Not only are the numbers of healthcare professionals in the country clearly inadequate, but we are not to chart a clear vision for the nation’s healthcare system. The challenges within the Nigerian healthcare system are too many to enumerate here, because of time limitation, but a short list will underscore the scope of the problem. The challenges include the following:
Shortage and uneven distribution of manpower
Disproportionate on cure of disease at the expense of preventive care
Limited physical infrastructures and inequities in healthcare delivery
Inadequate funding of healthcare
High cost of medical equipment and pharmaceutical products
Delay in the implementation of the national healthcare insurance scheme
Endemic corruption within the system
Incessant labor strikes and inter-professional conflicts
Poorly developed emergency response system and
Ineffective leadership at the Health Ministry
These challenges are too familiar, but they can be overcome with the right leadership and implementation of a dynamic medical education curriculum that is responsive to the problems within our healthcare system. The first medical school in Nigeria was established in 1948 at the University College, Ibadan, and it adopted the University of London medical curriculum, which subsequently was transplanted to the other newly created medical schools. For over six decades, no concerted effort has been made to align the contents of our medical curriculum with emerging global standards despite appeals from several quarters. Meanwhile, our healthcare system continues to crumble.
Unfortunately, healthcare professionals in Nigeria must share part of the blame for the failure to propel our healthcare system forward in dynamic ways to ensure sustainability, intra-and-inter-professional cohesion, commitment and increased funding for the health sector. Healthcare professionals in Nigeria usually think mostly of themselves and the benefits that may accrue to them rather than the broader and more comprehensive ways that will systematically improve the health sector. The failure to teach and practice the interdisciplinary team approach of patient management in our traditional medical schools create the milieu for intra-and-inter-professional rivalry; which is one of the most challenging issues leading to continued underdevelopment and poor quality healthcare services in Nigeria.
Given the intractable challenges in the health sector, it is logical to conclude that the British medical curriculum imported into Nigeria has been unresponsive to the dynamics in the nation’s health care system. In recognition of this untenable situation, the federal government in January 2007 constituted a Technical Working Groups of the National Advisory Committee for the Undergraduate Medical and Dental Curricula to fashion an undergraduate medical and dental curriculum for the nation. The undergraduate curricula that they produced retained the general framework of the traditional British curricula but several “clinical” and “non-clinical” contents recommendations added. The new curricula are envisioned “to be the gold standard for quality and relevant medical education” and were crafted to “produce competent, compassionate, and confident graduates who will engage in ethical practice and who will be socially responsive and accountable and globally relevant.” A summary of the recommendation is presented in the Appendix.
The white paper of the undergraduate curricula was published in 2012 and was recommended for adoption by all the Medical Schools in the country. Seven years after the publication of the white paper, it is currently not clear how many of the traditional medical schools have implemented the recommendation. It is business as usual in our medical education!
The UNIMED Philosophy to Medical and Health Sciences Education
To address the hitherto challenges mentioned above in our healthcare system, UNIMED decided right from the beginning to implement a curriculum that is different from those of the traditional medical schools in the country. We developed a multi-disciplinary team approach curriculum that will prepare our graduates with the knowledge, skills, and attitudes necessary to foster collaboration and re-build an impartial health system essential to address the multiple health challenges in our country.
UNIMED is a Specialized Medical University that teaches all branches of medicine using an interdisciplinary instructional approach that requires the faculty in the Natural, Basic Medical and Clinical Sciences to work in teams to teach the fundamentals and scientific principles that have implications for the practice of medicine and the promotion of health. Aside from teaching, our faculty at UNIMED are expected to participate in front-line basic and applied health sciences research, as well as deliver service in our contiguous communities’ private practices, hospitals and clinics.
The faculty at UNIMED believe very strongly that every healthcare professionals must be competent in their specific professions but must also have knowledge and skills outside their discipline that will enable them to be compassionate practitioners qualified to deliver high quality care. These include skills in inter-professional relations, broader aspects of development, the sociology of health and development, entrepreneurship and business building, political and strategic reasoning, legal and ethical issues and cultural and environmental relations. To ensure that UNIMED graduates are competent in these domains, our approach to curricular development is composite and interdisciplinary in implementation to ensure that no one profession is taught exclusively by faculty of that same profession, and that the students have practical experiences in entrepreneurship, and field work in multi-disciplinary clinical settings, engage in transformational research that fosters policy linkage, and create opportunities for management, and leadership building.
The UNIMED History and Developmental Milestones So Far
Through a proclamation of the Ondo State House of Assembly in October 2014, the first Specialized Medical University in Nigeria was conceived. The University was initially called the Ondo State University of Medical Sciences, and later the name was changed to the University of Medical Sciences (UNIMED) and was approved by the National Universities Commission (NUC) on April 22, 2015. At that time, UNIMED was the 40th State-owned University and the 140th University in the country.
Before the establishment of the first Medical University in Nigeria, several countries including the USA, Caribbean Island, Japan, South Africa, Sudan, Ghana, and Tanzania have had experiences in establishing and managing various kinds of Specialized Medical Universities. Over the past four years, I have had the privilege as Vice-Chancellor to visit some of these Universities in Japan, Ghana, and Tanzania.
Indeed, the Tokyo Medical Women University in Japan, which I visited in October 2018, is one of the highest performing Universities in Japan. Established in 1900, the University currently ranks 151st among Universities in the world and has some of the most sophisticated medical facilities for research and teaching in Japan.
To my knowledge, the establishment of UNIMED was fortuitous rather than purposefully designed. The journey began in June 2014 when I paid a courtesy call on the then Governor of Ondo State, His Excellency, Dr. Segun Mimiko. In the usual manner of showcasing his achievements as Governor of the State, he drove in his car with me in the owner’s seat, and the then Commissioner of Justice and Attorney General of the State, EyitayoJegede, SAN in the front seat.
Without telling me, he drove incognito to the Medical Village in Ondo City, an edifice that he had completed two years previously and which was then functioning very well. The Medical Village, as it was then called, consisted of state-of-the-art facilities in trauma care, general and specialized surgical care, kidney specialist care, obstetrics and gynecology, and child health. On inspection of the facilities, I immediately divulged to Mr. Governor that those were the most ultra-modern and well equipped comprehensive medical facilities that I had seen anywhere in the country at that time. I then spontaneously recommended that based on the vast expanse of adjoining land, and the comprehensiveness of the services available, the Village could form the nucleus of a Medical University. I reminded him that Ondo State was the only State in South-West that did not have a medical school in any of its existing Universities. Indeed, Ondo State despite being an oil-producing zone was then the only State in Southern Nigeria that did not have a Medical School. This is despite the fact that Ondo State had one of the highest numbers of professors in medicine, some of the most accomplished professors of medicine (such as Professor Oladipo O. Akinkugbe), and indeed about five professors that had been honored with the National Order of Merit in the Medical Sciences (NNOM) in the country. I decided to push his ego further by telling him that as a medically qualified Executive Governor, he will be making a grave mistake if he did not consider establishing a medical school in his State during his tenure as Governor. I further quipped that the medical village facilities were excellent points of reference where a comprehensive Medical University could be established.
To be continued tomorrow
Professor Okonofua, is Vice-Chancellor, University of Medical Sciences (UNIMED), Ondo City, Ondo State being a keynote address delivered at the Seventh Professor Sofoluwe Memorial Lecture, organized by the Alumni Association of the University of Lagos, recently.
Culled From TheGuardian Newspaper