Nigeria’s health sector is one that has suffered all forms of neglect as other key sectors, such as education. At 62 years (by October 1), and blessed with enough resources, both human and capital, Nigeria by all standard, should have been more developed to the point of contending for a World Power status. But this is obviously not the case.Historically, though, Nigeria has undergone various forms of developments: from the days of colonial rule, through self-rule characterized by years of military dictatorship with intermittent civilian rule, to the present day democracy, the country could easily be said to have seen the good the bad and the ugly. Unfortunately, however, this has not reflected in what the country has become today by global consideration, compared to even some countries that have far less resources to boast of, and hence considered poorer.
Consequently, its history, particularly the nasty side, keeps repeating itself, and this manifests in virtually all sectors of the country’s being, one of which is the health sector.Like all sectors of Nigeria’s economy, the health sector has not been given the attention it deserves, resulting in not just those who have the wherewithal to seek effective and reliable health care outside the shore of the land, but also brain drain of the country’s finest health care providers to other countries. Nigeria, no doubt, currently faces tremendous health challenges.Experts have at various points sought to identify these challenges from different perspectives. In spite of the diverse reasons they arrived at, all agreed on three: corruption, lack of proper funding, and Bad (or poor) management of resources.
Available statistics on Nigeria’s health sector paint a grim picture: an average of 20,000 Nigerians travel to India each year for medical assistance due to the absence of a solid healthcare system at home; and Nigeria is responsible for a high amount of under-five child death. In a recent report, the United Nations Children Education Fund (UNICEF) said “preventable or treatable infectious diseases such as malaria, pneumonia, diarrhea, measles and HIV/AIDS account for more than 70% of an estimated one million under-five deaths in Nigeria”. The World Health Organization (WHO) also stated in another report that nearly ten percent of newborn deaths in the world last year occurred in Nigeria, and that five countries accounted for half of all newborn deaths, with Nigeria third on the list.
These countries are India (24%), Pakistan (10%), Nigeria (9%), the Democratic Republic of the Congo (4%) and Ethiopia (3%). Most newborn deaths occurred in two regions: Southern Asia (39%) and sub-Saharan Africa (38%). Although some other studies, like the Global Burden of disease, show steady improvements in child survival rates, the persistent rate of avoidable deaths in Nigeria truly calls for concern. The question that readily comes to mind is why Nigeria’s health sector is in such precarious state, given its human and capital resources, which are globally acclaimed as the best? Is it the result of lack of personnel? This is not likely, considering that about 77% of African American doctors in the United States (US) are Nigerians.
In fact, Nigerians have achieved notable feats in American medicine to the point that there is now a popular joke that if all Nigerians withdrew their services from the health sector in the US, the sector would collapse. In this wise, the story of the Nigerian doctor, Oluyinka Olutoye, based in Houston, is still very fresh: he made history not long ago by bringing out a fetus from a mother’s womb, removed a tumor, and then successfully restored the unborn baby in the womb. there’s hardly any top medical institution in the US or Europe where you won’t find Nigerians managing at the top echelon. Universities, both in Nigeria and abroad, annually churn out hundreds of qualified medical doctors that could compete favourably with their peers in the globe to a reasonable extent, even with the disadvantage of a beleaguered educational system suffering from the same plague as its health counterpart.
This brings one to the issue of corruption in Nigeria’s health sector, which, not surprisingly, is only a manifestation of what all other sectors of the economy is, and which ultimately points to the fact that those who are in governance have not deemed it necessary to improve the sector, knowing that they could afford the best treatment in the world. Government’s performance in the health sector in terms of creating the enabling environment for the development of the health sector at best has been abysmal. Investment in infrastructure has been poor and meager remuneration for health workers has resulted in a massive brain drain to the US and Europe, where they are highly taken care of. According to the President of the Medical and Dental Consultants Association of Nigeria (MDCAN), Dr. Victor Makanjuola, more than 100 of its members left the country in the past 24 months. As at 2020, Nigeria had a doctor-patient ratio of 1:2,753, in sharp contrast to the World Health Organisation (WHO)’s minimum recommended ratio of 1:400 or 600. AIn his words, “the mass exodus of medical and dental consultants to more developed countries has brought significant disruptions to Nigeria’s health care ecosystem”.
Meanwhile, the annual budget of the government for the health sector is 4.17% of the total national budget, which is the equivalent to only $5 per person per year. Hardly does a year pass without a major national strike by nurses, doctors, or health consultants. The major reasons for these strikes are poor salaries and lack of government investment in the health sector. Unfortunately, many Nigerians cannot afford private hospitals because they are simply too expensive. Finance is obviously a major problem for patients. Consequently, it wouldn’t be out of place for one to think that management of the National Health Scheme (NHS) through the Health Maintenance Organizations (HMOs) would help people secure better quality health care. But, here, again, corruption has crushed this opportunity and made quality medical care inaccessible for people who contributed to the system, because they do not get the value of their contribution. In terms of funding, despite the myriads of healthcare issues experienced by Nigeria, the Federal Government has continued to pay lip service to funding the health sector.
While each subsequent Minister of Health in Nigeria the country’s return to democratic rule in 1999 assumes office with high hopes of transforming the health sector, majority of them left the position with little or no positive effect to the sector, and, by extension, not making any significant impact on the health of Nigerians. Some even left the sector worse off. This is partly due to their poor policy formulations, leadership styles, or insurmountable challenges they met on ground, which also include the unwillingness of relevant authorities, such as the Presidency and National Assembly, to do the needful. Global economic and development experts have often said for any nation to be considered strong economically, and on human capital development, it must have given priority to the education, and health of its citizenry.
This seem to be why in April 2001, members of the African Union (AU), including Nigeria, met in Abuja and agreed to allocate 15 per cent of their national budgets to the sector with the belief that if this was done, the poor health indices across the continent would be resolved in five years. Unfortunately, Nigeria could not use the same clout it exhibited in bringing these countries together to make that “Abuja Declaration” come alive: Nigeria had since then refused to honour an agreement it played host to 21 years ago, resulting in the poor health indices, high mortality rate and reduced life expectancy rate currently experienced in the country.
Since the declaration, the highest health allocation for Nigeria was in 2012 where 5.95 per cent was allotted to the health sector. In 2014, it allocated N216.40 billion (4.4%) , in 2015, it was N237 billion (5.5%), while in 2016 and 2017 it was 4.23% and 4.16% respectively. 2018 followed the same trend, with further reduction of the proposed health sector allocation from 4.16 per cent in 2017 to 3.9 per cent, even with the ever growing health sector concerns. Meanwhile, the World Health Organisation (WHO) says for Nigeria to be seen to prioritise healthcare, it must at least spend a minimum of N6, 908 per Nigerian in a year. When multiplied by 200 million people will amount to N1.4 trillion. WHO, also recommended a minimum of 13 per cent of annual budget for health.
Notably, the Nigerian Government has not tilted towards the WHO’s 13 per cent, not to talk about the AU’s 15 per cent, even as some countries have started raising their health budgetary allocation towards fully keying into the WHO recommendation of 13 per cent or the Abuja Declaration by the African Union of 15 per cent. Rwanda, for instance, reportedly devoted 18 per cent of its total 2016 budget to healthcare; Botswana budgeted 17.8 per cent; Malawi, 17.1 per cent; Zambia, 16.4 per cent; and Burkina Faso, 15.8 per cent. Nigeria, on the other hand, still lags behind in this regard, a situation that has had direct consequences on the funding capacity of the Health Ministry and its affiliated agencies and parastatals, thereby making the fight against poor healthcare very unrealistic. For instance, while N340 billion was allocated to the health sector in the 2018 national budget, how much was indeed released by the Federal Government to the health sector at the end of the day, and how much was actually spent could not be ascertained. This brings to the fore the challenge of “bad management of resources”, which are even in adequate at the point of allocation, and possible release, which cannot be ascertained.
This scenario vividly captures the situation at the lower two tiers of the health sector – State and Local Government – which even spend far less in percentage. Here, however, Rivers State stands out, as the incumbent Governor, Barr. Nyesom Wike, made the health sector part of his priority. Since he assumed office in 2015, he has touched virtually all facets of the health sector from infrastructural development, through provision of equipment, and manpower development for the sector. It started with the workforce in the primary healthcare sector which was on strike, and the secondary health care sector, which was either shut down or facilities dilapidated when he assumed office. Governor Wike quickly swung into action with what later became his characteristic energy and proactive leadership style by first recalling the striking Primary Health workers to work, and also paid House Officers at the then Braithwaite Memorial Specialist Hospital (BMSH) their outstanding dues and allowances, inherited from the previous administration. The question likely to be playing in the minds of keen observers of the health sector in the State may not be far from whether his successor can continue from where he will stop at the end of his tenure. At the Federal level, there have been calls for a way forward. Most of such calls harp on the need for policy makers in the country and health professionals in Nigeria and the Diaspora to come together and come up with a blueprint for the sector. Such blueprint should have a time lag for each stage, and be genuinely followed to the letter. They also propose a genuine and deliberate effort by the Federal Government to meet either the WHO’s 13 percent or AU’s 15 percent of total budget to the development of the health sector in terms of infrastructural and human capacity development, and equipment, as well as ensure that such monies are put into the use they are meant for.
By: Sogbeba Dokubo