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Poor Utilisation Of Resources Remains Problem Of Healthcare Sector, Says Osibogun


Osibogun-30-5-15-CopyWith your experience in public health research and management, what will you say are the solutions to the various challenges facing the nation’s healthcare system?
THE challenges facing the healthcare system in Nigeria are several. One challenge is the challenge of insufficient funding of the health system.

The total health expenditure per capital for Nigeria is roughly about $61 per head. But the total health expenditure per capital in the United States of America is about $8,000 and per capital expenditure for health in Europe is between $4,000 to $5,000. You know that $61 cannot buy the same thing $5,000 can buy. Of course, you can only spend what you have. So the total health expenditure per capital being $61 is also a reflection of our gross domestic product (GDP), which is our productivity level as a country.

To understand the GDP, I will give you some figures to compare with those same countries mentioned earlier. The GDP per capital for Nigeria is between $2,000 to $4,000 per head. And GDP per capital for United States of America is $50,000 and the GDP for Europe is roughly about $40,000 per capital. By Europe, I mean countries like Britain, Netherland among others.

You can see that the available wealth between developed countries and developing countries are different. So, developed countries ‘appear’ to have more wealth than developing countries. And because they have more disposable wealth, they are, therefore, in a better position to invest more in health sector.

It is not as if some developing countries are not also wealthy. But the actions that are required to be taken to make developing countries become wealthy are actions that require political decisions as well as economic engineering.

We have resources we can potentially turn into wealth for the benefits of our people; it requires political leadership and economic reengineering.

The second challenge is the challenge of proper management of resources. Even the $61 we are expending on health, are we expending it efficiently as we ought to? So, the question of efficient utilisation of resources is the second question. To give a clear picture, I will compare three countries. We are expending $61 per capital, while Ghana is expending about $54 per capital. So, we are spending more than Ghana. But Ghana has life expectancy of 58 years, while we have life expectancy of 49/50 years. So, if you look at the health outcomes in Ghana, they are generally better than the health outcomes in Nigeria. But Ghana is spending less than Nigeria.

In other words, even the $61 expenditure per capital we are spending, if we apply it judiciously, we can get better results.

I am not saying that those results will be as good as the ones in the west because if you look at the life expectancy in the United States of America, it is about 78 years, and in Europe it is about 81 years, compared to life expectancy in Nigeria of about 49/50 years. But if we manage the available resources efficiently, we can achieve greater results than we are achieving now.

Inefficient management of resources may be tied to the third challenge which is restiveness in the health sector. We waste a lot of resources in unnecessary inter-professional rivalries leading to frequent strike. When you run a system that is most of the time shut down, it results into wastage of resources, because one union will go on strike, today but will resume after two weeks; another union will take over from there. So, the citizens are not getting adequate benefits for the service and resources that are utilised.

That itself may be tied to the fourth challenge which is how we structure the health system. We structured the health system in such a way that proper funding of health services, and provision of those services are to large extent politicised by these unions. The politicisation of health service delivery is what has resulted to these incessant strikes. But government has a responsibility of making sure that services are available and accessible to the citizens.

But there are other mechanisms we can also used to structure services. In the United States of America, the biggest hospitals are not public hospitals; they are private hospitals. So when you have these hospitals in the hands of private persons, government can now make a different arrangement to ensure that citizens have access to services.

I am saying that the funding of services, and provision of services may not be entrenched in one sector.

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