**5. Political issues with changing governments**

Political instability in the country and frequent widespread violence combine to limit the number of foreign agencies that participate in the surgical management of heart disease in Nigeria. Some of these charities have personnel and equipment. Some foreign physicians want experience in treating types of heart disease that are

*Establishing Sustainable Pediatric Cardiac Surgery Program in Nigeria: Challenges and Prospects DOI: http://dx.doi.org/10.5772/intechopen.102737*

no longer common in their countries. However, even charitable organizations cannot take their safety for granted. Furthermore, political decisions that affect the treatment of heart disease vary with each political leader, and these leaders change very often. Their successors do not maintain continuity. Some emphasize primary health care to the detriment of the treatment of heart disease.

*Intensive labor*: The practice is labor-intensive at no incentive. Safety of patients guides the staff activity rather than welfare of the worker. More often than not, the treatment of patient usually exceeds expected period of time. This can easily lead to frustration if the involved personnel have not prepared for any extra time on duty post. Majority of the staff are based in the intensive care unit with the attendant stress.

**High cost of treatment/low sponsorship**: As a result of heavy outlay in the provision of surgical treatment, patients are made to pay higher than an average patient in the hospital. Many of these patients are indigent and therefore cannot afford the bill. Moreover, there is no universal health insurance coverage for the citizens, which would have sponsored patients for this kind of treatment. We have a situation where the government has succeeded in providing infrastructure, but the patient cannot benefit from the available services. When compared with the cost of treatment abroad, it is still far cheaper to provide this locally.

**Inter-professional conflict**: It is an established fact that our healthcare field has been experiencing inter-professional conflicts. The surgical team managing the heart disease is inclusive. These conflicts rob the patients the united attention that would have helped in overcoming their predicament. Some members of the team keep to the legality of the duty but are morally bankrupt, and this causes problem. Other causes of problem are pride, envy, jealousy, inferiority/superiority complex, and cheating.

**Others**: Public utilities such as water and electric power are not readily available, and they are very essential in this business. Hospital resorts to alternative source of power outside the national grid, and this is more expensive, thereby increasing the cost of treatment. Non-payment of salary as and when due and stagnation in service add to the challenges in the management of their patients.
