological advancement has helped in improving diagnosis and saving lives in the health care system. For an efficient health coverage, access to new live-saving technologies should be a norm. Health technology is defined as the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of life (WHO).
4) A sufficient capacity of well-trained, motivated health workers:
As diseases keep evolving, new ways to tackle them are accessed by training of health personnel periodically. Well trained health care capacity improves medical science and health care delivery. Motivation in the area of their remunerations, allowances and promotion as at when due will not only foster diligence in service deliver by health care personnel, it improves productivity and efficiency.
The National Health Bill 2014 provides for "Human Resources" development in Section 3 (d) :
10 per cent of the fund shall be used for the development of Human Resources for Primary Health Care;
The National Council is obligated to:
the provision of appropriately trained staff at all levels of the national health system to meet the population's health care needs; {3}
Section 43 (a-h) of the National Health Bill 2014 further throws more light on the need to have a well trained staff and on motivation of health workers in Nigeria.
Section 2. (1) The Federal Ministry of Health shall-
(d) promote adherence to norms and standards for the training of human resources for health;
What is the way forward then? How would we remain relevant in realization of our objectives in providing comprehensive eye care examination, provision of necessary medications, glasses, treatments and surgery, necessary ocular rehabilitation for those with severe visual handicap through the National Health Insurance Scheme?
It is my opinion that Optometry in Nigeria should evolve away from the shadow of mediocrity in the Nigerian Health care sector and grow some teeth by pursuing autonomy of our profession.
By the way, Nigerian Optometric Association (NOA) defined the Nigerian Optometrist thus:
Optometrists are independent primary eye care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures; as well as diagnose related systemic conditions.
The emphasis here is on "independence". I have the hunch that the future of our dear profession lies in our independence and our ability to curve out for ourselves a niche and truly bring eye care to the people that really need it.
The last part of this elaborate discussion will be deliberated on subsequently...
To be continued!
