Nigeria: Health of the nation

There are many nagging issues beleaguering the Nigerian health delivery sector but I will be focusing on a few disturbing ones. Some few years ago, the World Health Organization (WHO) ranked Nigeria 187 out of 191 countries in its ranking of the world’s health systems. We are often called the giant of Africa but varying indicators point towards the contrary.

Ghana, Togo and Mali ranked better than Nigeria with 135, 152 and 163 respectively. Even neighbouring Chad republic that relies so much on our expertise in most sectors of their economy ranked 178! The issue of healthcare financing/budgeting has consistently been a major challenge in Nigeria and Africa as a whole.

The WHO standard of minimum budgetary allocation for the health sector has consistently been tinkered with by government, to the detriment of our health delivery system. In April 2001, Heads of State of African Union countries met in Abuja and pledged to set a target of allocating at least 15 per cent of their annual budgets to improve the health sector. In spite of this commitment, our leaders at the federal, state and local government levels have violated this redemptive measure with impunity as successive governments have failed to deliver on the Abuja promise.

The most challenging aspect of our health delivery system is the issue of the primary health care system. The level of civic dereliction and negligence by governments at the federal, state and local levels is extremely appalling. Former National President of the Nigeria Medical Association (NMA), Dr. Kayode Obembe, has continually complained bitterly about the level of redundancy, deterioration and negligence in our primary health delivery system. In terms of structures, manpower, medical facilities and availability of drugs, it is very obvious that urgent restructuring is needed to revive the deteriorating health sector.

It is the height of systemic and social abandonment to know that most primary health delivery centres are more dependent on NGOs, multilaterals and private donors; the HIV/AIDs, malaria, polio and tuberculosis preventive and treatment services in the nation is at the mercy of NGOs and private donors. The government, at the federal, state and local levels should take full ownership and responsibility for the primary health care system by redesigning and restructuring the delivery system to be ‘grass-root friendly’. Government should design and perfect an alternative quality control system to monitor, evaluate and certify the quality of delivery system in the primary health sector. Most primary health delivery centres exist only on papers and not in their operational form, the Federal and state government should carry out a painstaking audit in all the local wards in the 36 states to evaluate the authentic state of our health delivery system.

Another area that needs to be seriously readdressed is the issue of the quality and quantity of medical personnel in the nation. The Nigerian Medical Association (NMA) had for the umpteenth time warned on the looming scarcity of medical doctors in the nation, the appalling depth of brain drain in the Nigerian health sector needs urgent attention. A significant number of medical doctors, mostly in the public sector, have continuously complained about their working environment and some had already migrated to USA, Canada and UK for a more conducive and rewarding environment. It is also sympathetic to know that approximately one-third of medical graduates trained in Nigeria ultimately end up in Europe and USA. It is good to note that this continuous exodus of medical personnel is not all about the poor remunerations, but mostly as a result of frustration resulting from inconducive environment, lack of career development, alarming dearth of medical resources, blatant mismanagement coupled with unprecedented corruption in high places.

I am reaching out to the Honourable Minister of Health, Professor Isaac Adewole, to set-up a special committee to look into the issues around the exodus of Nigerian doctors to foreign countries and also modalities that need to be put in place to even attract those trained overseas to come back to Nigeria.

In his own position as a medical doctor and seasoned politician, the governor of Ondo State, Olusegun Mimiko, said the dearth of seasoned, well-trained professionals in the medical industry has been the bane of qualitative, efficient and sustainable healthcare delivery in Africa. He also emphasized on the exodus of highly competent doctors, pharmacists, nurses and other medical professionals with the attendant toll on the WHO’s Health Care Professional-Patient ratio.

The issue of reproductive health is also an area that needs urgent attention. The President, Society of Gynaecology and Obstetrics of Nigeria (SOGON), Prof. Brian Adinma said: “Nigeria is still one of the 10 countries responsible for 60 per cent of maternal mortality in the world.” I am really fascinated by the novel initiative of the Governor of Ondo State and his pioneering project tagged the “ABIYE INITIATIVE”. The Abiye Safe Motherhood project aimed at reducing maternal deaths by 15 per cent and child deaths by 26 per cent respectively, has already received great commendations from global observers. Former World Bank African Region Vice President, Mrs Oby Ezekwesili, once remarked that “Ondo State had provided a role model and benchmark for the African continent in tackling infant and maternal mortality rate.” The federal government must come down from its lofty height to learn from this initiative and see to how it can be replicated and even improved upon in other states of the federation.”

I will also want to address the issue of ‘unpatriotic’ rush by Nigerians for medical tourism in foreign countries. Nigeria loses over N200 billion yearly to medical tourism. It is sympathetic to know that some Nigerians even visit Sudan for heart-related surgeries that can easily be done here in Nigeria. It is noteworthy that the same country (Sudan) that has been ravaged by civil war for nearly two decades, now boasts of a world- class medical facility, Salam Centre for Cardiac Surgery. India, Britain, the United States and Germany are among the preferred destinations of most Nigerians, with India actually becoming a medical tourist hub for the nation.

I would like to advise the honourable minister of health to constitute a stakeholder committee comprising Commissioners of Health, Permanent Secretaries in the health ministry, the Chief Medical Directors (CMDs) in the various tertiary health institutions and professional health gladiators to map out a ‘redemptive’ strategy to fully equip and upgrade our tertiary health institutions to measure up with global standards.

Another aspect that should not be taking lightly is the discriminatory treatment among various health practitioners. The National President of the Nigerian Union of Allied Health Professionals (NUAHP), Dr. Obinna Ogbonna, has reiterated severally the effect of discriminatory treatments among health practitioners. We must find a levelling ground among the doctors, nurses, dentists, pharmacists, medical laboratory scientists, nutritionists and others. We must systematically remove the discordant marginalization in policies and welfare packages so as to allow for maximum synergy among health practitioners. It is very obvious that the continual hegemony, stratification, marginalization and rivalry have always contributed to the destructive show of supremacy that mostly results into incessant national strike that has threatened to cripple and polarize the health sector.

One of the prevailing health issues resulting from the aftermath of security issues in the nation is that of the Internally Displaced Persons (IDPs). Nigeria has one of the largest populations of displaced persons in Africa and if strategic attention and monitoring is not given to this surge, it might really drain the distribution of medical personnel in the nation and also encourage classical corruption in case of inaccurate accountability figures being projected.

It was a mixture of hope and despair when the Prof. Isaac Adewole declared a “nutrition emergency” in Borno State, adding that: “We stand to lose 80 children each day if we don’t do anything”. It was also encouraging to know that an emergency team was set up to look into the intense malnutrition affecting camps for internally displaced persons (IDPs). In order to alleviate the surge of malnutrition among internally displaced people (IDPs), the United Nations Central Emergency Respond Fund (CERF) has released US $ 13 million to provide immediate life-saving food, nutrition and protection assistance to 250,000 new accessible people in North East Nigeria. We need urgent clarifications on the issue of donations from UN and other donors so as to avoid mismanagement of these life-saving and palliative funds.

Next week, I will be writing on gender equality and reduced inequalities. Until then, act locally but think globally.