It is an undeniable fact that in the last 53 years of Nigeria’s history, her health sector like other sectors of the country’s economy has had its good and bad times with uninspiring national health indices attributable to years of cumulative insults, lack of professional order and best practices, a weak private health sector, poorly developed social infrastructure, as well as policy inconsistency.
It is an undeniable fact that in the last 53 years of Nigeria’s history, her health sector like other sectors of the country’s economy has had its good and bad times with uninspiring national health indices attributable to years of cumulative insults, lack of professional order and best practices, a weak private health sector, poorly developed social infrastructure, as well as policy inconsistency.
It is troubling that after 53 years of Nigeria’s independence, her health system is still struggling to deliver health dividends of democracy to her long suffering people.
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Nigerians had expected that following the Walter-Harkness Ten Year Development Plan as well as the enunciation of the first National Health Development Plan in 1960, Nigeria before half a century of her independence would have achieved Universal Health Coverage with all her citizens having access to quality and affordable healthcare. Sadly, many factors have continually conspired against the realization of this laudable objective, despite the current efforts of the Federal Government through the country’s Honourable Minister of Health, Prof. Onyebuchi C.O. Chukwu, to reposition the health sector.
Some of these factors include:
(1) Poor governance at most levels of government;
(2) Political instability, policy inconsistency and evident lack of political commitment to health by most state and local governments in Nigeria;
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(3) Monumental corruption and infrastructural decay;
(4) Undue politicization of the health sector coupled with declining professionalism and non-adherence to best practices;
(5) Poor constitutional and legal framework for health in Nigeria, particularly the absence of a National Health Act that clearly makes the health rights of the people justiciable; that defines the roles and responsibilities of healthcare professionals, as well as the roles and responsibilities of Local, State and Federal Governments in the management of the three levels of healthcare;
(6) Poor co-ordination, integration and implementation of health policies, programs, projects and donor support;
(7) Poor funding and budgetary provisions for health, far less than the stipulated 15% of the National budget as prescribed by the World Health Organization and affirmed by the 2001 Abuja declaration of African Heads of State;
(8) Poor Health Human Resource (HHR) Development Plans and Reward System in the health sector, including poor remuneration, poor working conditions and poor motivation of the health workforce; as well as inadequate numbers and inequitable distribution of the health workforce;
(9) Worsening poverty and low level of Health Coverage for all Nigerians;
(10) Inadequate involvement of health professional associations and communities in the planning, implementation, monitoring and evaluation of health policies, programs and projects; as well as in budget monitoring;
(11) Weak private health sector coupled with inefficient utilization of healthcare resources;
(12) Pervasive quackery in the health sector with poor enforcement of extant laws;
(13) Poorly developed data base and Health Management Information System, coupled with poor use of Information Communication Technology, particularly e-Health in advancing access to healthcare;
(14) Conflicting professional regulatory laws/Acts in the health sector which has been a major factor responsible for disharmony in the health sector;
(15) Weak Primary and Secondary levels of care with a weak Referral System, attributable to evident lack of commitment to the development of the primary and secondary healthcare systems by most local and state governments; and
(16) Poor state of other social and physical infrastructure, including roads and power supply.
Despite these challenges which have affected the life expectancy of Nigerians and blighted Nigeria’s progress in her health sector, it is important to note that there have been some achievements recorded over the years in the health sector, particularly in the last decade. For instance, whereas most other public/government parastaltals and banks have either collapsed or are at the verge of collapsing, the indigenous managements of most public and private hospitals in Nigeria have survived the travails and systemic decay of the Nigerian society. This is an achievement in itself, especially when one recalls that the International Hospital Group of British managers imported some time ago to run National Hospital, Abuja, could not contend with the suffocating environment under which the current Chief Medical Directors and Medical Directors of public hospitals operate. Of course, one cannot forget the tremendous milestones recorded in Nigeria’s health sector in the 80’s and early 90’s with general improvements in Primary Health Care, as well as noticeable improvements in institutional and human resource development.
On account of some development initiatives by the current Federal Minister of Health, Prof. Onyebuchi C.O. Chukwu, backed by renewed commitment to health and good governance by some state governments, in addition to the contributions and constructive support of other stakeholders in the Nigerian project, there seems to be hope that with respect for professionalism and best practices in the health sector, Nigeria’s healthcare delivery system can be repositioned to meet the health and development needs of Nigerians and citizens of the world.
This hope is further strengthened by some improvements recorded in Nigeria’s health indices, as reflected in the results of some recent health surveys. These include improvements in the Maternal Mortality Ratio from its 2003 figure of 800/100, 000 live births to the 2010 figure of 545/100,000 live births, and now below 400/100, 000 live births in 2013 (according to the National Bureau of Statistics). Similarly, the Infant Mortality Rate is said to have improved from its 2003 figure of 100/1000 live births to 75/1000 live births, while Under-five Mortality Rate is said to have improved from its 2003 figure of 201/1000 live births to 157/1000 live births.
As Nigeria celebrates her 53rd Independence anniversary, she could in subsequent years, witness better performance in her overall growth and development if greater efforts are made to secure:
(1) Greater commitment to electoral reforms and enthronement of good governance, as well as credible, committed, accountable and people-centered leadership at all levels of government;
(2) Political commitment to health by all levels of government, particularly state and local governments with political leaders at local, state and federal government levels committing themselves to the utilization of public healthcare facilities in their communities, states and local governments rather than the frequent recourse to foreign medical care for medical conditions that can be effectively managed in Nigeria; This will save Nigeria from the huge capital flight and annual loss of over $800 million due to unrestricted medical tourism;
(3) Transparent and sustained implementation of poverty reduction schemes to reduce household poverty;
(4) Rapid expansion of the National Health Insurance Scheme with commitment to Universal Health Coverage by government at all levels. This will substantially reduce catastrophic health expenditures by Nigerians and improve their overall standard of living;
(5) Sincere improvement in the budgetary provision for health to at least 15% of Nigeria’s national budget, backed with adequate release and effective utilization of the available funds and resources;
(6) Provision of modern and standard health infrastructure and facilities with sustained maintenance and facility/infrastructural upgrade; backed with a strengthened computerization, automation and public-private policy.
(7) Urgent resuscitation, rehabilitation and strengthening of the secondary and primary healthcare systems with strengthening of the Referral System and employment of an adequate and appropriate mix of health manpower, including the employment of at least one Medical Officer of Health per Primary Healthcare Centre in each Local Government Council;
(8) De-politicization of the health sector with emphasis on professionalism, best practices and adherence to professional job description, ethics and values;
(9) Concrete provisions for health in Nigeria’s constitution with the health rights of the people defined and made justiciable to empower them to demand accountability from their leaders;
(10) Accelerated passage of the National Health Bill (NHB) with assent by the President of the Federal Republic of Nigeria; Nigeria has no excuse not to have a National Health Act in this 21st century;
(11) Improved co-ordination, integration and implementation of health policies, programs, projects and donor support;
(12) Committed implementation of the National Strategic Health Development Plan by all levels of government;
(13) Establishment of effective and responsive Health Human Resource (HHR) Development Plans and Reward System in the health sector, in a way that drives productivity and attracts health human resources;
(14) Improved Remuneration and welfare packages with universal application of wages in the health sector to encourage retention of health personnel in rural areas;
(15) Involvement of health professional associations, communities and other stakeholders in the planning, implementation, monitoring and evaluation of health policies, programs and projects; including their involvement in budget monitoring at institutional and governmental levels;
(16) Ban on indiscriminate advertisement of herbal and medicinal products on the electronic and print media to save Nigerians from the untoward effect and dire complications of quackery exhibited by charlatans;
(17) Empowerment of existing regulatory bodies and agencies with institution of stiffer penalties for quacks in the public and private health sectors; including the introduction of life imprisonment;
(18) Improvement in the data base and Health Management Information System for appropriate research and decision making; coupled with improved utilization of Information Communication Technology, particularly e-Health in advancing access to healthcare;
(19) Resolution of conflicting professional regulatory laws/Acts in the health sector to return harmonious relationship in the health sector, particularly in the area of laboratory services in Nigeria’s public hospitals;
(20) Improvement in health-related social sectors such as Power, Transportation/Roads, Education, Water, Agriculture, Security and Housing; and
(21) Resolution of the chaotic drug distribution market in Nigeria through ingenious means such as the creation of regulated drug markets by the government, and enforcement of the extant laws guiding prescription of prescription-only medicines by only licensed medical doctors/dentists and veterinary doctors. Stiffer penalties should be prescribed for illegal prescribers of prescription-only medicines.
(22) Government support for the private health sector through the institution of a private health and hospital development fund.
I am sanguine that if most of these strategic recommendations are given serious consideration and implemented, Nigeria in the not-too-distant future should have a healthcare delivery system that compares favourably with that of other developed countries.
Dr. Osahon Enabulele
President, Nigerian Medical Association
&
Vice President (WAR), Commonwealth Medical Association
The views expressed in this article are the author’s own and do not necessarily reflect the editorial policy of SaharaReporters
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