God, Save Our Souls

God, please save our souls in Nigeria. The parlous state of the nation’s health sector needs divine intervention. I came to this conclusion when I reflected on the health care delivery system of my native land. For crying out loud, how on earth can we have a government in place and life will become this short, brutish and nasty? For decades, we have been kicking out polio and rolling back malaria without any significant success. These are preventable and curable diseases. Our maternal mortality and infant mortality are scary, second to none in Africa. Fifty two years after Independence, my compatriots still die of cholera, diarrhea, typhoid fever, pneumonia and other such minor ailments that can be treated by paramedics in other climes. If this is not shameful, I think nothing again can embarrass us.

During the October 1 Independence Day speech, President Goodluck Jonathan only made two bland statements on the state of Nigeria’s health care delivery. He said, “In the last two years, we have put in place structures for an upgrade of the country’s health sector, to promote in every respect, the individual citizen’s right to quality, affordable and accessible healthcare. In this regard, we are devoting resources under the Subsidy Reinvestment Program to reducing malaria incidents, dramatically reducing maternal and child mortality, and eradicating polio.” What do these sentences connote? To me, these are broad, general statements that lack specifics; no milestones, no benchmarks. While President Jonathan may not be forthcoming with details of his efforts in the health sector, his Minister of State for Health, Dr. Mohammed Ali Pate, disclosed on Monday, June 25, 2012 in Lagos at the inaugural private health sector summit that the country loses $500m or N81bn yearly to other countries under medical tourism as Nigerians seek solutions to their medical challenges abroad. This is preposterous! Just imagine what that kind of humongous sums of money can do if spent on improving our deplorable health sector.

Since the 1990s when government promised Health for All by 2000, later shifted to Vision 2010 and now Vision 2020, none of these plans has been realised. It is just three years to 2015 when we are supposed to meet the health-related Millennium Development Goals 4, 5 and 6, that is; Reduce by two-thirds between 1990 and 2015, the under-five mortality rate; Improve Maternal Health by reducing by three-quarter the maternal mortality ratio and achieve universal access to reproductive health; and combat HIV/AIDS, malaria and other diseases hoping that in the magic year 2015 we would have halted the spread of HIV/AIDS and malaria as well as achieved by 2010 universal access for treatment of HIV/AIDS. Where is Nigeria on these indicators?

According to the World Bank, Nigeria has infant mortality rate of 78 deaths per 1,000 live births (2011 estimates). It must be stated that this is a slight improvement from the 89 per 1,000 live births in 2007. Nigeria contributes the second largest maternal deaths in the world after India. India and Nigeria are said to account for a third of global maternal deaths, with India at 19 per cent (56,000) and Nigeria at 14 per cent (40,000).

While speaking on Channels Television News at 10 on Sunday, October 7, 2012, President of Nigeria Medical Association, Dr Osahon Enabulele, highlighted some of the challenges facing Nigeria’s health sector as follows: Poor political commitment to health; poor funding of the health sector; health policy not being part of the fundamental objectives and directive principles of state policy recognized by Chapter II of the 1999 Constitution of Nigeria as well as not being part of the fundamental human rights itemised in Chapter IV of the constitution; lack of a National Health Act; and poor staffing, among others. A 2012 BGL report on Nigeria healthcare system is said to have identified infrastructure decay, brain drain, incessant workers’ strikes and low investment in the sector as being major issues with healthcare services in Nigeria.

Additionally, and in my own view, the country also faces the problem of quackery or unqualified medical personnel; corruption; fake, expired and adulterated drugs; wrong diagnosis of ailments by some laboratory technicians and doctors; lack of adequate enforcement of laws guiding medical practice by the regulators such as National Agency for Food and Drug Administration and Control, Nigeria Medical Association, Federal and State Ministries of Health as well as Pharmaceutical Council of Nigeria. The National Health Insurance Scheme conceived to provide medical coverage for users under the scheme is alleged to have only a paltry five million enrolled patients out of a potential estimated 170 million population.

Where do all of these challenges leave Nigerians? It has left us at the mercy of alternative medical practitioners such as herbalists, witch-doctors, quacks and fake spiritualists who masquerade as prophets or alfas. A visit to rural communities will reveal that many inhabitants of these towns and villages patronise these merchants of deaths. Any wonder thousands of people die like fowls from preventable and treatable diseases?

Pate disclosed that the Federal Government, through the Federal Ministry of Health, has set up a Private Sector Roundtable on Health in Nigeria charged with the task of “a rapid diagnostic of the private health sector” in order to curb the nation’s capital loss to medical tourism. The Tony Elumelu-led Ministerial Committee on the Private Sector Healthcare Initiative hopes to come up with strategies, and a road map for the unlocking of private sector entrepreneurship in Nigeria’s health sector. The goals, we are told, is to have at least one world-class private sector hospital in each geo-political zone, in order to drastically reduce the exodus amongst health care professionals and citizens and curtail the capital flight through medical tourism. Much as it is a good idea to partner the private sector to play a pivotal role in health care delivery in Nigeria, we must not lose sight of the fact that health is a social service which needs to be made affordable and accessible to the needy. If left in the hands of the private sector that is in business to make profit, the issue of affordability will be compromised.

Government needs to tackle the problem of the health sector holistically through law and administrative reforms, proper funding, staffing, equipping, welfare and implementation of health laws and regulations. It is high time we also place premium on preventive medicine by embarking on civic education of the citizenry on how to live healthy lifestyle. Environmental health officers (popularly called Wole-wole in Yorubaland) are essential to this process of enlightenment and enforcement of environmental hygiene.