Nigeria should invest heavily in healthcare financing, research
Health care performance in the country has had its good and disappointing period. It had done well with primary health care performing so well until the exit of Professor Olikoye Ransome-Kuti when the primary Health care collapsed irredeemably. All the health indices (Childhood immunization against vaccine preventable diseases, childhood nutrition, maternal mortality, child mortality) nose-dived. The figures are very bad. Simply put, Nigeria healthcare performance will require a strategic focus for a gradual recovery provided there is palpable commitment form Governments, health workers and other stakeholders.
Health research is a thoroughly neglected component of Health delivery system.We certainly have made progress in some areas, while we have performed poorly in some other areas. There has been improvement in policy formulation but there has not been commensurate policy implementation. There has not been sufficient investment in healthcare delivery, as the country has continually witnessed paltry budgetary allocation to health of between four to five per cent of national budgets. The performance of the states (except maybe, one or two) to say the least is disappointingly poor. The situation in Local Governments is woeful and clearly, it may be true to state that the Primary Healthcare System in the Local Government is said to be in coma.
Human capital development in training Medical Doctors and Nurses, even when not adequate, has witnessed some improvement. There are now over 33 Colleges of Medicine, training Medical Doctors, as against only University College Hospital, Ibadan at Independence, to LUTH, ABU and University of Nigeria in the sixties. Schools of Nursing have been upgraded to Colleges of Nursing and midwifery and increased number across and recently, many Universities have started training Nurses and Medical Laboratory Scientists. Additionally, Nigeria has a very well established National Postgraduate Medical College (NPMCN) to train Medical Specialists and Consultants in fifteen (15) Specialties.
This is against what was obtainable at Nigeria’s Independence when all Medical Specialists were trained abroad, mostly in United Kingdom at huge costs with monumental drain in the country’s foreign exchange to Nigeria. The West African Postgraduate Medical College, which also trains Medical specialists, has huge contributions by Nigeria, (both financial and human resources) to its establishment.
Unfortunately, there is unacceptable mal-distribution of health care personnel to the detriment of the rural area, which has huge burden of diseases and ill health.
A great challenge in the human resource component of the health care delivery system, is the failure of the states to employ, train and retrain Specialists and other health workers in their Secondary Health system, leaving the Federal Government to carry the huge burden of health care, since the National Health Insurance Scheme remains infantile and stunted in growth and development, with failure to impact positively on the health of Nigerians, particularly the very poor. The National Health act of 2014 should bring with it improved quality healthcare, but the implementation is yet to be perfected and we hope implementation will be made sustainable.
What have been the challenges? The challenges are numerous ranging from inadequate and poor fund allocation; to inadequate number and mal-distribution of health care personnel; to poor work attitude of health care workers to patient care; to the old, antiquated, dilapidated and dysfunctional equipment; to failure to invest in health research which outcomes will improve quality of health care and finally, to the current unbridled professional rivalry, where all the allied health care professionals have demonstrated palpable hatred for the Medical Doctor.
What are your recommendations on how to improve healthcare delivery in the country after 59 years? My recommendations include:
(a) Nigeria should invest heavily in health care (Health care financing) and health research
(b) Health Insurance be made compulsory for all Nigerians
(c) Intensive recruitment and deployment of Medical Doctors and Nurses to primary Health care facilities to provide quality health care to rural Nigerians
(d) Judicious use of the Basic Healthcare provision fund (BHCPF) at the primary Health facilities for procurement of Drugs, consumables and other essential items as well as improving the infrastructure for conducive work environment.
(e) The State Governments should take up the responsibility of rehabilitating and equipping the General Hospitals as well as primary healthcare facilities
(f) Human Capacity development of health workforce must be intensified to improve quality of care as well as the strategic focus and regular and Continual Professional Development (CPD)
(g) Innovative and well conceived strategy through public-private partnership (PPP), must be adopted to ease the procurement of Diagnostics (Laboratory and Radiological) which are essential to support diagnostic accuracy of pathologies and improve quality of care
(h) Commensurate incentives to health care workers, as a reward for excellence must be instituted to curb the current monumental brain drain
(i) Rural allowance for rural healthcare workers will create some commitment to the provision of rural health care
(j) Governments must make fund for research a priority and strategic focus.
*Professor Innocent Ujah, is a Consultant Obstetrician & Gynaecological Surgeon Jos University Teaching Hospital, Plateau State, and former Director General, Nigerian Institute for Medical Research (NIMR), Yaba, Lagos.
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