Beyond tobacco: Addressing core challenges in Nigeria’s health sector

The deteriorating state of health care delivery system in Nigeria is one that should worry everyone. While aggressive advocacy for stiff tobacco control continues in the country with millions of dollars backing it up, more and more life-threatening issues continue to rear their ugly heads. The health sector problems are enormous and clearly show that the anti-tobacco donors and their local implementers have misplaced priorities. As the drama in the health sector continues, we are suddenly hit with the Ebola Virus Disease (EVD).

A closer look at the tobacco control advocacy and the media sensationalism that often goes with it, as opposed to research and proper health education of Nigerians, presents a picture of a self-seeking project. Fortunately, the African culture is a strong mitigating factor to any rising trend in tobacco consumption. If the World Health Organisation (WHO) and the NGOs involved in tobacco control advocacy really want to do anything serious, they should ride on the African culture which largely frowns at smoking and embark on more education in order to support the right form of lifestyle choices. Moreover, a lot more could be achieved if half of the enormous energy and funding pumped into tobacco control advocacy was sunk into some form of advocacy to ensure that the health care delivery system is brought up to standard. This would save the lives of millions of Nigerians who are dying not from tobacco smoke but from lack of access to basic health care.

Indeed, Nigeria and most African countries need to urgently focus on more salient issues. Very few people in Nigeria can afford good health care, and many of those who can afford it have to go outside the country to places like South Africa and India to get quality health care. The number of lives that have been lost in Nigeria due to poor health care delivery system, lack of equipment, wrong diagnosis, among others, is indeed frightening. This is in addition to the brain drain that the sector continues to face daily. 

Given this scenario, it stands to reason that more money needs to be injected into more serious issues, such as cataloguing those diseases that currently have no cure and are peculiar to our region/country and funding research of same, subsidising HIV drugs to make them accessible to infected patients, finding a lasting solution to malaria, addressing the problems of maternal health, making sure that the Ebola threat is truly eliminated and a permanent cure secured, as well as sensitising various segments of the health sector to ensure that standard practices are maintained so that health care givers are themselves not exposed to trauma while treating patients. 

The basic issues that have impeded sound health care delivery to Nigerians for decades need to be addressed. This is where our focus should be right now. If we don’t get the priorities right, then we are nowhere near the sustainable development that we so fervently desire, neither can we address the problem of inclusive growth. A situation where just a few can afford good medical care by flying out to other countries is simply unacceptable. 

Meanwhile, as global response to the issues associated with tobacco consumption remains divergent depending on which side of the divide the proponent is, the use of tobacco has progressed and many more scientists are looking at how to use it as fuel for airplanes. It has also emerged that tobacco plant plays a major part in the manufacture of the new drug being tested for potential cure of the much-dreaded Ebola. This drug, according to various media reports, was administered on the two American doctors who were infected with the disease. The doctors are said to be responding to treatment.

We, therefore, need to transcend beyond the current debate and look for what can be done with tobacco. This will include backing up research into how to take away the smoke constituent that causes the harmful effect, offering consumers healthier choices, as well as ensuring that more work is done in assisting people to choose the right kind of lifestyle that promotes healthy living. This is not only with regard to tobacco but also in other areas where Nigerians are most susceptible.

The recent WHO report on Africa’s health sector paints a grim picture. According to the report, “A child born in Africa faces more health risks than a child born in other parts of the world. Such a child has more than a 50 percent chance of being malnourished, a high risk of being HIV-positive at birth, while malaria, diarrhoeal diseases and acute respiratory diseases account for 51 percent of deaths. A child born in the African Region is more likely to lose his or her mother due to complications in childbirth or to HIV/AIDS, while that child has a life expectancy of just 47 years, and is very likely – at least once in his or her short life – to be affected by drought, famine, flood or civil war, or to become a refugee.” 

The report further says that people living in the African region are more exposed to a heavy and wide-ranging burden of disease partly because of this region’s unique geography and climate. “These factors make malaria, for instance, more intractable in Africa than it is elsewhere. At the same time, non-communicable diseases and injuries are emerging as significant contributors to the disease burden. Nowhere has HIV/AIDS killed such large proportions of the population as it has in Africa. Nowhere has the old scourge of tuberculosis re-emerged to fuel the HIV/AIDS epidemic as it has in the African region. No other region has witnessed so many armed conflicts and other humanitarian emergencies. Nowhere is poverty so prevalent. The population of the African region represents about 10 percent of the world’s population, but an estimated 45 percent or more of its people live below the poverty line, on less than $1 a day. About 330 million people in this region – one-third of the world’s 1.1 billion poor – are caught in this poverty trap, in which low household incomes lead to low household consumption and, in turn, the countries in which they live have low capacity and low productivity,” it adds.

These facts are so very true of Nigeria. As Nigerians, we all know what we face when the lives of those we love or those we know are lost as a result of poor health care delivery system. It is high time we did the right thing. Tobacco consumption is a problem, but more critical is getting the basics right. If we get the basic health care system right, address the issues fuelling the constant strikes in the health sector, and inject more resources into educating tobacco smokers and researching into alternatives for the consumers, then we will be on the right track to building a healthy nation.

Olusegun Samson