Healthcare services in Nigeria have been and are still very poor. One of the limitations to the full achievement of a universal healthcare delivery system is the limited coverage of Nigerians under Social Health Insurance. The National Health Insurance Scheme (NHIS) in Nigeria was established under Act 35 of the 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost through various prepayment systems. Through this scheme a universal coverage for all Nigerians is targeted at an affordable cost.
By its structure it aims to provide social health insurance in Nigeria on a contributory basis where health care services of contributors and their dependants are made from a common pool of fixed regular amounts made by the contributors. However, the coverage of the National Health Insurance Scheme is still below 5%. Some of the reasons for this can be attributed to ignorance, weak governance, funding etc. Most people covered that make up this 5% are workers in paid employment where a direct deduction from their wages (their contribution) is made into the pool. The larger uncovered population is mostly the unemployed who live in the rural areas. There are people in paid employment who are yet to key into this plan for lack of proper machinery that seeks to enforce the provisions of the act setting up the scheme.
Also, essential (Basic) healthcare services are lacking, as most PHC facilities are short of the minimum healthcare package stipulated by the National Primary Healthcare Agency. Where Private clinics are available, they are not affordable, since about 70% of Nigerians live below $1/day. Given that over 65% of Nigerians live in rural areas, it is easy to understand why most Nigerians do not have physical and financial access to basic healthcare services
Secondary health facilities (General hospitals), though fewer in number, have not fared better in terms of human and material resources availability. Few State Governments, like Lagos, Kaduna and Imo States have invested heavily in health infrastructure at the secondary level. For instance, Imo State Government, under Owelle Rochas Okorocha has built 27 brand new General Hospitals spread across all the LGAs in the State. However, investment in Secondary Healthcare needs to be complemented by provision of basic healthcare services at the Primary level, which is most accessible to majority of Nigerians.
Tertiary Level Care is under the purview of Teaching Hospitals, Federal Medical Centres and other specialized centres. The Federal Government in 2005/2006 under the FGN/VAMED Project initiated an ambitious, phased scheme to refurbish and equip all teaching hospitals in Nigeria, designating some as centres of excellence for treatment of specific diseases.
A decade after this initiative, the upgraded teaching and specialist hospitals have not filled the manpower and equipment void they were meant to prior to this intervention. There is therefore a compelling need to re-appraise the notion of Government intervention in upgrading health facilities in Nigeria. A Paradigm shift should be effected to allow innovative public-private models. The nation can take a cue from the GSM revolution that has made it easy and affordable for every Nigerian to have access to telecommunication services that were once a sole preserve of the wealthy.
A lot needs to be done to get the health sector working again. We must get to ask ourselves, why do facilities owned by the Private Sector work better?
Challenges of healthcare service delivery
Most critical challenges arise from the aforementioned limitations. Funding constraints play a major role in the non-availability of affordable and accessible healthcare services by Nigerians. There appears to be, in addition, insufficient political will by Governments at all tiers to invest appropriately in healthcare.
There are also Human Resource Constraints. The health sector in Nigeria is facing a major human resources crisis. It has been a challenge trying to understand why with the large human resource base the nation prides itself about, there still exists a huge deficiency in the health workforce. According to Elizabeth Omoluabi writing for the International Organization for Migration on the Needs Assessment of the Nigerian Health Sector, she says; “The needs assessment shows that Nigeria’s current stock of practising physicians (30,232 doctors by 31st December, 2013) is only about 35% of the officially quoted numbers from a database whose content has never been updated since 1963. As a corollary, the density of Human Resources for Health is much lower than often officially acknowledged. With 0.17 doctors to 1000 population, Nigeria’s physician density is actually among the lowest in Africa and compares very unfavourably with emerging countries like South Africa (5.5), Tunisia (11.9), Algeria (12.1), Brazil (17.2), Mexico (28.9); and developed countries, such as Greece (60.4), Austria (47.5) and Italy (42.4). Nigeria has less than one-tenth of the required number of doctors to meet its needs.”
With the mal-distribution of the available workforce, and the increasing brain drain resulting in shortage of critically needed health professionals, the health sector recognizes there is a gap that has to be filled if we are to measure up with key indicators. We must realize that human resources are critical in the provision of quality health care..
The shortage of health workers is the cause of the deplorable health indices in major parts of the country, poor quality of service in many public and private health establishments and a loss of confidence by many Nigerians.
There must be a conscious effort to nip in the mud the constant incidence of industrial actions and strikes have that have further dragged the nation’s health sector aground in the collective interest of the nation and its citizens.
One major challenge also is the present economic downturn that the nation is currently grappling with. We are optimistic that soonest the nation will come out of the dilemma. This has its impact in the development of the health sector. However, substantial investment in health should not wait for the economy to improve, we can instead utilise it to assist the economy. Economic recovery can be buoyed by investment in health and human capital development.
In the same vein, we must unlock some negative socio-cultural determinants that hinder positive health seeking behaviour among vulnerable Nigerians, especially the illiterate, poor and marginalized rural dwellers. The preferred resort to traditional medicine is a huge factor that hampers the drive to get quality healthcare to them.
The above challenges and many more are reasons why a lot of the nation’s citizens have lost faith with the Nigerian health system and will rather seek solace with other facilities outside the shores of the nation.
..Excerpts of the public lecture delivered by Hon. Deacon Chike Okafor (House of Representatives member representing Okigwe South federal constituency, and the chairman, house committee on health care services) at the Grand Campus, Eastern Kentucky University, United States of America, on Friday 7th of April, 2017.
Chike Okafor
Hon. Chike Okafor is a member of the House of Representatives representing Okigwe South federal constituency, and the chairman, house committee on health care services
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