Diagnosing Nigeria’s public health challenges

Nigeria is often referred to as the “Giant of Africa” owing to its large population and economy.  There are more than 250 ethnic groups speaking about 380 languages with a diverse range of cultural and religious beliefs and practices in Nigeria. In spite of all these strengths, public health challenges have been a nagging problem bedeviling the well-being and stability of the country for a long time.

The major public health issues facing Nigeria are poor sanitation and hygiene, control of vector borne diseases, maternal and infant mortality, infectious and non-communicable diseases, sewage disposal, drug and substance abuse, alcohol abuse, environmental pollution, road traffic injuries, incessant doctors strike among others.

Unless measures are being implemented, Nigerians will continue to die unnecessarily from preventable conditions. The WHO Global Status Report on non-communicable disease listed Nigeria and other developing countries as the worst hit with deaths from non-communicable diseases.

These diseases with a rising burden in Nigeria include cardiovascular disease, tuberculosis, hepatitis, cancer, diabetes, chronic respiratory diseases, sickle cell disease, malaria, asthma, coronary heart disease, obesity, stroke, hypertension, road traffic injuries and mental disorders etc.

According to a report published by the Statistica Research Department, the top 10 causes of death in Nigeria in 2019 are neonatal disorders accounting for 12.25%, Malaria 12%, Diarrhea 11.36%, Respiratory Infections 10.85%, HIV/AIDS 5.18%, Ischemic Heart Diseases 4.37%, Stroke 3.98%, Congenital birth defects 3.26% Tuberculosis 2.84% and Meningitis 2.82% respectively. The summation of these ailments alone has accounted for almost 69% deaths of Nigerians in that particular year!

Also, as of 2021, the life expectancy at birth in Nigeria stands at about 60.87years. More specifically, this figure equaled 59 years for males and 63 years for females. It is not encouraging that Nigeria’s figure is among the lowest in Africa as well as in the world.  

Nigeria has one of the highest Tuberculosis burden in the world (311 per 100,000) resulting in the largest burden in Africa. Worse still, the country is frequently being hit with myriad forms of infectious diseases on an occasional basis. Notable among them is the ongoing pandemic due to COVID-19 outbreak which emanated from China towards the end of 2019. Others include Lassa fever, Monkeypox and Ebola virus.

Nigeria, being an attractive destination for commerce, is therefore not isolated from global pandemics which occur with some degree of unpredictability. Despite these occurrences of outbreak, there has not been an effective and efficient emergency response and disease prevention system in Nigeria to tackle these issues.

Commendably, Nigeria’s prompt and robust response to the Ebola outbreak of 2014 in West Africa remains a watershed in the management of public health emergencies in the world. This was done by using surveillance and isolation of contacts to limit the spread and a few months later, the outbreak was contained and was branded a “remarkable success story” by the World Health Organization. Similar efforts are currently being applied on the current COVID- 19 pandemic in addition to vaccination and tremendous successes were recorded as revived patients are being discharged on a regular basis. 

Furthermore, the combination of meningitis and tuberculosis also present a threat to Nigerians as these duos of bacterial infections are responsible for about 5% death of Nigerians annually. As a highly contagious bacterial disease, meningitis usually flares up in concentrated outbreaks in Nigeria such as in the April 2017 epidemic which culminated in the lives of over 1000 people.
 
The Nigerian health sector is currently facing significant challenges which include, among others an uncompleted agenda on the containment of infectious disease, as well as the rapid and on-going emergence of non-communicable diseases. While there is shortage of health workers as a result of economic and social brain drain, it has been estimated that there are only about 27 physicians per 100,000 people in Nigeria as against the WHO’s recommendation of 1 physician to 600 people. These multifaceted challenges are compounded by arisen economic policies, socio-political factors in the country’s history and limited institutional capacity to provide efficient responses at a population level.

More so, lack of commitment on the part of the government, especially during military rule has helped a lot in worsening the fragile sector again. Furthermore, there is no equitable distribution of human resources between urban and rural areas. Over 70 percent of doctors are concentrated in urban areas where only 51% of the population reside, thereby leaving 49% of the population who live in the rural area at the mercy of inadequate health personnel.

According to the latest version of National Security Strategy 2019, a document released by the Office of the National Security Adviser (ONSA), the global trends of antimicrobial resistance and substance abuse exacerbated by influx of counterfeit drugs also remain a potent threat to Nigeria. This phenomenon is further reinforced by the activities of fake drug cartels and globalized criminal networks which eventually breed drugs and substance abuse. 

The primary health care on which the Nigerian health care system is based has not helped in effectively solving the numerous health problems in Nigeria. Cost effective interventions for priority public health issues such as non-communicable diseases, injuries, maternal and child health etcetera are hardly being used.

In addition, inter-sectoral cooperation and collaboration between the different health-related ministries still remains a major issue. This has no doubt played a critical role in sabotaging the effort of health care delivery in Nigeria.  In this regard, Nigerian government should in collaboration with other International Health Institutions do the needful to provide an efficient and effective health care delivery system in Nigeria. Therefore, Government should improve its plan on tackling the major public health issues i.e. HIV/AIDs, Tuberculosis and Malaria which still remain the major health issues in the country.  

Subsequently, construction of additional medical centers especially in remote areas and rehabilitating the existing ones should be of utmost priority. Recruitment of more medical practitioners and providing a conducive working atmosphere will also go a long way in solving lingering public health issues facing the country.

In the event of curtailing drug abuse incidences, the Government should continue to promote the ideals of International Health Regulations (IHR) while working with relevant agencies to curb the spread of fake or expired drugs and their subsequent abuses.
Mukhtar writes from Madobi, Kano State. ([email protected])