Nigeria’s Health Care Infrastructure Continues to Lag Behind
Nigeria’s health sector has suffered years of neglect. Promises made over the years are still largely unfulfilled and the bulk of policies and laws still lay dormant without implementation. There is a lack of coordination, a fragmentation of services, dearth of medical resources, including drugs and supplies, inadequate and decaying infrastructure, inequity in resource distribution as well as access to care.
In the past few years, Nigerians have dealt with several outbreaks of diseases such as Ebola, Lassa fever, cholera, monkey pox, all of which claimed the lives of over 2,000 people. Poor facilities, poor staffing, lack of equipment, low disease surveillance rate among other factors were identified as part of reason why most of the diseases were not quickly curtailed.
Apparently, spending and implementation have not matched policies. For instance, Nigeria spends only a paltry 3.9 percent of its budget on healthcare which is just a fraction of the World Health Organization’s recommendation of 15 percent.
The nation’s high maternal mortality rate remains worrisome as it is one of the highest in the world. One Nigerian woman dies in childbirth every 10 minutes. Nationally, the maternal mortality rate is 545 deaths per 100,000 live births, nearly double the global average.
Because of the poor state of the health sector, there has been a consistent mass migration of doctors and health professionals out of the country. This is in relation to the incessant strikes and poor working conditions and environment at the healthcare delivery centres. This development has led to an acute shortage of staff across the three levels of health care delivery in the country.
Political office holders and other well-to-do citizens of the country have had to travel out of the country to seek medical attention. They have also had to send their wards to countries with better equipped health care systems. Sadly, those who cannot afford the usually exorbitant bills for treatments in hospitals are allowed to manage the poor health systems in the country.
Today many primary health care centres across Nigeria are characterized by dilapidated structures, low staff, poor electricity, water, and cannot effectively serve people in the rural areas. Most pregnant women still seek the services of traditional birth attendants for delivery. Many children in the rural areas also miss out on routine immunizations which are meant to be one of the responsibilities of effective Primary Health Care Centres.
In the last three years, doctors under the Nigeria Medical Association and National Association of Resident Doctors have embarked on nationwide strikes which have crippled the health sector. In 2015 and 2016, two strikes were called by doctors to call attention to their demands for better working conditions.
Apparently, the health sector under the present administration has attracted media attention mostly due to unpleasant events reflecting the true state of health care delivery in Nigeria. After the series of strikes held by medical practitioners to seek improvements in their working conditions, nothing has changed.
But there were promises to ensure Universal Health Coverage; constructions of 10,000 Primary Health Centres to ensure effective health care delivery at all levels; implementation of the National Health Act that was signed into law by the past administration and revitalization of seven cancer treatment centres among others.
In April 2016, several months before his first ever medical trip to London, Nigeria’s president, Muhammadu Buhari condemned the use of Nigerian resources on international medical expenses.
“While this administration will not deny anyone of his or her fundamental human rights, we will certainly not encourage expending Nigerian hard-earned resources on any government official seeking medical attention abroad, when such can be handled In Nigeria” he said, according to a statement from the Ministry of Health at that time.
But Mr. Buhari himself has drawn several criticisms for travelling abroad in search of medical attention, abandoning the Nigeria health care system. This is even after he promised during his campaign to end medical tourism- the practice of Nigerian politicians who travel abroad to receive medical treatment.
In the Nigerian health sector, there is also the problem of counterfeiting, faking and cloning of drugs which is compounded by poor regulation and enforcement. Capacity utilization is equally a hindrance and there is a serious problem with the handling, storage and distribution of drugs which remains chaotic. This has led to a loss of confidence in all drugs whether imported or manufactured locally.
The way out of this mess
The fact remains that the health system in Nigeria does not measure up to global standards, which is why individuals who can afford it, seek medical care elsewhere.
But can anything be done to address this rot in the health sector?
As humans, you just have a little control over the place you wish to seek care but you don’t have control over where you will take ill or be injured. It is one more reason why there needs to be improvement in the quality of health care services in the country.
In order to achieve Universal health coverage- to at least take care of the health needs of poor citizens who cannot afford health care, it is important to strengthen the National Health Insurance Scheme (NHIS) and explore other health care financing system like the community based health insurance which some states have keyed into.
This scheme will significantly cater to the informal sector especially for rural dwellers.
Universal Health Care means that all people and communities can use promotional, preventive, curative, rehabilitative and palliative health services they need and of sufficient quality to be effective, while also ensuring that the use of those services does not expose the user to financial hardship.
There is also the impelling need to ensure that leaders muster the political will for quality and effective health care services in Nigeria. The need to urgently equip Primary Health Centres and consider offering free medical services for the aged, women and children cannot also be overstated.
The issue of human resources for health is another challenge that needs urgent attention: the ratio of health workers to patients so as to reduce the inefficiency by training and retraining of health personnel, welfare and equitable distribution of the health work force across the nation as well as accountability and prudent management of available funds.
In his address during a press conference by the Nigerian Medical Association to mark the 2018 Physicians Day, the National President of Nigerian Medical Association (NMA), Dr. Francis Faduyile said that some African countries like Ghana, Liberia, Senegal and Burundi have shown that removal of user fees increased the utilization rates of health care services. He noted that in Rwanda for instance, the health insurance scheme expanded health services for poor people from 7 percent in 2003 to 91 percent in 2010.
In recognition of the importance of health financing in order to achieve Universal Health Coverage, there is also an urgent need to improve enrolment in the country’s National Health Insurance Scheme (NHIS) from the current less than 5 percent.