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About the Writer: Kanayo A Odoe (BL, J.D.

, MSc, BSc) is a lawyer, engineer and chemist with a keen interest in healthcare delivery. He is the Managing partner of Chancery & Scribe--a law practice in Nigeria. He loves philosophy and history.September 2012

THOUGHTS ON DEVELOPING NIGERIAS HEALTHCARE Nigeria has struggled relentlessly to salvage its healthcare system. In a 2000 survey by the World Health Organization (WHO), Nigerias healthcare was ranked 187 out of 190 countries in the world that are member states. A United Nations report released May 16 2012, called Trends in Maternal Mortality: 1990 to 2010, showed that 14 percent of the worlds deaths are related to childbearing are in Nigeria1. In trying to salvage the poor healthcare system in Nigeria, the National Assembly signed a Healthcare bill which has been trumped as a great piece of legislation that will turn the Nigerian healthcare sector around. The bill caters for children below five years old, pregnant women and the elderly, leaving the young able bodied citizens out of the expansive reach of the healthcare benefits. Though the goals of the law are noble, attaining the spirit of the law will be difficult. It is in this stead that the current Minister of Health has set up a committee to meet the challenges of Nigerian Healthcare system. In order to address the current healthcare crisis, Nigeria has to determine whether to adopt a Universal Healthcare System or Private Healthcare System in solving the healthcare dilemma.

http://www.unfpa.org/public/home/mothers/MMEstimates2012

Universal Healthcare System Socialized medicine is another name for Universal Healthcare and is a system of providing medical and hospital care for all at a nominal cost which is done by means of government intervention and regulation of health services and subsidies derived from government taxation2. In universal healthcare, the government provides funding for most or the entire healthcare provided for by private hospitals or government hospitals; approximately 8.4% of the United Kingdoms GDP funds the NHS3.

Most of the Western World practices socialized medicine. Other notable countries that practice universal healthcare are Cuba, Australia and Russia. How best to practice effective universal healthcare raises the question as to whether the government will also fund medicines prescribed in addition to treatment given to patients. England provides healthcare for all of its citizens through its National Health Service (NHS).

NHS in England The NHS employs more than 1.7 million people including 39,409 general practitioners, 410,615 nurses, 18,450 ambulance staff and 103,912 hospital

2
3

The American Heritage Medical Dictionary.

International Health Systems: Issue Modules, UK-KaiserEDU.org, www.kaiseredu.org/IssueModules/International-Health-Systems/UK.aspx

and community health service medical and dental staff4 catering to more than 52 million people in England. The funding for NHS for the 2011/2012 year is around 106 million which is derived from government tax on its citizens. The secretary of state for health, which is equivalent to our minster for health, is the head of the NHS and reports to the prime minister.

Even with the current expenditure on healthcare by the NHS, the healthcare delivery has been considered not as efficient because of the rising population of baby-boomer generation5. England has however achieved relative success in reducing the long wait times for care by increasing hospital capacity and staff as well as setting shorter maximum wait times (18 weeks)6.

HOW NHS WORKS The United Kingdom, which includes England, has a system of generalist primary care delivery care delivered by General Practitioners (GP). The GPs have two principal roles: (1) to provide primary care; and (2) to act as gatekeeper for access to special care. An individual cannot seek speciality care without referral from their GP7.

Private Healthcare Approach

4 5

www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx

International Health Systems: Issue Modules, UK-KaiserEDU.org, www.kaiseredu.org/Issue-Modules/International-HealthSystems/UK.aspx


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Id. Id.

Healthcare under this model is funded almost exclusively by private enterprise. Private insurance companies, pharmaceutical companies and private hospitals sell their services to those who can afford to pay for the services. Private insurance companies, pharmaceutical companies and private hospitals are interdependent on each other through pure principles of private enterprise. This model as practiced in the USA is available to those who can afford to pay for their healthcare insurance and they get to choose the type of healthcare and hospitals they want. Individuals get healthcare insurance from private insurance companies at a cost. Usually private insurance is purchased by deducting the insurance premiums from an employees income, or an employers business revenue. Some companies also offer their employees health insurance as a perk. Companies have the option of choosing which private insurance company they will use.

Although private enterprise governs the system of healthcare in the USA, the USA government still provides healthcare to a group of persons through a model that can best be described as social medicine or universal medicine. Medicare is a government initiative that provides healthcare services to the elderly and to people with disabilities while Medicaid provides coverage to low income families. Strictly speaking, therefore, no system practices an exclusively economic model of medicine whereby it is either pure capitalist enterprise or social economic theory.

PROBLEMS WITH EITHER APPROACH Advocates for private healthcare assert that under universal healthcare, access to hospitals and doctors are slow with long waiting lists. The arguments posit that due to the high demand for doctors, patients had wait times before they could see their doctors. Experts said the NHS's need to cut costs was prompting patients to fund their own hip or knee replacement, hernia repair or cataract removal. "We are certainly picking up that some patients are being asked to wait longer than they would have expected and are therefore deciding to pay for themselves rather than wait," said David Worskett, chief executive of the NHS Partners Network, which represents more than 30 firms both forprofit and not-for-profit that work with the NHS8.

On the other hand, under private healthcare, a patient is treated on the basis of his insurance and on the basis of his ability to pay for his healthcare, which excludes the poor, the young, or generally those who cannot afford to pay for insurance.

Private Insurance in UK

NHS rationing boosts private healthcare firmsreport http://www.guardian.co.uk/business/2011/sep/13/private-healthcare-boosted-by-nhsrationing

Private medical insurance is usually designed to treat acute conditions9. It must be noted that Private health insurance in the UK is not seen as a direct replacement for the NHS. The exact conditions covered by private medical insurance varies between policies, but will generally not include some chronic conditions10 and private medical insurance is also unlikely to cover preexisting conditions that were present when you took out your policy. Private medical insurance policies also vary in the level of cover provided. Most will cover in-patient services11 but not out-patient services12. Generally, private medical care in the United Kingdom has four main advantages13: 1. Speed of access to treatment: For many people, this is the biggest advantage of private medical insurance. Being covered by private health insurance means that youll receive prompt attention when you need it, without waiting weeks for an appointment and perhaps months on an NHS waiting list for your surgery or treatment. 2. Choice of timing: Patients with private medical insurance can

choose when to have treatment for less urgent problems. For example, you could fit elective surgery around your work schedule or other commitments, or choose to have treatment when friends or family are
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These are short-term health problems that need treatment but that also respond quickly, leading to a full recovery. 10 These are long term illnesses that need constant or regular care. 11 In patient covers treatment, surgery and hospital stays 12 Out Patient consultations such as aftercare and drugs, and preventive medicine are generally options that come at added cost. 13 http://www.healthinsurancesolutions.co.uk/private-insurance Private Medical Insurance, Individual Health Insurance UK

free to help with childcare. 3. Choice of hospital, consultant and surgeon: As well as choosing the timing of your treatment, private medical insurance also allows you to choose the hospital you are treated at and the consultant or surgeon who treats you, although the number of hospitals available to you will depend on your level of private medical insurance cover. 4. A higher standard of facilities: Another advantage of private medical insurance is the guarantee of high quality facilities if there is need to stay in hospital. Most private hospitals, and private wings within NHS establishments, will provide a private room with en suite bathroom, as well as an a la carte menu, open visiting and many other premium facilities.

The benefits stated above for private healthcare insurance in the U.K echoes benefits argued for by the U.S.A, which practices private healthcare.

THE NIGERIAN APPROACH What model to adopt will depend on the economic ideology Nigeria adopts. Whether to adopt the English system or that of United States of America will depend on the adoption of principle behind healthcare delivery that Nigeria chooses. Is the ideal in Nigeria in line with Universal Healthcare as stipulated in the Universal Declaration of Human Rights or will Nigeria adopt

the purely capitalist notion that hinges healthcare delivery on a citizens ability to afford or pay for health care?

It is my view that there should be an interplay or coordination between the Federal Government, State Government and Private institutions if Nigeria is to solve its failed healthcare delivery system. Reforming Nigerias health sector will be very expensive. Realistic as well as thoughtful goals and decent standards must be set based on data analysis.

Comparative analysis of the UK model and the USA model suggests that neither system practices purely Universal Healthcare as in the case of UK or purely private medicine as in the USA. Each system borrows a leaf from the other. It is the degree of practice that makes a system a Universal System or a Private System. A key issue to note under the Universal Health System is the burden placed on the UK healthcare system due to the rising population thereby increasing wait times needed to see Doctors. The complaint in private healthcare as in the USA is the inability to give quality healthcare to those who cannot afford it. However, the USA has adopted some form of Universal healthcare for a limited class of people under its Medicare and Medicaid programs for the poor, elderly and for veterans.

A belief in the principles of market economy will mean that Nigeria adopts the private healthcare initiativesthe USA model. If Nigeria adopts the principles set fort in the Universal Declaration of Human Rights, then it means that Nigeria will lean more towards the U.K model of medicine. Regardless of the ideology adopted, the road to a decent healthcare delivery will have its challenges. As stated above, countries with universal healthcare, face the challenge of long patient wait times and cash squeeze as the population in the Western World is increasing. However, in the private healthcare delivery system as practiced in the USA, the number of people can get quality healthcare is limited to those with financial. Private healthcare delivery seems dependent on passing a financial means test.

In Nigeria, structural and institutional challenges must be addressed before adequate healthcare delivery is attained. These issues are hinged on our failing educational system14, a rising population, power, and data access. If population is not checked, heavy financial and manpower burdens will be placed on our healthcare system. On review of Table 1 below, USA, France and UK spend 17.6%, 11.9% and 9.6% of their GDP on healthcare, which translates

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Nigeria with the failing and falling standard of our educational sector, we cannot produce the

managers and scientists for the next generation. As it stands, our universities are under equipped with computers and up to date medical journals. Technology is the new frontier. Please see my article, EDUCATION: PREPARING NIGERIA FOR THE 21ST CENTURY. The second arm of our educational failure is the inability to educate Nigerians on the need for clean environments.

to roughly 2.5 Trillion dollars, $320 Billion, and $245 Billion on a population of 314 million, 65.35 million and 62 million respectively in USA, France and the U.K. However in Nigeria, with a GDP of approximately $413 Billion and a population of about 166 million people and counting, a budgetary allocation of about 5.1% of the GDP is allotted to healthcare. This budgetary allocation translates to roughly $ 21 Billion a year that is meant for healthcare. In the first place, corruption must be confronted if all intended budgetary allocations are to be spent on its intended purpose. Money alone has never solved problems but right thinking applied towards finding a solution to a problem. It is my position that the commission set up for revamping our healthcare sector should dwell more on data and data analysis and the study of different systems around the world in prescribing an approach, which the Nigerian government should adopt.

The Federal government should create effective regulatory framework that should govern the States or regions in Nigeria as well as the private sector.

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COUNTRY USA FRANCE CANADA UNITED KINGDOM (UK) GERMANY CUBA SOUTH AFRICA NIGERIA Table 1

POPULATION (MILLION)15

GDP ($)16 314 15.09 TRILLION 65.35 2.712 TRILLION 34.89 1.736 TRILLION 2.452 TRILLION 2.3 TRILLION 57.5 BILLION 500 BILLION 413 BILLION

HEALTHCARE SPENDING (% of COUNTRY GDP)17

DOCTORS PER 10,00018

W.H.O RANKING OF BEST HEALTHCARE SYSTEM FOR 190 COUNTRIES

17.60% 11.90% 11% 9.60% 11.60% 10.60% 8.90% 5.10%

24.22 34.47 19.8 27.43 36.01 67.23 7.7 3.95

37 1 30 18 25 39 175 187

62.262 82 11.25 48.81 166

ANALYSIS Data collected by the World Health Organization (WHO) in 2007, show that there are 13 physicians per 10,000 population with large variations between developed countries and developing countries. In the African region, there are 2 physicians per 10,000 while in the European region there are 32 physicians to 10,00019. The World Health Organization states that even though there are no global standards, it is suggested that at least 23 healthcare professionals (which include physicians, nurses and midwives) per 10000 will meet the modicum for providing decent healthcare in any country.

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http://travel.state.gov/travel/cis_pa_tw/cis/cis_987.html#country http://www.guardian.co.uk/news/datablog/2012/jun/30/healthcare-spending-world-country#data 17 Id. 18 Id. 19 Physician density per 10 000 (2007) WHO World Health Statistics Health workforce, infrastructure, essential medicines, www.who.int/whosis/whostat/EN_WHS09_Table6.pdf

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In a population of more than 165 million people and counting, Nigerias educational institution needs to produce and maintain at least 379,500 healthcare professionals with one-fifth of the 379,500 healthcare professionals being physiciansabout 75,900. Currently, Nigeria has 25 accredited medical schools with each medical school graduating about 200 students or less every year. Sadly, Nigerian doctors that graduate from our medical schools seek better financial rewards in developed nations. This brain drain poses a threat to our already failing healthcare sector.

Policies for training and regulating the admission of medical students in to medical schools and the remuneration that physicians and healthcare providers should expect within the Nigerian context to hinder the brain flight from our country ought to be developed as a matter of urgency. To improve the human capacity in Nigeria, we should review Nigerias admission process into universities. Meritocracy as a guiding principle will save the decadence and lackadaisical attitude we see with a lot of physicians. There is an erosion of integrity in any system that puts emotional preference over excellence in the admission process into universities. In the Western World, students with the best grades, not average grades, in their external exams, gain admission into medical schools. Meritocracy in any system puts the best people forward and in turn this will be reflected in the practice of medicine.

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Secondly, even if Nigeria were to meet the WHO Millennium Development Goal (MDG) in terms of the number of healthcare professionals per the population, it will be difficult for hospitals to meet the healthcare demands of the Nigerian population where a lot of people suffer from diseases like malaria and cholera. These diseases will eventually place a burden on the system thereby making it difficult for doctors to deal with the more serious diseases.

For instance, malaria is a disease that Nigerians have had to grapple with for so many years and it accounts for 50 percent of out-patient consultation, 15 percent of hospital admission and also top cause of death in Nigeria. (National Malaria Control Plan of Action 1996 to 2001). Malaria is an economic problem. See Malaria in Rural Nigeria; Implications for the Millenium Development Goals, Olufunke A. Alaba and Olumiyiwa Alaba.20

If diseases that are primarily environmental or structural (as in the case of bad roads and accidents or okada riders) are not eradicated or drastically reduced in Nigeria, training physicians will be cumbersome and national resources wasted because in the end the healthcare system will be out-staffed by the population of sick people who need attention. This point is further illustrated in a speech given by Bill Clinton in 2007 where he complained about the possible burden on Americas healthcare sector if the rising obesity population was not checked.
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Olufunke Alaba is at the Department of Economics in University of Pretoria and Olumuyiwa B. Alaba is with the Department of Economics at Bowen University Iwo Nigeria.

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To meet our healthcare challenges, engineering sciences must also be used to curb waterborne and airborne diseases that place burdens on our healthcare system as well as bad roads which lead to so many unwarranted accidents that further place burdens on our health care facilities. The role of physical science in improving the healthcare sector is just as critical as the role of the medical sciences. In order to address the issue of adequate healthcare, physicians, engineers and scientists must play a combined role.

Proper environmental engineering methods can help in eradicating diseases such as the malaria, cholera and dysentery. The fact that Nigerians still suffer from these diseases is inexcusable. A focused and purposeful approach to healthcare issues will help in dealing with healthcare deficiencies. With determination, malaria along with cholera and dysentery and other water borne diseases would be of the past. In context, in 1933 malaria affected 30 percent of the population in a certain region of Tennessee USA. The USA Public Health Service played a vital role in the research and control operations; and by 1947, malaria was essentially eliminated. Mosquito breeding sites were reduced by controlling water levels through proper water channeling techniques and insecticide applications known as DDT (dichoro-diphenyl-trichloroethane). There are now arguments against DDT but the fact remains that DDT was used to eradicate malaria in the USA and other civilized countries.

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Strangely Nigeria still appeals to the UN, the UK and the USA for help in the form of imported drugs and mosquito treated nets. The USA treated its own malaria problems with DDT and proper environmental engineering techniques. It is common knowledge that mosquitos thrive in stagnant water thus the logical thing to do will be to eradicate stagnant water. This can be accomplished through good drainage systems and proper disposal of septic tanks. Mosquito treated nets basically benefits those who produce and supply them to Nigeria. The USA also suffered from cholera about 100 years ago and they realized that cholera was a social problem, which required improved of sanitation. But it takes an appreciation of the facts and serious of leadership to tackle these diseases and issues. While Nigerias purported healthcare reform bill seeks to mirror the United Kingdom, Nigerias healthcare sector will only succeed when we address the root causes of the basic issues stated above. Enactment of legislative bills without more will not eradicate a failed healthcare system. Rule of Law Medical Malpractice and gross negligence are areas that have not been thoroughly enforced in Nigeria. Doctors seem to get away with murder in this part of the world. Criminal prosecution or civil suits against medical practitioners and healthcare facilities should be encouraged to raise the standard of care by healthcare providers.

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A focused plan targeted to elevating our system of education, improving our enforcement of laws and our judicial system and appreciation of the fact that engineering science is another leg on which our healthcare development stands on is crucial in developing our healthcare system. It is also my position that State governments in the spirit of true federalism should play more a active role in providing for the health and welfare of their citizens. The burden on the federal government should focus more on enforcements and developing policies that will lead to a more vibrant and healthy society.

DEVELOPING A SYSTEM On the basis of data collected, see Table 1 above, Nigeria needs about 75900 physicians to meet its healthcare demands. To strengthen Nigerias healthcare, the issues that the Federal Government must address are: 1. Best Financial Remuneration to retain Doctors 2. What arm of medical system the Government will fund 3. What amount of Nigerias budget will go towards Healthcare (This can be answered after proper analysis of data with regards to population and required training institutes) 4. Who builds and maintains hospitals 5. Whether Insurance for all, Pay as you go system, or both pay as you go and Insurance But before adopting the right model, the Federal Government must focus on the type of diseases that we want to treat. This focus will be based on the

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incidence of the type of disease and the difficulty involved in treating these diseases. Thus, we must set up institutions to address our most critical health issues. Some of the health issues that Nigerians face are cancer, diabetes, hypertension, infant mortality and trauma as a result of accidents.

For instance, In the USA, there were 20, 380 Obstetrics/ Gynaecologists as at 2011. Research and data shows that the ratio of OB/GYN to female population is approximately 27.10/ 100,00021. Each year, 1200 Ob./Gyn are produced in USA to meet the demands of the population and it costs approximately $80,000 to train a medical student through 4 years of medical school. An additional 6 years is needed for the specialist course of Obstetrics and Gynaecology22.

Another leading cause of death that seems to be endemic is the scourge of cancer. Using the USA as a standard, there are approximately 12,500 oncologists to nearly 1.4 million diagnosed cancer patients but in India, the ratio of cancer patients to oncologists in India is 1600 to 1.

It is my view that Nigerias Healthcare model should be patterned after the Banking Sector model where an independent agency is set up, like the CBN. The head of the agency should be empowered to formulate regulatory
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A Critical Deficit of OBGYN Surgeons in the U.S by 2030, Bhagwan Satiani et al; Dept of Surgery & Obs. And Gyn Ohio State Univ. College of Medicine, March 28, 2011, http://www.sciRP.org/journals/ss 22 Id.

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standards and to have an oversight function over our healthcare facilities and professionals. It is also my view that those in the private sector intending into build hospitals, clinics or diagnostic centers should obtain and pay a substantial amount for licenses to operate. This form of financial hurdle will limit the participation of unserious players and encourage serious private participation.

HEALTHCARE PROVIDERS

CLINICS

SURGICAL CENTERS AND TRAUMA

DIAGNOSTIC CENTERS

Diagram 1

Provision of Healthcare should be grouped into 3 main areas. 1. Clinics 2. Surgical Centers for trauma and surgeries 3. Diagnostic Centers

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Surgical Centers Surgical centers are designed exclusively for short stay surgery. The centers are staffed and equipped to treat all types of medical problems. A typical surgical center has surgeons, registered nurses, sophisticated hospitals and trained and certified anaesthesiologists. It is my view that the private sector, Federal Government and State government should participate in developing Surgical Centers.

The Federal Government should develop surgical centers in federal universities as teaching hospitals, while the State governments should develop the State university teaching hospitals. Private sector can develop surgical centers or enter into agreements with the State government to manage and equip the State institutions.

Doctors in teaching hospitals will be government employees and remunerated by the Government. The monies used to maintain the doctors and the centers will be generated from the National budget. To give incentives to the Doctors, a starting salary for surgeons can be set at about =N=12 Million a year and adjusted to inflation in Nigeria.

However, the role of the Federal Government through this new Agency will be to regulate the number of surgeons produced from our medical schools each year and the criteria needed to enter a surgical residency program. For

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instance, according to the U.S. Department of Labor there are 20,400 practicing orthopaedic surgeons and residents as at (2009-2010), and they represent a mere 3-4% of all practicing physicians23. Each year in the United States, roughly 650 students complete their orthopedic surgery program24. The average yearly salary for an orthopaedic surgeon is dependent on a number of factors like where they live and work, the size of the business, and years of experience; the median salary for orthopaedic surgeons in the U.S. is $406,307 each year25.

In the United Kingdom, there are more than 18,000 surgeons currently practicing in England of which 5,600 are consultants, 9,200 trainees and 3,000 in specialist or non-training grades. In Wales there are approximately 1,000 (330 consultants, 540 in training and 130 non-training)26. There are 1.1 consultant surgeons per 10,000 head of population in the UK but this figure is not evenly spread across the surgical specialties and some specialties are currently short of their target work-force for example, paediatric surgery, ENT and neurosurgery27. The average surgeon takes 11-12 years of further training after medical school to reach consultant level in his chosen specialty and a surgeon will typically be
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http://www.orthopaediccare.net/orthopaedic-surgeons/ Id. 25 Id. 26 http://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/surgery-and the-nhs-in-numbers 27 Id.

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around 35 years old when they become a consultant28. Gaining the practical craft skills needed means a close working relationship between trainees and consultants there is currently an average 1:1 ratio of later stage surgical trainees to consultant but this varies across the specialties and the average surgeon will work in the NHS for 25 years after becoming a consultant29.

The States should be allowed to develop surgical centers but must obtain a license from the Federal Government before building these centers. The license should be given to States if standards set by the Federal Independent Agency are met.

The private sector can also build surgical centers but must pay a fee to obtain a license to build and operate the surgical center. I propose that the fee to the federal government should be renewed every 3 years. The Federal Government can set license fees at about =N= 25 Million for those seeking the license. Once the fee is paid and the standards are met, the Federal Government should not deny the private individual or corporations. The monies generated from these licenses will be used to fund medical schools and salaries for the government independent agency on health.

People with private insurance can go to private hospitals or people who want to pay out of pocket. People without insurance and people with government
28 29

Id. Id.

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insurance will go to the Government sponsored hospitals, which should be medical schools with developed surgical centers. If the hospital beds in government sponsored surgical centers are full, the Nigerian NHS can refer patients to the private surgical centers and the government can pay for the private hospitals visit. There is no doubt that this model may encourage corruption as the private sector may develop fictitious names to send bills to the government even though no surgery was performed. This type of problem is usually sited whenever socialized medicine is practiced or where there is government participation in enterprise.

The only way to reduce or curb this type of corruption is to enforce laws which prescribe punishment for perpetrators. Corruption in any endeavour is a problem.

Clinics I believe that clinics should be a terrain for private enterprise. Like what obtains in the Nigerian banking sector, a clinic should be defined in terms of bed space, size of physical structure and what types of services the clinics render. The size and scope of the Clinic will determine the type of License given to set up. The cost for getting a clinic license can be pegged at =N=15,000,000 for specialized clinics and =N=10, 000, 000 for general clinics. A specialised clinic can be defined as that clinic that deals with diseases like Diabetes, cancer, stroke, geriatrics, and other complicated diseases. A general clinic can 22

be defined as that clinic used to deal with fertility issues, tropical diseases such as malaria, cholera, etc as well as other general out patient diseases.

Letters A, B, C in Diagram 1 above, are the license class issued by the government to those who intend to run or own clinics. For instance, a license class A gives a person the right or license to own a hospital/ clinic with a minimum number of beds associated with the license. For instance, License A will allow the ownership of hospital with no more than 25 beds. License B will be given to private persons or juristic persons who intend to run a clinic/ hospital with no more than 80 beds while Licence C will be given to run or own clinics with no more than150 beds. The cost associated with each License class with respect to clinics/ hospitals can be pegged at perhaps =N= 7.5 million, =N=12.5 million and =N=15 million. Certain conditions will be associated with getting a license. Strict compliance to standards such as method of waste disposal, location of the hospital, spacing between beds, number of nurses that must be hired, the maintenance of data and transmission of data with respect to types of illnesses, death and birth records, age of patients admitted etc, which must be sent to the Bureau of Statistics and the Health Agency.

The fees associated with setting up and obtaining a license will regulate the healthcare sector by eradicating sub-standard hospitals and establishing strong financial base for hospitals that can afford to pay for the license. The

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license fee also allows the agency to make money, which it will use to fund itself and to monitor as well as regulate healthcare centers. The strong financial base of hospitals will allow for public law suits where the owners of the clinics are negligent or fail to live up to the standards of medical.

Any license given will be reviewed and renewed once the conditions for maintaining a healthy and decent practice is maintained. The guidelines for setting up a clinic must be clear and any person or group trying to set up a clinic must abide by the guidelines. Diagnostic Centers Diagnostic centers deal with testing of various diseases. The minimum financial requirement for a diagnostic center can be set at =N= 5 million, renewable with the sum of =N= 1.5 million every 3 years for the first 2 renewals, after-which the renewal fees can be reviewed keeping in line with the economic realities of Nigeria. Requirements for a diagnostic center will depend on the minimum number of equipment proposed to run a diagnostic center. For instance, the minimum standard before a license is give to run a diagnostic center will be that the applicant will have equipment do basic blood work such as cell counts, malaria parasite test, cholera test, and HIV/AIDS test amongst others. In addition, every diagnostic center should have equipment needed to test for diabetes and an X Ray machine should be present in every diagnostic center.

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Those diagnostic centers that have an MRI (Magnetic Resonance Imaging), PET (positron emission tomography) scans, Ultrasound, and CAT scans should be given tax holidays and should be patronized by the Government insurers where government employees need to do tests. These scans and the physical environment they are kept in should meet the best practices standard as set out by the department of health responsible for regulations.

CONCLUSION My model as suggested above merges the British health care system with the USA healthcare system. By blending both systems, the financial demand on the Nigerian government is reduced. The government can also generate funds needed to run its agency to monitor healthcare standards or and abuses within Nigeria. Private healthcare and government patronage of diagnostic centers in addition to private use will attract foreign investors looking to invest in our healthcare system.

While these are proposed methods for developing Nigerias healthcare system, this research shows that a critical aspect of developing our healthcare system is the collection of DATA. So in attempting to develop our healthcare system, we must develop a system for keeping and collecting data. This is critical in any advanced society because it helps with planning.

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Data analysis will help the Nigerian government develop and address the issues surrounding our environment and our healthcare. The Nigerian Health Agency (NHA) will be the independent agency responsible for analysis and determination as to how we improve our health sector. Again, the Banking model is the best model that will help in boosting our failed healthcare sector.

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