Confucius admonished in one of his famous quote that “By three methods we may learn wisdom: first, by reflection, which is noblest; second, by imitation, which is easiest; and third, by experience, which is the most bitter”. The challenges of the Nigeria’s healthcare sector bring to bear the popular philosophical postulation: “a person who fails to plan, plans to fail”. The first casualty of non-planning was the relegation of preventive, mostly primary healthcare, abolition of sanitary inspection and increasing focus on procurement-driven curative & secondary and tertiary healthcare.
According to Dr Olamide Orekunrin, the problems of healthcare provision in Nigeria are manifold. There are many approaches and theories on how the situation could be improved for the millions of Nigerians currently without access to basic healthcare.
The Facts & Figures You Don’t Know
In 2011, Life expectancy for males stood at 46.76, while for women 48.41, Nigeria ranked 220 in terms of life expectancy globally.
According to the United Nations Population Fund (UNPF)2010, the maternal mortality rate per 100,000 births for Nigeria is 840 compared with 608 and 473 in 2008 and 1990 respectively. The under-5 mortality rate, per 1,000 births is 143.
These are mostly caused by increased population, inadequate access to quality care in rural and remote areas and shortage of midwives. In fact, the workforce requirement to attain 95 per cent skilled birth attendance by 2015 is estimated to be 6,790 according to the World Midwifery’s Report, 2011 compared to South Africa’s requirement of just 710.
A 2008 Demographic and Health Survey (DHS) found that for 25% live births, only 5% were attended by nurses or midwife, and 9% by a doctor. Correspondingly, 35% live births took place at a health facility.
Women living in urban areas were much more likely to be attended to by health care specialists than those living in rural areas (65% and 28% respectively in 2008). This imbalance in access to specialist care between urban and rural areas has been evident in all DHS surveys in Nigeria since 1990, but the gap has not narrowed over time.
Spending by private citizens, the Federal Government and the 36 states of the federation on foreign medical services is estimated at about N30 billion annually. This is digging a huge hole in the GDP of Nigeria. In 2009, the Kaduna State government spent about N900 million for overseas medical treatment for the well-connected and much less on primary healthcare
The disparities between the North and South is even more disheartening indicating that state governors and local government chairmen in the North have a lot more to do, and must wake up and invest more to prevent the avoidable deaths of mothers, infants and many children under the age five.
Who Is To Be Blamed?
The World Economic Forum has suggested that it would take economically developing countries 300 years with the existing infrastructure to achieve the same doctor to patient ratios that exist in many western countries. Nigeria can neither afford this, nor need to wait on a 300 year plan. What is needed is a ‘right now’ plan to save lives today.
To worsen an already bad case, it is noted with regret that corruption has permeated the system and is threatening to suffocate what is left of the rot. Most of the equipment classified as unserviceable were, indeed, discarded as scrap in foreign countries. Unfortunately, some corrupt Nigerian officials travel there, at state expense, to pay for them to be refurbished and then brought into the country as new. With the percentage of Nigerians living within the lower middle class and lower class strata, the consequences of this are higher mostly because they depend on public health institutions as they cannot afford the huge bills of private hospitals. Ironically, those behind the situation are usually sponsored by government to get medical treatment abroad, their families inclusive, whenever the need arises, in what is offhandedly referred to as medical tourism.
Winifred Ogbebo, a writer for leadership Newspaper on July 13,2015 writes on the many troubles in Nigeria’s health sector and states how peculiar it is. If its professionals are not at daggers drawn over salary and monetization benefits, it is embroiled in one controversy or the other. Many argue that Its distressing for Nigerian doctors or health practitioners to involve themselves in strikes. Over the years, this has brought untold hardship, sufferings and avoidable deaths to many families and patients across the federation. It has forced many people away from public hospitals to privately owned ones where cost of services is prohibitive and hardly affordable. Many others too have had to rely on traditional medicine as an alternative.
In 2015, the president of Medical and Dental Consultants Association of Nigeria (MDCAN), Dr Steve Oluwole lamented that for two years, his professional colleagues had not been able to make any meaningful impact in health care delivery in the country. He said such attitude to hospital services is unheard of in Europe, North America, other African countries, or anywhere else. Oluwole said the basis for the existence of health services had been replaced with unprecedented unbridled activism that “ignores and disrespects the ethics and established norms of unionism”.
While concurring to this, Former Minister of Health, Prof Christian Onyebuchi Chukwu, admitted that there are challenges militating against the sector’s growth and that certain factors were cross cutting. He observed that the many strikes and counter strikes that have bedeviled the tertiary hospitals for sundry issues have weakened the health services, shown maximum disrespect for human lives, and jettisoned the established order of humanity to care for the sick.
A Possible Way Out
A Harvard University study revealed that a preventative mobile health program returned $36 in savings on healthcare costs for every $1 spent on prevention. Creating a culture of health as opposed to a focus on illness requires a commitment to prevention. Nigeria must focus on preventing diseases and injury as it is the most cost-effective, common-sense way to improve health. A great and unnecessary proportion of healthcare funding is spent treating diseases and illnesses that are preventable. This ought not to be so. is when preventive healthcare fails that a visit to a medical professional becomes necessary. At the moment, the countries healthcare facilities are grossly inadequate and can only serve 5–10 percent of their potential patient load.
The problems of the Nigeria’s healthcare sector are numerous and require collective effort, creative planning, focused management and sensible application of resources on the part of the Federal, states, and local governments as well as the private sector.
No sector has suffered more than education and healthcare due to the nations abandonment of development planning in our governance strategies.
Driving down healthcare costs, providing universal healthcare coverage and concentrating on public health will all factor into a unique solution for Nigeria.
[Header image]– Curt Carnemark / World Bank / Flickr – CC BY-SA 2.0
