Sun, July 27, 2014 15:47:14
Nigeria’s fragile health system shares similarities with other developing economies like Pakistan and Ghana in terms of progress and challenges. I’ll begin with the positive aspect. With respect to the Millennium Development Goals, Africa’s biggest economy has made some progress. WHO statistics show that compared to the 1990 level when infant mortality rate (IMR) exceeded 180 deaths/thousand, child mortality in the West African country have reduced to about 120 deaths/thousand at national level. And if we further disaggregate that data, we’ll see that South-western Nigeria has met the MDG in that IMR has reduced by two-thirds relative to 1990 level in the region. Yet there are other parts of the country where IMR is nearly as twice as what we obtains in the South-western region.
However, inequality in the distribution of human resources for health underpins the sharp contrast in IMR between the two regions. For example, data obtained from the Federal Ministry of Health shows that 4 out of 10 physicians and 5 out of 10 pharmacists are in the South-western region alone while the remaining five geopolitical zones shares the rest.
Also, the Federal Government recently launched the Universal Health Coverage which would ensure that those who are not civil servants or employees of corporate bodies such as traders and artisans are covered by the National Health Insurance Scheme NHIS. This development is expected to improve the health of about 180 million Nigerians most of who normally rely on herbal and home remedies or pay out of pocket at public and private health institutions.
In terms of the challenges, one may have to wonder how many African countries have better health outcome than Nigeria despite the latter’s relatively large health workforce and impressive GDP. The fact is the strength or weakness of a health system has more to do with leadership and efficient use of human and financial resources than how much a country earns as GDP or the absolute number of health professionals. Zambia, a South African country, for example, outperforms both Nigeria and Pakistan in human development index according to the recently published human development report. And that’s despite Zambia’s smaller economy. While Nigeria’s health sector may be said to need more health professionals and funds, considering her mammoth population, I believe that with political will and commitment of stakeholders, far better health outcomes can be delivered at the current rate. In order to strengthen the health system, the following are some keys issues that need to be addressed.
The politicians who appoint administrators of the sector must ensure the best personnel is put at the helm of affairs. If appointments are a means of settling political allies, then the system would not be making people use of the best persons. Corruption, attitudinal problems and frequent strike actions by health workers are offshoots of leadership problems which must also be dealt with headlong. All these prob
lems manifest in many embarrassing ways. For example, there are serious regulatory issues where for instance, people who are not pharmacists are “selling” antibiotics and other prescription drugs indiscriminately in the open market. And the government has not been able to stop that.
Similarly, the horrible situation of toilets (exposed by Channels TV reporter) in Lagos University Teaching Hospital and how the awkward Chief Medical Director was passing the buck to the “FederalGovernment ” makes one feel home is safer. The CMD and other senior people in public hospitals know how to ensure their own toilets are clean and disinfected. But they don’t care to ensure the facilities available to the patients for whom the hospital exist are in decent condition. Perhaps I won’t be wrong to say that if you want to know how good a health facility is, don’t go see equipment in the theatre, first check their toilets.
Furthermore, politicians must be seen to make use of public health institutions. This will be a token of their investment and faith in the health system. Embarking on medical tourism even for conditions or services that we have skilled health professionals to take care of is a sign that politicians themselves know they are not making personal and adequate investment in health. That of course sends a bad signal to the public that what is on ground is not good enough.
I can draw a sharp contrast between two politicians: Bala Ngilari, the embattled Adamawa Deputy Governor (now resigned) who flew to Dubai for a “medical check up” (only to make a frantic return back to Nigeria when he caught wind of his impeachment); and Kelvin Hopkins, a British MP of Luton North, who does health checks in the same health facility used by members of his constituency. Thus, it is not hard to see why, generally speaking, Nigerians do not trust the health system and would only seek medical attention at an advanced stage of their disease condition when things are getting out of hand. Even Onyebuchi Chukwu, the current health minister who sits on multimillion dollars foreign aids for health and all health facilities in Nigeria, has been alleged to travel abroad for basic health services. Dora Akunyili, former Information Minister and Nigeria’s FDA boss died of cancer in an Indian hospital in June
Political and healthcare leadership should ensure that the quality of healthcare they themselves can use is what is made available to the public. Otherwise even they will be victims someday, because there are emergencies that would need such a timely intervention that they would have died before getting to “Dubai”.
Finally, developmental issues affecting health must be addressed, especially poverty. Fighting disease is nothing as long as poverty persists. We cannot separate development from health. There are cases where people who barely eat once in a day are also managing cardiorenal diseases like hypertension and diabetes. How can they afford or comply with their medications? Their conditions would rather deteriorate, resulting in stroke, gangrene, blindness, heart failure and many other morbidities.
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