Sunday, June 26, 2016

Ending the perennial crisis in Nigeria’s health sector


The parlous state of Nigeria’s health sector should be of utmost concern to all well-meaning compatriots. The country’s health indices are nothing to write home about. Preventable and treatable diseases continue to claim thousands of lives in this clime. Malaria, typhoid, dysentery, malnutrition, high blood pressure, diabetes, meningitis, tuberculosis, pneumonia and many others continue to present health burden to Nigerians. At present, my country has the highest infant and maternal mortality in Africa. A Demographic Health Survey in 2013 allegedly found that Nigeria contributes about 13 per cent of global maternal mortality, with estimated 36,000 deaths annually. James Entwistle, the United States Ambassador to Nigeria while delivering a speech at the launch of the Healthmagination Mother and Child Initiative on March 4, 2016 said there is  excessively high maternal, neonatal, and under-five death rates in Nigeria and said that there are 40,000 maternal deaths per year in Nigeria.

It is reported that less than 30,000 medical doctors are at present practicing in Nigeria while there are about 150,000 registered nurses nationwide.  Though the ideal Doctor – Patient ratio should be 1:600, in Nigeria average Doctor-Patient ratio is put at 1:53,333 while Nurse-Patient ratio is 1: 1,066. According to the 2015 World Health Organisation data, life expectancy at birth in Nigeria is 53 years for Male and 56 years for Female.

Nigeria’s health crises are self-inflicted. Many of our health facilities are obsolete and inadequate. Many of the primary health care centres across the country are not well resourced. There are no adequate personnel or equipment. Same applies to our General Hospitals and Teaching Hospitals. Many decades ago, a prominent Nigerian denotes our health centres as mere consulting clinics. These days, the consulting clinics are even more closed than open due to the incessant industrial actions embarked on by different unions in the health sector. As I write this piece, the Joint Health Sector Unions in federal tertiary health institutions are on a seven-days warning strike. The union in a communiqué issued on Wednesday, June 22, 2016 by its President, Biobelemoye Josiah said embarking on the warning strike was to press home their demands. This was coming on the heels of another strike by National Association of Resident Doctors. The NARD president, Dr Muhammad Askira, said there were issues yet to be attended to by government. He said:  ”Resident doctors who work in states of the country that were yet to be paid their salaries; skipping and all accrued arrears for doctors yet to be implemented in most hospitals in the country; unpaid December salaries of doctors in some federal hospitals, and, house officers’ entry steps have not been effected.”

The five day warning strike embarked on by NARD in May indirectly led to the death of my younger sister, Tolulope Brimah (nee Ojo) on May 19, 2016. She was on admission at the University College Hospital for an heart related ailment and was scheduled for medical procedures in the last week of the month. Unfortunately, on Wednesday, May 11, NARD went on strike and all in-patients at the hospital were forcefully discharged irrespective of their delicate state of health. My sister who was making steady progress ahead of the operation was one of those discharged involuntarily and from there on her health took turn for the worse till her death the week after. There are thousands of such untimely deaths recorded annually due to the recurring industrial crises in Nigeria’s health sector.

It was this unfortunate phenomenon that has hiked incidences of medical tourism in Nigeria. According to the Chief Medical Director, Genesis Specialist Hospital, Ikeja, Dr. Roger Olade, “It has been estimated that Nigerians spent $1.9bn on medical tourism in 2014.” Olade, who spoke at the inauguration of the hospital in Lagos in March 2016, noted that Nigerians paid over N320bn for surgeries and treatments in Dubai, India and the United Kingdom in 2014. He argued that the government had yet to enact policies that would support its best hands in medicine to return to practice in Nigeria. According to him, instead of wooing doctors in the Diaspora, the Federal Government, through its unfriendly policies, is frustrating those who want to practice in the country. True, so very true!

It has been reported that approximately thirty percent of trained medical personnel in Nigeria stay in country to practice. Many of them are in Europe, America, Middle East and other parts of the world practising. The brain drain is largely caused by lack of equipment, inhuman working conditions, insecurity, corruption and several other challenges. Why on earth should government be owing medical personnel salaries? Does it make sense to have doctors and medical personnel begging for food? There have also been incidences of doctors being kidnapped or beaten up by relations of hospital patients. Government routinely breach agreements reached with various medical unions with impunity and when they go on strike, they are threatened with mass sack as was the case with 14,000 resident doctors who were sacked last Tuesday before reasons prevailed and government rescinded that decision after the intervention of the House of Representatives leadership. This is very untoward!

I had thought that with the signing into law of National Health Bill by President Goodluck Jonathan on December 24, 2014, things will improve in Nigeria’s health sector. Unfortunately, almost two years down the line, it’s the same old story and lamentations. The Act, experts said, seeks to provide a framework for the regulation, development and management of a National Health system and set standards for rendering health service in the country. Some of the accruing benefits of the National Health Act include the provision of free basic health care services for children under the age of five, pregnant women, the elderly and persons with disabilities in the country.  Additionally, the law guarantees the universal acceptance of accident victims in both public and private health institutions. Interestingly and deservedly too, the law bans senior public officers’ use of public funds for treatment abroad, especially for ailments that can be treated locally.  This was part of the reason the recent trip by President Muhammadu Buhari to United Kingdom to see Ear, Nose and Throat (ENT) specialist for his hearing challenge generated a lot of furore.

Sadly, while there is low budget for health in Nigeria, some of the international partners helping out are having a raw deal as some of the funds were either embezzled or misappropriated. Such was the case with The Global Fund to Fight AIDS, Tuberculosis and Malaria, GFATM, an international financing institution that invests the world’s money to save lives.  GFATM reportedly suspended disbursement of funds for malaria, HIV/AIDS and Tuberculosis in Nigeria this May 2016 following discovery of large scale fraud by recipient organisations in Nigeria. Executive Director, Global Fund, Mark Dybul, said “The investigation report found fraud and collusion in the amount of US$3.8 million.”

The way out of these crises are for government at all levels to increase funding for the health sector, ensure industrial harmony in the sector, fight corruption in the system, implement the National Health Act, incentivize Nigerians to embrace the National Health Insurance Scheme and provide enabling environment for private sector participation in health care delivery.

Jide is the Executive Director of OJA Development Consult.