Tinubu and Nigeria’s health sector

 

Health is wealth so says a popular adage. Out of the 17 United Nations Sustainable Development Goals, at least two of them are health-related. Goal 3 says, “Good health and well-being” while Goal 6 speaks to “clean water and sanitation.” Truth be told, Nigeria’s health services are largely in disarray. Doctors, Nurses and other health workers in public health institutions are overworked and underpaid. No wonder many of them voted with their feet and emigrated to Europe, America, the Middle East, including other African countries to ply their trade.

An October 20, 2022 report in Premium Times quoted the then President of the Nigerian Medical Association, Uche Rowland, as having said at a symposium, “One doctor is available to treat 30,000 patients in some southern states, while in the North, it is one doctor to 45,000 patients. In some rural areas, patients have to travel more than 30km from their abodes to get medical attention where available; thus making access to healthcare a rarity.” Given the fact that there are only 24,000 doctors available, the current doctor-patient ratio is 1: 9,083, a stark contrast with the World Health Organisation’s recommendation of one doctor to 600 patients. With 218 million people to cater to, Nigeria requires at least 363,000 additional doctors to meet this target.

Perennially, doctors and health workers embark on warning or indefinite strike to press home their demands for better working conditions. In the course of these countless industrial disputes, many patients who cannot afford the services of private health services die preventable deaths. According to Healthy Newborn Network, “The 2023 UN report on Trends in Maternal Mortality from 2000-2020 revealed that nearly 28.5 per cent of global maternal deaths happen in Nigeria. The report further states that a woman in Nigeria has one in 19 lifetime risks of dying during pregnancy, childbirth, or postpartum; whereas in the most developed countries, the lifetime risk is one in 4900.’

According to Statista, “As of 2023, the mortality rate of infants aged under one year old in Nigeria was measured at 55.17. This means that there were about 55 deaths of children under the age of one year per 1,000 live births. Child mortality rates in Africa are very high. Among the countries with the highest infant mortality rate in the world, almost all of them are African countries.”

Some of the factors fuelling the lack of adequate healthcare delivery to Nigerians are the paucity of funds to run government hospitals thereby leading to inadequate equipment and hospital consumables; understaffing of hospitals and clinics; insecurity; unhealthy rivalry among medical and health workers’ unions; and policy summersault from successive governments. Is it not inconceivable that the electricity supply to a tertiary health institution like the University College Hospital, Ibadan will be disconnected over an unpaid N490m electricity bill?  Meanwhile, it costs more to power the premier health institution with generators given the cost of diesel. Many of the equipment of our health institutions have broken down due to a lack of proper maintenance culture. It is therefore no news that many laboratory tests in government-owned hospitals are conducted at private laboratories outside the government facility. Shameful!

There have been stories of health workers working 24-hour shifts due to inadequate staff. Bandits have kidnapped some medical and health workers to demand ransom from their families. Despite over 20 years of establishing the National Health Insurance Scheme, enrollees on the prgramme are very low, mainly government workers. Thus, about 70 per cent of patients still pay out of pocket. There have been scenarios where patients are detained after being discharged from hospitals due to the high indebtedness they incurred during treatment.

Another major concern in Nigeria’s health sector is the challenge of fake, expired and sub-standard drugs and medical consumables. Many people have loudly complained of lack of improvement in their health despite buying prescribed drugs. It is very scary that unscrupulous merchants of death have flooded markets with fake and substandard drugs, thereby exposing their fellow human beings to grave danger. Ironically, genuine drugs are very expensive largely due to the devaluation of the naira and exchange rate as most of the drugs consumed in Nigeria are imported from abroad and with the exchange rate between naira and international currencies such as the dollar, pounds and euro being disproportionate, imported drugs and medical equipment are very dear. Quite unfortunate for Nigerians, the rising cost of doing business and the inclement business environment in Nigeria have made many pharmaceutical companies to fold up in the country.

Many Nigerians are now trooping to religious worship centres for their healing. Others are moving in droves to herbalists for herbal concoctions to save their lives. Either way, many sick people now seem to believe more in pastors and herbalists for their healing and deliverances than trained medical doctors who are competent to deal with their issues. Expensive medicare also paved the way for quackery to thrive.  Auxiliary nurses are now opening clinics to practise as medical doctors. Many fake doctors, some of whom dropped out of medical schools, now opened hospitals to treat unsuspecting members of the public. Nigeria’s health situation is indeed very dire.

Tinubu, the 16th President of Nigeria, has appointed two professionals to be in charge of the Federal Ministry of Health. The Coordinating Minister of Health and Social Welfare is   Prof. Ali Pate while Dr Tunji Alausa is the Minister of State. Tinubu has launched Nigeria’s Health Sector Renewal Compact between the federal, the 36 state governments and development partners. He unveiled the compact while commemorating the 2023 World Universal Health Coverage Day with the theme, ‘Health for All, Time for Action’ held recently at the Banquet Hall of the Presidential Villa, Abuja.

In October 2023, Pate said the Federal Government had made provisions for retired medical providers in non-administrative positions to be re-engaged on a contractual basis. He disclosed this in Abuja while fielding questions from newsmen after his visit to the National Hospital Abuja. According to him, this is to close the human resource gap being experienced in the health sector owing to various reasons such as the ‘brain drain’ of clinical manpower. “The recent circular essentially provided for medical providers who are in non-administrative positions, that is those who are in clinical positions to be re-engaged in a contract basis on the same terms as they were so that we do not lose the few that are remaining.” This is a welcome development.

According to the Centre for Social Justice, a non-governmental organisation based in Abuja, “In the 2024 Federal Health Budget, the total sum allocated out of the overall expenditure of N27,503,404,073,861 is N1,228,100,390,765 inclusive of the N125,737,146,031 provided for the Basic Health Care Provision Fund. This is 4.47 per cent of the proposed budget expenditure. This is slightly less than one-third of the 15 per cent Abuja Declaration commitment. However, there are other provisions related to health in the budget vis, provisions for the National Health Insurance Scheme fund of MDAs (N120,096,348,469), NHIS for military retirees (N4,025,476,074), NHIS for corps members (N5,000,000,000), counterpart funding including global fund/Health (N7,416,508,000), GAVI/Immunisation counterpart funding (N137,210,720,045), Presidential Committee on Health Sector Reform (N500,000,000), and another Presidential Committee on Health Sector Reform (N500,000,000). These add up to an extra N274,749,052,588.00. This increases the health vote to N1,502,849,443,353.00 being 5.46 per cent of the proposed overall expenditure. This is just 36.43 per cent of the Abuja Declaration.  A 15 per cent of the overall budget vote would have amounted to N4,125,510,611,079.15. The extant health vote leaves a funding gap of N2,622,661,167,726.15.”

In terms of combating the menace of fake and substandard drugs in circulation in the country, the National Agency for Food and Drug Administration and Control should be well-resourced to deal with this existential threat to the health of Nigerians.