By Oluseyi Olubanjo

The hope of the good people of Ekiti State got rekindled for an anticipated facelift in the State’s health sector on Wednesday, 24th February, 2021 when, on the floor of the hallowed red chamber, Sen. Michael Opeyemi Bamidele representing Ekiti Central Senatorial District, presented a Bill for an Act to provide for the establishment of the Federal University of Medical and Environmental Sciences, first of its kind in the annals of medical education in Nigeria. The novel health institution is envisioned to be domiciled in Bamidele’s home town, Iyin-Ekiti in Ekiti State, Southwest Nigeria.

The announcement of the Bill during its First Reading at the Senate’s plenary was greeted with applause from well-meaning Nigerians given its timeous arrival, especially at a time when the parlous state of our nation’s health sector has just been exposed by the challenges posed by the COVID-19 pandemic which bedeviled and ravaged the entire world since about twelve months now. Aside the pathetic dearth of modern health care facilities and lack of adequate funding, one perennial problem facing the Nigeria’s health sector is the paucity of adequately trained and well-motivated medical personnel.  Unfortunately, this puzzle has lingered over the years with little or no attention from the Federal Government.

Official Statistics on yearly basis shows Nigeria, Africa’s largest country is in dire need of medical doctors to meet the health needs of its citizens. It has been reported that only one doctor is available to cater for every 4, 845 Nigerians. According to the report of a research conducted by Premium Times in December, 2017, Nigeria had 42,845 registered doctors, dentists and alternative medicine practitioners working in the country. Of this number, 39, 912 were medical doctors while registered dental practitioners stood at 2, 901. Invariably, Nigeria’s ratio of doctors to population is about eight times below the World Health Organization (WHO)’s recommendation of one doctor to 600 patients. Worse still, the data supplied to Premium Times by the Medical and Dental Council of Nigeria (MDCN) did not include the number of doctors and dentists who have left Nigeria to work abroad since 2017.

Owing to non-adequate workforce, Nigeria’s health professionals are over-worked. A doctor is supposed to see a maximum of 20 patients a day but they are seeing about 150 on daily basis. Certainly, by the time such medical personnel gets to 50 years in age, he is already exhausted. Even a nurse that is supposed to see about four patients has to take care of 50 patients in a ward, certainly, he/she will get tired. Going by this disturbing trend, Nigeria might find it difficult achieving its Universal Healthcare Coverage goals. WHO identified critical shortage, inadequate skill mix and uneven geographical distribution of the health workforce as posing major barriers to achieving the health related Millennium Development Goals (now Sustainable Development Goals). Also, only five of the 49 countries categorized as low-income economies by the World Bank meet the minimum threshold of 23 doctors, nurses and midwives per 10,000 populations that was established by WHO as necessary to deliver essential maternal and child health services. Nigeria though no longer termed low-income country drastically falls short of these recommendations.

The availability of medical manpower is also skewed as many health workers do not work in the rural areas where their attentions are needed. Nigeria has been struggling to provide skilled care at birth to many pregnant women as well as emergency and specialized services for newborns and young children. This has direct consequence on the number of deaths of women and children. Currently, Nigeria ranks one of the countries with the highest maternal and child mortality rate. Some pregnancy-related services can be delivered by mid-level health workers, but they do not count for an effective workforce. These should consist of a carefully planned balance of professionals, paraprofessionals and community workers. The shortage of these impedes access by women and children to lifesaving interventions and services.

Medical education in Nigeria faces numerous challenges and problems such as lack of a coherent admission policy, inadequate funding, poor planning and erosion of values have led to a general perception of low standards and quality. The Universities have been the mainstay of medical education in Nigeria. The government policies on medical education are translated into reality through the universities and regulatory bodies. The first official attempt at offering medical education in Nigeria began in 1927 when the government set up an institution for training medical personnel to diploma level. However, this program was abolished as the available facilities and teachers were inadequate to attain acceptable international standard. This failed attempt was followed by the establishment of the University College Hospital, Ibadan in 1948 as a college branch of the University of London, to offer standard medical education/training for medical personnel. Since then four generations of medical schools have evolved. The Medical and Dental council of Nigeria (MDCN) remains the main regulatory body for medical and dental practices in Nigeria. The MDCN was established by the Medical and Dental Practitioners’ Act of 28 June 1988 (M8 LFN 2004) to replace the Nigerian Medical Council established by the Medical and Dental Practitioners’ Act of 18 December 1963.

According to MDCN, there are thirty-one (31) fully accredited and six (6) partially accredited medical school in Nigeria. Nine (9) of the thirty-one (31) fully accredited Nigerian medical schools have dental schools of which seven (7) are fully accredited and two (2) have partial accreditation. Minimum requirements have been set out by the MDCN in terms of student intake, minimum physical facilities, learning resources, administrative facilities and teaching staff requirements. Though Nigeria is the most populous nation in Africa with four generations of medical schools, much has not changed in the blue print of her medical education curriculum since the inception of the first medical school in 1948. These have remained more-or-less the same over the years as can be seen from the handbooks of most medical schools. Of course, there have been modifications here and there, but the objectives have remained practically the same. The greatest modification followed the emphasis on primary health care as recommended at Alma Ata stressing the importance of primary health care as the cornerstone of training.

Of great concern is the debate that graduates from medical colleges in Nigeria trained under the present curriculum may lack necessary skill and aptitudes required for success in the changing practice environment of the 21st century. In response, the Federal ministry of health in conjunction with the Medical and Dental Council of Nigeria (MDCN) and the National University Commission (NUC) had on several occasions set up committees in an attempt to review the medical and dental education curriculum in the country. This however, has not yielded any favourable results. The failure of these committees/meetings therefore necessitate a new approach in improving the quality of medical education in Nigeria. This underscores the urgent critical need to establish specialized medical universities by Federal and State Governments across the country as it has become more imperative to create more access to higher health and medical studies.

According to Sen. Bamidele in his lead debate of the Bill for the establishment of the Federal University of Medical and Environmental Sciences, the proposed university is envisioned to preoccupy itself with the development and offering of academic and professional programs leading to the award of Diplomas, First Degrees, Postgraduate research and higher degrees with emphasis on planning, adaptive, technical, maintenance, developmental and productive skills in the field of Medicine, Biomedical engineering, scientific and allied professional disciplines relating to health resources with the aim of producing socially matured persons with capacity not only to understand, use and adapt existing technologies in the health industry, but also to improve on those disciplines and develop new ones, and to contribute to the scientific transformation of medical and other health practices in Nigeria.

Furthermore, the lead debate recognizes the fact that the nation’s health sector has a very high potential and requires high level medical, scientific and administrative skills to drive it. To this end, the Federal University of Medical and Health Sciences, when established, would be a modern institution that would develop world-class medical personnel that can sustainably manage our nation’s health sector by providing medical expertise at the highest level. The university is therefore aimed at further advancing knowledge through research and the nurturing of unique innovations, entrepreneurship and wealth management in its core area of interest. In the entire nation, only two universities are in this category:  the Ondo State University of Medical and Health Sciences, Ondo, Ondo State and Eko University of Medical Sciences, Ijanikin, Lagos State. However, while the former (as the name implies) was established by a State Government, the latter is a privately owned university. Both of them cannot compare with the infrastructural capacity and service delivery that is expected of a federally owned specialized university of medical sciences. The University College Hospital (UCH) is the largest health institution in the country with over 10 wards but its infrastructural capacity and professional manpower delivery is now far below the threshold of global standards. It is self-evident that Federal Medical Centers, State-owned General Hospitals and Medical Teaching Hospitals in the Southwest geo-political zone such as OAUTH, LUTH, OOUTH, LASUTH, LAUTH and EKSUTH are overstretched given the lack of adequate funding, scarcity of 21st century medical facilities as well as the paucity of well-motivated workforce.

Against this background, the establishment, by the Federal Government, of a specialized tertiary institution mainly for research, teaching and impartation of medical and environmental sciences in each of the six geo-political zones in Nigeria would be adjudged to be in the overall best interest of the Nigerian masses, whose precarious living conditions, make them not to be able to afford the luxury of medical tourism in foreign enclaves.

The host community for the proposed medical and environmental university is Iyin-Ekiti, a town in Ekiti State, Southwest Nigeria. It is very close to Ado-Ekiti, the State capital. The town was established between 1951 and 1954, when the Uyin people of the villages of Araromi, Okesale, Oketoro and Okelawe moved to the site, then sparsely occupied. Iyin presently has eight primary and three post primary Schools, a modern police station and barracks, a general post office, a local government maternity center and a general hospital. The town also has a commercial bank and one micro-finance bank. However, Iyin-Ekiti is in dire need of federal presence inspite of several illustrious patriots who hailed from the town and have contributed immensely to national growth and development such as the likes of Late General Adeyinka Adebayo (former Military Governor of the defunct Western Region), Late Oba John Ademola Ajakaiye (former Chief Judge of Ekiti State), His Excellency, Otunba Niyi Adebayo (first Executive Governor of Ekiti State and current Minister of Trade and Investment), Mr. Babatunde Omotoba (former Minister of Aviation), Major General Bamidele Olawunmi (former NYSC Director General), Dr. Eniola Ajayi (Nigerian Ambassador to Hungary) as well as Senator Michael Opeyemi Bamidele himself. Moreso, the centrality of the town within Ekiti State and its easy accessibility readily makes it a suitable location for the university project under consideration.

Fortunately, in demonstration of its preparedness to host the world-class health institution, Ekiti State Government with the support and understanding of the good people of Iyin-Ekiti and other critical stakeholders, had earmarked a vast land of about 1000 hectares for a befitting edifice that could compare with other cutting edge tertiary health institutions in its category. Equally, notwithstanding the fact that the facility is primarily aimed at leveraging a great improvement in the access to quality health care system by the people of Ekiti and neighbouring States, it harbours a huge potential for employment generation to Ekiti graduates and young school leavers, thereby leveraging the local economy and complementing the efforts of the State Government in the area of job creation, career advancement and youth development.

On Thursday, 24th June, 2021, the Senate Committee on Health held the public hearing on the bill, alongside other pressing bills of national importance. In the bid to further demonstrate their commitment to hosting the proposed ivory tower, the public hearing was attended by a powerful delegation from Iyin-Ekiti led by the Oluyin of Iyin-Ekiti, HRM, Oba Adeola Adeniyi Ajakaiye. Other members of the delegation were Pastor Akinjide Akinleye, the Permanent Secretary of Ekiti State Ministry of Health and fortunately, the Vice President of Iyin Progressives Federal Union, Prof. Adeyinka Adeyemi, first professor of architecture in Nigeria and former Vice Chancellor, Prof Owa Afolabi, a professor of Tourism and Hospitality Management, High Chief Simeon Ayodeji Esan, the Odofiyin of Iyin-Ekiti, other prominent chiefs as well as a host of women and youth leaders from the town. During his presentation at the hearing, the spokesperson for Iyin community, Pastor Akinjide Akinleye stressed that Iyin community is fully prepared to assist extensively in the take-off of the university through the provision and location of good accommodation for the staff and students, the existence of a conducive learning environment capable of stimulating learning, the presence of a divisional police headquarter and Nigeria Security and Civil Defence Corps (NSCDC) post to adequate security and safety for the personnel, suitable physical assets such as a good road network, constant electricity supply which was linked to the national grid since 1967, the presence of banking facilities, a sprawling hotel and hospilaty business environment and a good public library to promote reading culture aside the proximity of the town to Ado-Ekiti, the state capital and Igede-Ekiti  where the headquarters of Irepodun/Ifelodun local Government council is located.

To further press home their eminent and laudable request for the citing of the university in Iyin-Ekiti community, His Excellency, Otunba Niyi Adebayo in company of the Oluyin of Iyin-Ekiti and Sen. Michael Opeyemi Bamkidele, paid a courtesy visit to the office of the Vice President, Prof. Yemi Osinbajo at the presidential villa in Abuja on Wednesday, 23rd June, 2021, with a view to courting his understanding and support towards ensuring that the proposed university becomes a reality.

In conclusion, the Nigerian health care system, like in some other developing countries, is bedeviled with poor health indices and poor service delivery to majority of the population. The Nigerian public health system is characterized by grossly ill-equipped facilities ‘as well as inadequate and poorly-motivated personnel. These problems are linked to poor management of resources across levels of health care in the country. Over the years, medical practice in Nigeria has evolved in scope and practice, as there is now a changing perception of the role of doctors from being solely a healthcare provider to that of an all-round professional with administrative and managerial responsibilities. Contemporary doctors may have to take up responsibilities that include but are not limited to clinical, teaching, research, leadership, and managerial roles in the line of duty. The ability to perfectly blend these roles is the foremost attribute of a first-rate doctor, and this is a crucial asset when viewed against the backdrop of scarce human resource for health required for quality healthcare delivery. It is believed that the establishment, proper funding and adequate equipment of specialized universities of medical and health sciences would help tremendously in filling these yawning gaps in the medical profession and invariably translate to a drastic transformation of our nation’s health sector. Thanks to the critical thinking of Sen. Michael Opeyemi Bamidele, a pro-active, development-oriented and visionary Federal lawmaker who saw the urgent critical need for a health institution of that nature and went ahead to initiate a bill for such novel citadel of learning. Even though he is a seasoned lawyer and not a medical practitioner, his timeous intervention in this regard speaks volume of the quality of his representation and leadership capacity. One can only encourage lawmakers like him to keep the flag flying in the overriding interest of Nigerian people.

*Oluseyi Olubanjo is the Special Assistant on Public Affairs, Research and Documentation to Senator Michael Opeyemi Bamidele, Chairman, Senate Committee on Judiciary, Human Rights and Legal Matters, National Assembly, Abuja.