Communique Issued at the end of the 16th Annual Scientific Conference & All Fellows’ Congress, Eko Akete 2022

BACKGROUND

The 16th Annual Scientific Conference and All Fellows Congress (ASCAF) of the National Postgraduate Medical College of Nigeria (NPMCN) took place at the Eko Hotels and Suite, Victoria Island, Lagos from Monday 8th to Friday 12th August 2022. The theme of the conference was “Strengthening the Health System in the midst of a Pandemic, while the sub-themes included Emigration of Health Workers: Impact on Health Services; and Health issues of internally displaced persons.

The Annual Scientific Conference and all Fellows Congress of NPMCN and Postgraduate Medical College Fellows Association (PMCFA) kickstarted with a pre-conference press conference on Friday 5th August 2022 attended by media organizations where the College President, Dr Akin Osibogun, FMCPH, PNMC raised the alarm on the exodus of specialist doctors from the country. He urged government at all levels and medical stakeholders to formulate strategies and policies that could stem the tide and retain them in the country. The Opening Ceremony was held on Tuesday 9th August and The Prof. Theophilus Oladipo Ogunlesi Annual lecture was delivered by Dr. Sebastian N. N. Nwosu, FMCOph of the Faculty of Ophthalmology of the College. He delved extensively into ‘striving for excellence in sub-specialty medical training in Nigeria.’ There were nine (9) scientific sessions with 56 peer reviewed abstracts and 13 posters presented by Consultants and Resident Doctors on the sub-themes of the conference including rare to uncommon clinical cases.

OBSERVATIONS

1. The College has produced over 7300 Medical and Dental Specialists serving the nation since its inception, thus saving the country billions of dollars that would have been spent in postgraduate medical training abroad and has introduced the Doctor of Medicine (MD) degree program which has 357 graduates till date. The products of the postgraduate medical education programmes of the College are at strategic positions in various hospitals, medical schools, health research institutions and health administration organizations in both public and private sectors throughout the country and abroad.
2. The Nigerian Health System is still confronted by various challenges including inadequacy of qualified medical manpower and insufficiency of healthcare funding compounded by inefficient resource utilization resulting in unacceptable health indices.
3. There is a need for concerted efforts among government, the private sector and other stakeholders to strengthen the Nigerian health system in other to cope with current health challenges and unforeseen health problems like pandemics.
4. Despite the efforts by the College, other Sister Colleges, and medical schools in Nigeria to raise the number of medically qualified health workers for the country, these efforts are being defeated by the phenomenon of massive brain drain. This brain drain is not only affecting Specialists but also non-specialist doctors.
5. The COVID -19 Pandemic exposed the weakness of our health system but provided an opportunity to strengthen it. Nigerians died from other diseases aside from COVID-19 as services were not available. Our Health system has not shown sufficient capability to transform, adapt and withstand a sudden catastrophic or epidemic occurrence such as the COVID -19 pandemic.
6. A large percentage of Nigerians continue to experience poor access to health services, high out-of-pocket expenditure for health and low coverage for services by health insurance organizations, although recent legislation on National Health Insurance holds the promise of improving the situation.
7. The Primary Health Care (PHC) system is weak and its capability to support universal health coverage (UHC) needs to be strengthened.
8. There have been an increased number of internally displaced persons (IDP) in Nigeria mainly due to insurgencies, armed banditry, natural disaster, oil spillage, postelection violence, and communal classes. This is having adverse consequences for the physical and mental health of those affected.
9. Increasing number of Nigerians are dying from cancers, cancer of the breast being the commonest while cancer of the lungs accounts for most deaths.
10. Poverty, malnutrition, and poor access to health services are the major drivers of the continuous existence of tropical diseases like cancrum oris (Noma).
11. Whilst the NPMCN and its sister Colleges continue to produce Medical Specialists for the country and the West African sub-region, the impact of this effort is diminished by increasing emigration of qualified medical manpower to Europe and North America. This will impact negatively on the provision of health services to Nigerians.
12. High work volume in the hospital for already engaged doctors and the bottlenecks in the employment of new doctors into public hospitals in addition to insecurity has contributed significantly to the emigration of health workers. Economic factors such as poor remuneration and unfavorable working conditions were also identified as the main drivers of the brain drain of health workers from the country.
13. An important lesson from vaccine nationalism that manifested at the peak of the COVID-19 pandemic is the need for a healthy amount of self-sufficiency in essential commodities. This requires the development of national manufacturing capacity for pharmaceuticals, devices, consumables, and vaccines.
14. Many Nigerians cannot transport themselves to point of health care and are not covered by the National Health Insurance Authority. Presently in Nigeria, there is poor ambulance services, inadequate skilled manpower for delivery of health service, lack of organization & coordination, and lack of ownership by various stakeholders
15. The scientific presentations revealed that Noncommunicable diseases such as obesity, high blood pressure, physical inactivity, and alcohol use which are known risk factors for heart diseases, have been on the increase in Nigeria.
16. Frontline health workers continue to be at risk of infectious diseases including COVID-19 infection and the risks are highest especially for older health workers and those with chronic diseases.

RECOMMENDATIONS
Following fruitful deliberations at the workshop, conference, and All Fellows Congress, the following recommendations were made:

1. Government must urgently do what it takes to stop the brain drain by providing job opportunities and improving the working environment of medical doctors.
2. The health sector, non-governmental organizations (NGOs), and the military should leverage the existing Government programme in providing care and support for the IDPs including providing more camps with functional and adequately staffed health facilities across the country.
3. The health system should be strengthened by advocating for improved political will, funding, and good working conditions for health workers.
4. Improve access to healthcare services by strengthening primary health care and social health insurance through the adequate implementation of the National Health Insurance Act and by assigning population/geographic responsibilities to Primary Health Centres throughout the country.
5. Governments at all levels should promote stronger collaboration between the public and private sectors to improve funding and further strengthen the health system.
6. The Government should address the challenges of insecurity which will reduce the burden of internally displaced persons in Nigeria and its consequent health challenges.
7. Governments at all levels should address the social determinants of health including poverty, malnutrition, and poor access to health services so as to better promote and protect the health of the citizens.
8. Government should partner with the private sector, researchers, and other stakeholders to build national capacity for local production of medical commodities including vaccines.
9. There is a need for improved community participation at all levels to improve ownership.
10. Governments at all levels should promote initiatives from the private sector and other stakeholders to scale up health insurance and ambulance services to improve access and coverage of health services.
11. Governments at all levels should strongly promote the health in all policy and encourage individuals, families, and communities to adopt healthy lifestyles by indulging in regular physical exercise, healthy diets, and cessation of smoking to reduce the occurrence of non-communicable diseases like diabetes, hypertension, and cancers.
12. The Federal Government should take the lead and in collaboration with other levels of government, establish and enforce guidelines to ensure a safer work environment to prevent harm and protect health of health workers at the workplace including during epidemics or pandemics.
13. Health workers should be trained and retrained in infection, prevention, and control.
14. Governments at all levels should put in place mechanisms to motivate and retain healthcare workers including ensuring adequate remuneration and insurance.

APPRECIATION

The College is deeply grateful to the President of the Federal Republic of Nigeria, His Excellency Muhammadu Buhari GCFR, the Executive Governor of Lagos State, Mr. Babajide Sanwo-Olu, the Honorable Minister of Health Dr. Osagie Ehanire, Honourable Minister of State for Health, Hon. Joseph Ekumankama Esq, Honorable Commissioner of Health, Lagos State, Prof. Akin Abayomi, Presidents and Past Presidents of the Postgraduate Medical Colleges, our distinguished Fellows, Chairman and Members of Local Organizing Committee, security agents, partners and supporters, distinguished guests and participants.

Dr. Ajibola Jeje, MD, FMCS 
Chairman, LOC ASCAF 2022     
  
Dr. Fatiu A. Arogundade, MD, FMCP
College Registrar, NPMCN

Dr. Akin Osibogun, MD., FMCPH, PNMC
College President, NPMCN