Thursday, July 7, 2011

Fixing Nigeria’s Ailing Health Sector

I shudder at the staggering number of preventable deaths in Nigeria. A country that God has graciously spared the horrors of holocaust, tsunami, earthquake, volcano, mudslide and other similar natural disasters ought to do something urgent to reverse the soaring number of avoidable deaths being recorded annually in the country. Reduction of child mortality, improved maternal health, and eradication of HIV/AIDS, malaria and other diseases are three of the eight millennium development goals meant for attainment by 2015. Four and a half years to the target date, our scorecard remains dreadful. Save the Children, an international non-profit group revealed that almost 800,000 Nigerian children die every year before their fifth birthday, making Nigeria the country with the highest number of new born deaths in Africa. The group released the figures at a Save the Children Special Campaign (STC) launched in Lagos on December 14, 2010.

In a paper titled Maternal and Child Health in Nigeria, Professor Friday Okonofua said “An estimated 500,000 women die each year throughout the world from complications of pregnancy and childbirth; 55,000 of these deaths occur in Nigeria. Nigeria is only two percent of the world’s population but accounts for over 10% of the world’s maternal deaths in childbirth and ranks second globally (to India) in number of maternal deaths. Risk of a woman dying from child birth is 1 in 18 in Nigeria, compared to 1 in 61 for all developing countries, and 1 in 29,800 for Sweden. For every woman who dies from childbirth in Nigeria, another 30 women suffer long term chronic ill-health. The UNFPA estimates that 2 million women suffer vesico-vaginal fistula globally, 40% of these (800,000 women) are in Nigeria.” 2010 UNGASS report said 2,980,000 people are living with HIV/AIDS in Nigeria. After South Africa, Nigeria has the largest number of people living with HIV/AIDS in Africa.

A January 2011 report by World Care Council revealed that “Nigeria has the highest TB (Tuberculosis) burden in Africa and is 4th among the 22 countries with high TB burden globally. It has an estimated TB prevalence of 521/100,000 (772,000) and estimated Mortality rate of 93/100,000 (138,000). The estimated prevalence of MDR-TB among new TB cases is 1.8% and 9.4% among previously treated TB with a prevalence of HIV in adult TB patients (15-49yrs) 27%.” Still, Nigeria is one of the four countries in the world, and the only one in Africa, where polio is still endemic. The others are India, Afghanistan and Pakistan. On June 28, 2011 during the commemoration of the World Sanitation Day, Dr Suomi Sakai, UNICEF's Country Representative said "It is estimated that about 33 million Nigerians defecate in the open, depositing about 1.7m tonnes of faeces into the environment annually. The development had resulted in a high level of contamination of the environment in which garbage and faeces often find their way into water resources.”

Prof. Onyebuchi Chukwu, the Minister of Health has his job cut out for him. Health being a concurrent issue in Nigeria’s federal structure, the honourable minister needs to redouble his efforts and set about building synergy vertically among the three tiers of government, that is, the federal, state and local governments, particularly their ministries and department of health. Horizontally, he needs to do same among the many agencies and departments under his ministry. We have long been hearing of health for all by certain date, yet in 2011 access to quality and affordable health remains abysmally low. Most alarming is the high rate of mis-diagnosis of patients by health practitioners. I lost a junior colleague on June 6, 2011 to wrong prognosis by two leading public hospitals in Abuja when they could not detect a cancerous breast. By the time the right diagnosis was done at a private hospital, it was too late, the lady died.

Similar stories abound. There have been instances of someone with malaria being diagnosed and treated for typhoid fever, or someone with minor stress being treated for hypertension. A legal luminary who died not too long ago was alleged to have been diagnosed of bronchial infection when he actually had lung cancer, the truth was not known until he went abroad for confirmatory test. This recurring wrong prognosis calls to question the competence of our health technicians, radiographers and laboratory scientists.

Many Nigerian public hospitals be it primary health centres (PHC), General Hospitals or Teaching Hospitals are grossly underfunded and concomitantly, ill-equipped and understaffed. This partly account for high level of brain-drain being experienced in the sector as many well trained medical personnel have left the shores of Nigeria for greener pastures abroad. An estimated 25,000 Nigerian doctors practice medicine in United States of America alone. Thousands of others are to be found in the Middle East and other parts of the world. Those yet to emigrate are perennially embarking on industrial action to press home for better working condition. Many of them engage in private practice alongside their government job in order to augment their income.
Due to high cost of access to quality healthcare in Nigeria, many of the masses particularly in rural and sub-urban areas prefer herbal and prayer homes to hospitals. Though Nigeria’s National Health Insurance Scheme was established in 1999 to regulate and administer social health insurance in Nigeria. The scheme currently covers approximately 4.5 million people - about three percent of the country’s population. Even the quality of service rendered under the scheme has been a subject of controversy. Noteworthy is the threat posed by quacks to Nigeria’s healthcare delivery system. Due to the poor coverage of rural areas by orthodox and qualified health practitioners, a lot of charlatans now run clinics, hospitals, maternity homes and convalescing centres in many of our communities. They carry out surgery they were not trained for and administer fake and expired drugs on their patients. The menace of cloned and adulterated drug is still very potent many years after the establishment of NAFDAC.

The way out of this quagmire is simple. There is need for increased funding for Nigeria’s health sector. However, government alone cannot sufficiently fund the huge sector. The support of donor agencies and their non-governmental organisation counterparts is appreciated. However, our organised private sector must chip in their token as well. This they can do either through establishment and maintenance of public hospitals or by setting up a Trust Fund. Religious institutions should also come out to support government in ensuring quality health care delivery to Nigerians. The pace-setting efforts of the Catholic, Baptist and ECWA churches in setting up public hospitals as part of their missionary work is exemplary and worth emulating. Preventive measures also need to be scaled up to ensure that people voluntarily or forcefully embrace hygiene and sanitation. Our local governments need to bring back Sanitary Inspectors while adequate public enlightenment is needful. Cleanliness is next to Godliness, health is wealth and a healthy nation is a wealthy nation.