Across the world, the rapid growth in the number of people infected with COVID-19 has overburdened health systems, causing severe human suffering and resulting in almost 250,000 deaths. As the pandemic rages, it continues to pose a significant threat to the global economy, particularly affecting the most vulnerable and further stretching a social fabric challenged by high levels of inequalities.
In light of this unprecedented health crisis, several countries have ramped up efforts to contain the virus, implementing measures including social distancing and mass testing and contact tracing. Nigeria has followed the lead of developed nations and adopted similar measures. However, a stark difference in the implementation of these measures in Nigeria in comparison to other countries is that while these measures build upon already existing, well-funded and viable healthcare systems in these developed nations, the same cannot be said about Nigeria.
That Nigeria’s healthcare delivery system has been neglected and left to crumble is an understatement. Decades of underinvestment and misappropriation of funds have ensured that Nigeria’s healthcare system has deteriorated into one of the worst in the world. A 2018 study in the Lancet of global health care access and quality ranked Nigeria 142nd out of 195 countries.
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Over the past decades, the nation’s budgetary allocation to healthcare has consistently fallen below globally and regionally recommended thresholds. In the nation’s 2020 federal budget, the sum of ₦427 billion was earmarked to finance the health sector, up from ₦365 billion in the previous year. Nevertheless, this allocation to healthcare constitutes less than 5 percent of the government’s budget and remains significantly below the 15 percent benchmark stipulated in the African Union’s 2001 Abuja Declaration. The story is similar at the state level, with the average budgetary allocation to healthcare in states consistent with the federal government’s and below recommended thresholds.
A consequence of this chronic underfunding of the nation’s healthcare system has been the massive brain drain of the nation’s health workers. Nigerian healthcare workers, especially doctors, continue to migrate in droves to other parts of the world to find better working conditions. As at 2019, over 5,000 Nigeria doctors were registered with the United Kingdom’s General Medical Council (GMC). Overall, it is estimated that 40,000 of the 75,000 registered doctors in Nigeria practice abroad.
In addition, World Bank data shows that Nigeria’s total health expenditure amounted to 3.8 percent of GDP in 2017, below peers like Kenya (4.7 percent) and South Africa (8.1 percent). In fact, it is estimated that more than 100 million Nigerians cannot afford to pay bills for treatment in public health facilities. Furthermore, Nigeria currently has no viable system for affordable health care, thus low-income families, which constitute more than half of the population, do not have access to formal health care. The nation’s health insurance plan, the National Health Insurance Scheme – NHIS established in 1999 and intended to be universal, remains flawed, meaning that access to free and good quality healthcare for the entire population is limited. All of these explain the prevalence of poor health outcomes in Nigeria.
These health challenges are well-known and Nigeria has drawn global attention for its failing health care system. Nevertheless, the nation’s leaders had never paid attention to the nation’s healthcare system. In fact, despite having a three-month head start before the COVID-19 pandemic made landfall in Nigeria, Nigeria still failed to prepare adequately for the pandemic.
Now that the virus has laid bare the nation’s deplorable healthcare system, desperate efforts are being made to bridge the gap against the pandemic. However, this will most likely fall short, as the rot inherent in the system due to lack of attention over decades cannot be fixed in weeks. A sadly unfortunate situation given the heroics of the nation’s healthcare workers who continue to fight valiantly despite their deplorable working conditions and historical lack of support from authorities.
It is therefore pertinent that post-COVID-19, Nigeria must take a long, critical view of herself to understand the factors responsible for the abysmal state of the nation’s healthcare system, with a view to taking concrete steps to address the flaws in the health sector. In particular, it has become imperative that the nation’s governments at all levels dedicate significant budgetary allocations and public investments into the nation’s health sector.
Furthermore, there needs to be a realization that no nation can achieve a superb healthcare system without the existence of a functional health insurance scheme strategically conceived and implemented to guarantee universal health coverage. Therefore, there is a need to strengthen the nation’s health insurance system by addressing its flaws and ensuring that health insurance in Nigeria becomes universal and not only the preserve of the well-to-do.
COVID-19 has laid bare Nigeria’s deplorable healthcare system, and the nation’s leaders can no longer feign ignorance of its deplorable state. Only proactive actions to address the flaws inherent in the system and the factors responsible for its deterioration will help forestall another public health disaster in the future. A word is enough for the wise.
OLANREWAJU RUFAI
