It remains unclear how best to define and describe Nigeria's healthcare delivery system. The National Healthcare Insurance Scheme (NHIS) has been established as a way out of the limbo for people that would have difficulties in accessing, paying and receiving appropriate healthcare services anywhere in the country. However, many of those championing NHIS and Health Management Organisations (HMO) are divided on several opposing lines and boundaries of personal interest in the industry. This is one of the significant challenges for the realistic implementation of NHIS project and the full development of a viable and sustainable healthcare services and delivery system in Nigeria. There is evidence to assert that the commercial interest that would maximise the gains of a few out weighs the argument in favour of public interest that would benefit the entire population.

There are several options for realising the potential of healthcare economy in the country, but the preferred choice is usually one that is hardly subjected to any serious experts' analysis and public scrutiny. The decision on the option is made without due reference to specific research or based on established evidence of success in similar countries or societies, which would allow informed response by members of the public, especially the academics. There is undue reliance on narrow angle view of medical professionals without consideration of the holistic concept of health services business in the view of strategic management experts.

The politics of healthcare in Nigeria disempowers the majority of the citizens by denying them the fundamental basic knowledge of what, how, where and when the issues of healthcare are being planned and implemented. And once a professional group approves a political agenda, it becomes the right policy for the country irrespective of the faults and deficiencies.

Healthcare policy is neither aimed to achieve a national delivery system with standardized approach for equality of access, quality concepts, strategic management, funding and marketing, individual and organisational accountabilities, workforce recruitment, training and development; nor does it aim for respective states to channel their own courses without any connection to the centre. The disjointed co-ordination of the leadership structure and absence of management discipline have impacted negatively on effectiveness and efficiency in system development of a clearly definable healthcare in the country.

At the moment healthcare delivery is like a game of lottery where only the lucky ones can have access to healthcare services at the mercy of a Non-Governmental Organisation (NGO), Governor, President, Vice President or their respective wives, (our first ladies).

One of the legacies of military dictatorship is a policy of undue discretionary use and abuse of power where funding for specific healthcare needs of selected individuals either for treatment at home or abroad without concerns for the rest of the population. With democracy, it is important to point out the implication for non-universal approach for assessing and paying for specific healthcare needs of the citizens. There is a need to highlight that while charities can chose and pay for healthcare needs of individuals because it is their own money, people trusted with public responsibilities could not spend public fund for specific people with specific healthcare needs discretionally without subjectivity to processes that ensures equity and fairness. Public fund belongs to every member of the public and must not be used or seen to be used in manners that undermine a leader's commitment to addressing the healthcare needs of the general public.

When the wives of our President and Governor of Lagos State, Mrs Hajia Turai. Yar'adua and Mrs Fashola, addressed the issue of health and the free treatment of 500 people with visual problems which was initiated by Her Excellency, the First Lady of Nigeria, the question that called to mind was about the source of fund that paid for the treatment. Was it private fund, charity fund or public fund? Similar number of patients are hoped to benefit across all the states in the country. While this critical question does not underscore the kind gesture of the first ladies and the magnitude of the benefit derived by those targeted, it however does raise the issue of clarity in systems, needs assessment and responsibilities for planning, costing, delivering and evaluating healthcare services on the basis of priorities, the expected cost/efficiency value for both the individuals and the general society..

In view of the above, it would not be inappropriate to ask about the significance of national health insurance scheme (NHIS), considering the fact that access to healthcare services may be a mountain to climb by those whose needs are not championed by someone with a particular political interest. There was a case of two people with renal (kidney) problems who required transplantation as reported on NTA news where their doctor was appealing for donations to fund their treatment. The boy was 9 years old and the female was about 42 years.  There was no evidence of much response from the charity organisations (NGOs), the government of their state of origin or residence, the politicians or the federal government and others. It is uncertain what the outcome of their fate is. There are several members of the population sharing that fate and if not for the foresight of their doctor, no one would hear of their suffering simply because a country as blessed as Nigeria is yet to develop and improve upon its healthcare industry, efficient management and effective delivery systems.

So far, the song of healthcare reform in Nigeria does not seem to be in tune with the beat of the music in the systems of delivery. It continues to sound more like rhetoric with so much promises but little guarantees for realisation.

For realistic achievement in the national agenda for effective healthcare delivery in Nigeria, we must first identify who the experts are in strategic management of healthcare and consult widely across their range in order to have a balance debate that is anchored on clear principles of research evidence and international benchmarking. Also, the business activities of healthcare must be distinguished from the clinical activities and productivity and should be positioned as a fundamental public service directed at every member of the population.

The subject of healthcare should start to attract more public questioning and expert analysis. The media should play the moderator's role by pushing the debate and accommodating the different opposing arguments. Publishing one side of a story diminishes the opportunity for learning and knowledge development. Healthcare management issues are sparsely reported and yet many organisations across the public and private sectors lost millions of naira per day due to sickness absence. Performance of staff due to poor health affects productivity, quality and profitability, yet the media is more concerned about other economic news that has direct visible financial values.


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