Access To Quality Surgical Care In Nigeria: The Challenges And Way Forward

Patient experience concept. Stethoscope and smiled faces for hospital consumer assessment.
smiling pediatric medical professionals with african mother holding her baby

Quality medical care is a necessity in any society because of its effect on healthy living and quality of life. Good access to quality medical care again improves health outcomes; increased life expectancy and reduced costs. Patients with access issues may avoid seeking treatment with attendant consequences of increased morbidity and mortality.

In most Nigerian communities, quality medical care is most not available and where available, access constitutes a major challenge. More than fifty per cent of Nigerians are residents in rural settings. In such communities, health institutions are a mirage and where present, the issue often revolves around the availability of well-trained and competent healthcare personnel or good quality orthodox drugs. Sometimes, traditional beliefs and taboos constitute another hindrance.

In Nigerian urban communities, the availability of quality health facilities and personnel as well as people’s wrong perception of health-seeking behaviour may not be an issue like in rural and semi-urban areas. Most of the time, poverty is the real monster for which many sick persons die in their homes not being able to access treatment for their ailments.

The scenario cuts across all forms of medical care and perhaps worse surgical care. This is why in the year 2015, the concept of “Global surgery” was brought up by the Lancet Commission on Global Surgery. According to the concept, surgery as an arm of orthodox medicine or health care was believed to be marginalized and therefore an area of public health requiring some sort of heightened attention. Damilola A. Jesuyajolu and his research associates had claimed that five billion people, across the world, do not have access to quality and life-saving surgical interventions; how can Nigeria be an exception? There is doubt that the world is craving for a universal access to safe, affordable, surgical, and anaesthesia care at this time of our existence!

Several factors constitute limitations to quality surgical care. While examining access to quality surgical care, the focus should not be lost on geographical access to a surgical centre, availability of qualified surgical staff, amount of surgical infrastructure and many other important requirements. Access to timely essential surgery, Specialist surgical workforce density, surgical volume, Perioperative mortality, Protection against impoverishing expenditure, and Protection against catastrophic expenditure are similar important considerations.

Poverty and affordability of surgical care is a huge challenges in Nigeria irrespective of the part of the country where an individual is a resident. It is said that 40 per cent of Nigerians, constituting about 83 million people, live below the poverty line. Many Nigerians are also described as vulnerable to falling below the poverty line at any time due to many social challenges such as lack of jobs, inflation and recession among others. Surgical interventions or procedures cannot be free owing to the many requirements. If the person needing the surgery cannot afford to pay, someone somewhere has to be responsible.

The timeliness of access to surgical care is another headache in Nigeria. Certainly, delays to care will be a national issue given the brain drain syndrome bedevilling the country at this time. Health care givers including surgeons, anaesthetics and many others are poorly motivated. Doctors to patient ratio continue to fall under this scenario of poor pay and working conditions. How can Nigeria be saved?

An additional challenge is the distribution of surgeons in the country, which is skewed in favour of the cities. Furthermore, the number of surgeons produced by way of training at the postgraduate level is abysmally low compared to the Nigerian population’s needs. Most, if not all, medical doctors completing their undergraduate training at this time hold an aggressive desire for postgraduate training outside Nigeria and are actually leaving in droves. The country is short of surgeons in training and hence, in practice. This may be connected to the poor pay, kidnapping and high rate of banditry in the nation.

The way forward is for our government to develop political goodwill by which they will evolve a roadmap to quality healthcare and surgical services in the country. Political goodwill will engender the government to make a better and more reasonable financial commitment to the health sector by way of budgeting.

The government also needs to truthfully and sincerely empower the populace. A viable business environment needs to be created. Electricity supply appears to be a major reason many people cannot make ends meet and are out of jobs. Population control and access to western education are other focal areas needing government attention in resolving healthcare-related challenges in Nigeria. Good payment and another reward system for healthcare workers can also not be left out if the recent brain drain must be curbed.

The National Health Insurance Scheme (NHIS) if made efficient will help in resolving the issue of affordability of surgical care. Health Insurance Schemes are working satisfactorily in the western world from where Nigeria can borrow a leaf.
•Adegboro is a Professor of microbiology and immunology at the Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja.
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