The Chief Executive Officer of Duchess International Hospital, Dr Adetokunbo Shitta-Bey, speaks with VICTOR AYENI on how the nation’s healthcare delivery can be made affordable for the common man and how to halt the ever-growing brain drain and medical tourism, among several other topics
Can you tell us about yourself and your mission?
I am Dr Adetokunbo Shitta-Bey, CEO of the Duchess International Hospital in GRA, Ikeja, Lagos. I was born in Lagos on the 13th of April 1972 and educated at King’s College Lagos, University of Nigeria, Nsukka, King’s College London and Cranfield University School of Management, where I was awarded a Master’s in Business Administration.
I am a specialist family physician and academic General Practitioner by training. I hold a Master’s degree in Primary Healthcare and am a member of the Royal College of General Practitioners, United Kingdom.
I am interested in the health and socioeconomic issues affecting the wealth of local communities and I have a passion for clinical governance, medical education, healthcare systems administration and policy. My personal mission is to help build safe and sustainable systems of healthcare delivery across Nigeria and low/middle-income communities, one practice at a time.
You recently described your medical facility, Duchess Hospital, as a “one-stop-shop for primary, secondary and tertiary care services?”
The Duchess International Hospital is indeed a “one-stop-shop” for primary, secondary and tertiary healthcare services. This was from inception, identified as both an aspiration and a firmly defined goal. The mission of the hospital is – “to reverse medical tourism by delivering the highest standards of care, using the most advanced technology and treatments to give our patients the fastest, most convenient access to the best medical expertise available anywhere in the world.”
Our services are deliberately located in the heart of Ikeja and within a few minutes of the local and international airports. It costs N5,000 to register as a patient at the Duchess, and N5,000 for a consultation with a specialist family physician.
Many Nigerian elites have lost their confidence in the public health system due to dilapidated infrastructure, lack of medical equipment and ill-maintained facilities, what are the ways their trust in our health sector be regained?
We now find that there is a collective desire amongst Nigerian across all spectrums of society to seek robust and trusted healthcare solutions within the shores of our own country. The recent account of the Vice President, Professor Yemi Osinbajo, concerning his decision to undergo orthopaedic surgery at the Duchess International Hospital in July this year was a huge boost of confidence for both the public and healthcare establishments across Nigeria.
Our focus at the Duchess International Hospital, therefore, is to rebuild that sense of trust in the healthcare system of Nigeria, robust delivery of high-quality healthcare services, strong administrative and clinical governance, world-class specialist-led expertise and affordable pricing of our services for all Nigerians.
We are committed to providing “access to affordable world-class healthcare” on behalf of all Nigerians through five key priorities and objectives which are: reducing the cost of access to essential hospital services, maintaining quality evidence-based medical care, 24/7 access to emergency medicine and critical care, a wide range of specialist consultant-led services and treatments and prioritising directly addressing the needs of the population.
The Nigerian Medical Association has said the country spends $1bn annually on medical tourism. This is a humongous sum of money. How can this trend be reversed?
These figures from the Nigerian Medical Association, if accurate, are indeed quite significant. Of course, they are yet to be completely verified but the figures quoted by the NMA may well turn out to be an underestimation of the actual fact. To put it in context, this translates roughly to about 50,000 Nigerians each year spending an average of $20,000 per trip.
You are quite correct in stating that the essential problem that defines the tendency towards seeking medical treatment abroad, the so-called medical tourism, is a loss of confidence in public health services or what I prefer to refer to as “a failure of trust.”
This failure of trust, by the way, is not the exclusive preserve of the elite of society. It is a prevalent and perennial feature of health-seeking behaviour across all strata of Nigerian society, mediated as you say, by dilapidated healthcare infrastructure, lack of medical facilities and other factors, such as – the sub-optimal regulatory environment in which healthcare operates, the overall economic situation and exacerbated mass exodus of doctors and allied health professionals from the country in the last few years.
There have been reports of an alarming rise of medical doctors, nurses and other health workers migrating en-masse to foreign countries. What is your reaction to this?
Nigeria is currently experiencing yet another wave of massive “brain drain” of intellectual and clinical resources with a significant undermining effect on the state of healthcare delivery across primary, secondary and tertiary healthcare.
Doctors and allied health professionals need to receive the best training opportunities available at home and abroad for reasons of professional self-fulfilment and for the ultimate benefit of our healthcare delivery system in Nigeria.
My understanding is that we now have a ratio of 1 doctor to approximately 10, 000 people across the country. According to the latest NMA figures, about 6,000 doctors have left the country for greener pastures abroad in the last eight years.
What needs to receive more careful consideration is a structured policy framework that allows the training of healthcare professionals to occur, perhaps outside the shores of the country, if necessary, but also provides a mechanism to facilitate the timely return of these highly-trained resources.
This ideal is inextricably linked with issues concerning remuneration, healthcare infrastructure, the environment of undergraduate and postgraduate training in public institutions, taxation and incentives to mention a few.
This is a very complex, multifaceted problem indeed, made no less difficult by the prevailing socio-economic circumstances and the fact that we are graduating far fewer doctors and allied health professionals today than we were just a few years ago.
Reversing the brain drain and possibly achieving a position of “brain gain” in the long-term will require that we directly address these prevailing issues in addition to looking very carefully into more innovative ways of deploying our vast untapped and highly-skilled resource of trained scientists, allied health practitioners and other ancillary staff, in newly developed support and task-shifted roles where the unique skill-set, training and professional backgrounds can be fully utilised.
Maternal mortality is quite high in Nigeria, the United Nations Children’s Education Fund showed that Nigeria had the fourth highest maternal mortality rate on earth with 576 per 100,000 live births. What are the ways out of this issue?
The lifetime risk of dying during pregnancy, childbirth or after an abortion for a Nigerian woman is 1 in 22, compared to 1 in 4900 in developed countries; and according to the World Health Organisation, Nigeria accounts for over 34 per cent of maternal deaths globally.
Infant mortality follows a similar pattern and differences in mortality rate for both indices occur in regions throughout Nigeria depending on socioeconomic patterns and distributions, and access to high-quality, affordable maternal and child healthcare in primary and secondary healthcare facilities available in local communities.
Based on an estimate, 70 per cent of Nigerians are groaning in poverty and most Nigerians finance their healthcare needs through out-of-pocket expenditures. Are there ways healthcare can be made more affordable?
Health follows a social gradient. If you are poor in Nigeria, and in most parts of the developing world for that matter, you are far more likely to suffer poor health outcomes and have poor access to affordable quality healthcare.
Providing quality affordable healthcare is therefore the existential question that faces healthcare delivery in Nigeria today. Rendering these services “accessible” to the population is the work of healthcare administration. Adequate funding for healthcare is the central component to solving the problem of access.
We at the Duchess International Hospital have been the recipient of significant financial support from the Federal Government through the Central Bank of Nigeria’s health intervention fund. For precisely this reason, we can pass on the benefits to local communities of ordinary Nigerians by committing the long-term, to low and competitive fees across a wide range of services available at the hospital.
The tremendous goodwill and support received from the Federal Government and CBN have made it possible for us to render our high-quality services and unique specialities accessible to the public, helping us to live up to our mission to provide – “the fastest, most convenient access to the best medical expertise available anywhere in the world”.
In direct answer to your question, therefore, regarding ways in which healthcare delivery can be made more affordable in Nigeria – the solution to this problem requires both robust and sustainable mechanisms of funding and financing of healthcare as well as astute innovation, organisation and leadership in the design and delivery of quality healthcare services.