Killing Nigerians softly

 

The title of this piece is an adaptation of a popular song by the Fugees titled, “Killing Me Softly with His Song.” Health is wealth is a common cliché. And it is said that a healthy nation is a wealthy nation. Sustainable Development Goal 3 speaks of “good health and well-being” for all. How close is Nigeria in realising the much touted target of “health for all”? Many believed that in Nigeria, life is short, brutish and nasty as postulated by the renowned philosopher, Thomas Hobbes.

The budgetary provision for health care delivery is grossly inadequate both at the federal and sub-national level. At the federal level it has perpetually been less than 10 per cent.  The Bible in Psalm 90 verse 10 says, “The years of our life are seventy, or even by reason of strength eighty.” However, according to an online source, Statista says life expectancy at birth in Nigeria in 2023, by gender is 59.93 for male and 63.75 for female. Overall, it is 61.79.

According to UNICEF, under-five mortality rate is 110.8 deaths per 1,000 live births, which is more than 10 per cent. Information also gleaned from the website of UNICEF revealed that “Nigeria’s 40 million women of childbearing age (between 15 and 49 years of age) suffer a disproportionately high level of health issues surrounding birth. While the country represents 2.4 per cent of the world’s population, it currently contributes 10 per cent of global deaths for pregnant mothers. Latest figures show a maternal mortality rate of 576 per 100,000 live births, the fourth highest on earth.” This is heart-rending!

A May 14, 2023 report in THISDAY newspaper quoted the immediate-past Minister of Science and Technology and former Minister of State for Health, Senator Olorunnimbe Mamora, as saying that only 10 per cent of 30,000 primary healthcare centres across the states of the federation are functional and operational. This, according to him, is due to multiple factors, including dilapidated buildings and acute deficit of medical equipment. Any wonder sicknesses that could have been dealt with at the grassroots level are taken to general hospitals, Federal Medical Centres and teaching hospitals?

According to Dataphyte, “Analysis of the distribution of hospitals and population projections across Nigeria has shown Nigeria has an average of 17 hospitals to 100,000 persons. Based on data from the Nigeria Health Facility Registry, Nigeria has a total of 39,914 operational hospitals and clinics. This number combines private and public hospitals across the primary, secondary and tertiary levels of care.” A December 28, 2021 report in The PUNCH however says, “Data obtained from the health facilities register of the Federal Ministry of Health has revealed that Nigeria only has 40,017 functional hospitals and clinics across the 36 states of the federation and the Federal Capital Territory.” Unfortunately, many of these hospitals and clinics are not well resourced. There is a shortage of qualified personnel and medical equipment.

Funding of health services in Nigeria has been grossly inadequate. Many patients still have to pay cash or what is referred to as out-of-pocket in order to be able to access health care delivery. National Health Insurance Scheme is a body set up by Decree 35, of 1999 (now Act 35) operating as Public Private Partnership and directed at providing accessible, affordable and qualitative healthcare for all Nigerians. On May 24, 2022, it was officially gazetted by the Federal Government as the National Health Insurance Authority. Unfortunately, the number of enrollees under this scheme is still abysmally low due to the inefficiency and corrupt practices among the health care providers popularly called Health Management Organisations. It is believed that claims of these HMOs are not settled on time by the government and as such the quality of service offered to health insurance patients is simply abysmal. I do hope the newly appointed Director General and Chief Executive Officer of the agency, Dr Kelechi Ohiri, will be able to turn things around positively at the NHIA.

Due to the myriad of challenges facing Nigeria’s health sector, there has been a lot of restiveness as health sector workers go on routine industrial action. If it’s not the Nigerian Medical Association, it’s the National Association of Resident Doctors. Nurses and other medical workers are not left behind. It has become an annual ritual. Frustration over the lack of environment conducive to work, and remuneration as well as insecurity combine to pave the way for brain drain in Nigeria’s health sector. The ‘japa’ syndrome is most pronounced in the nation’s field. According to the Register of the General Medical Council of the United Kingdom, the number of Nigerian-trained doctors practising in the UK has climbed to 11,001.

A September 17, 2023 report in this newspaper says, “Leading experts in Nigeria’s health sector have said it would be impossible to produce sufficient personnel to effectively meet the country’s increasing healthcare needs with the current burden of brain drain. They held that it would take Nigeria 20 years, at the minimum, to produce 400,000 health workers needed to fill in the gap and cater to the health needs of Nigeria’s 220 million people. The senior medical professionals, while exclusively speaking with PUNCH Healthwise, said Nigeria has a horrible ratio of one doctor to 8,000 patients, which is against the World Health Organisation recommendation of one doctor to 600 patients. The Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, not long ago, said the country still needs about 400,000 health workers to cater to the healthcare needs of Nigerians effectively.”

A July 25, 2023 report, also in this newspaper, says Nigerians spent a total of $1.04m on foreign healthcare-related services in the first quarter of 2023. The total spending for the period under review was obtained from the quarterly statistical bulletin of the Central Bank of Nigeria for Q1 2023. The PUNCH observed that the amount spent in Q1 2023 was an increase of 40.54 per cent from the $0.74m spent in Q1 2022. A breakdown shows that medical tourism gulped $0.34m in January 2023, $0.32m in February 2023, and the amount increased to $0.38m in March 2023. “Commenting on the report, the National Vice Chairman of the Joint Health Sector Unions, Dr Obinna Ogbonna, said corruption, bad management, and poor infrastructure are to blame for the poor state of the Nigerian health care system, fuelling medical tourism. Nigerians, who are well-to-do, lack confidence in our medical facilities. Even though we have well-trained personnel that can handle all medical cases, the infrastructure and the equipment are not adequate.”

The situation in Nigeria’s health sector is very gloomy but not hopeless. I do hope Pate and his counterpart, Dr Alausa would do their best to turn around the situation. I like the idea of hiring retired doctors and medical practitioners as contract staff. The Federal Government recently approved the appointment of doctors, nurses, and other clinical healthcare workers as contract staff after attaining their compulsory retirement age or years. The government said the appointed contract staff would be on the same salary scale level that they retired on if they desired and deserved it. A circular dated October 5, 2023, by the Federal Ministry of Health directed the Chief Executive Agencies, Chief Medical Directors, Medical Directors, and heads of regulatory bodies and schools to ensure compliance with the circular earlier issued by the Office of the Head of the Civil Service of the Federation to all staff in their institutions.

While this is a welcome development, there is a need to ensure that all public hospitals are well resourced with good structures and latest medical equipment. Medical workers must also be well protected to perform their duties without fear of abduction or molestation. Preventive medicine should be prioritised by ensuring health education of the populace. As the saying goes, prevention is better than cure. The National Agency for Food and Drug Administration and Control should be alive to its mandate to ensure the safety of our consumables. Health care is a social service and should be made affordable to prevent Nigerians from patronising quacks and unwholesome solution centres.