Quality healthcare elusive despite promise of world-class hospitals

Wooing Nigerians in the months leading to his 2015 election victory, President Muhammadu Buhari was explicit on banning all government officials from seeking medical care abroad.

His premise was to level up the quality of all Federal Government-owned hospitals to world-class standard in five years, by raising the annual national health expenditure on each individual to about N50,000, from less than N10,000.

But walking these talks has suffered priority with the president’s several medical trips to London demonstrating to the rank and file of his administration that the world-class standard promised were offshore.

Most of the top government officials struck in the wake of COVID-19 crisis left their immediate locale to the corridors of the biggest private hospitals in Lagos, despite having 22 teaching hospitals, 20 federal medical centres and 17 specialty hospitals scattered across the country.

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Many government-run hospitals still can’t live up to the expectations of tackling medical emergencies as the challenges of low funding, deplorable infrastructure, and low ratio of health workers to patients mainly stand in the way.

Individual burden of healthcare expenditure has unfortunately sustained growth, while the government expenditure on healthcare has hovered below 5 percent of the annual total budget of the federation.

As exposed by the pandemic, the healthcare sector has few indices to defend the aspirations of the Buhari administration or the standard of quality that an oil-rich country deserves. Nevertheless, few bright spots exist.

Low budgeting

If the Buhari administration actually followed through on expending N50,000 on each Nigerian as annual government spending on health, it would have allocated an average of N9.7 trillion to the sector between 2016 and 2020, an amount twice the entire government budget of 2015.

With N4,166 spent monthly on each Nigerian’s healthcare and N136 daily, hospitals equipped to the taste of international standard could have been feasible with proper execution.

But the case is different. Government health expenditure as a percentage of the entire country’s spending fell marginally from 5.3 percent in 2015 to 5 percent in 2016. What followed was a significant dip to 4.4 percent in 2017 and a further 3.9 percent of 2021 ‘Budget of Economic Recovery and Resilience.’

Although the economy has been mired in recession twice in five years, the size of government’s investment in health reflects its poor positioning on the government’s scale of preference.

A health budget, typically included in the general government budget, is more than a simple accounting instrument to present revenues and expenses, according to a World Health Organisation report on budgeting.

“We keep looking at foreign investments as the saviour for healthcare, but good policy can also increase healthcare financing,” said Abasi Ene-Obong, chief executive of 54GENE. “It doesn’t have to be only investments, it could be the fact that more people can pay for or that health insurance is rejuvenated in the country and made in a way that people have access to it.”

According to Ene-Obong, Nigeria needs to demonstrate healthcare as a priority for investments to be attracted to the industry.

Health insurance

The National Health Insurance Scheme (NHIS) remains the case of a system working for very few among millions of needy people. Allocation to the scheme has been miserly with N144 million budgeted for it in 2020, for instance.

It covers barely 5 percent of Nigeria’s 206 million population who are mostly officials of the government in civil service and leaves others largely operating in the informal sector to grapple with rising out-of-pocket expenditure.

Lack of insurance has sunk many into poverty as out-of-pocket health burden grows heavier. Individuals’ expenditure on health already contributes $12.3 billion annually, about 80 percent of the country’s total healthcare spending.

For Ene Obi, the country director of ActionAid Nigeria, a non-governmental advocacy outfit, many aspects of the healthcare sector need to be revitalised, starting with the primary healthcare.

“For us who are not in government, we take private insurance, which is a lot more expensive. But what about the millions of youths who do not have jobs? What about the millions of women who are having children every day without jobs and their husbands are underemployed?” she said.

Compulsory care for gunshot victims

One of the bright spots of healthcare in the last five years is the Compulsory Treatment and Care for Victims of Gunshots Act, which took effect in 2017.

For the first time, the relevance of urgency in emergency care rose to the limelight as it became a crime for hospitals to reject victims of gunshots wounds on the grounds of not presenting a police report.

“Every hospital is to receive and treat victims of gunshot wounds with or without police clearance and/or payment of an initial deposit, but are duty-bound to report to the nearest police station within two hours of commencing treatment on the victim,” the Act states.

On the heels of this, hospitals stepped up emergency response to gunshot victims in the wake of a violent twist to weeks of the #EndSARS protest against police brutality last October. Healthcare workers were quicker to administer First Aid after the brief screening.

But many still doubt that the positive development will be sustained in the aftermath of the protest.

The implementation of the Act has not trickled down and Nigerians are still dying at the gates of non-complying hospitals. The government has not sanctioned any hospitals over rejection despite viral cases reported on social media.

Polio eradication

Another bright spot for the sector is getting rid of Polio. Nigeria was Tuesday, August 25, 2020, certified free of the Wild Polio Virus after over a decade of grappling with it. The feat meant a victory for both Nigeria and Africa, but experts have warned that resurgence might be imminent since the virus still exists actively in the Asian region and the challenge of the circulating vaccine-derived poliovirus remains in the continent.

Already, a mutated strain of the poliovirus has been reported in more than 30 countries.

Maternal and infant mortality

The final report of Multiple Indicator Cluster Survey released in 2018 by the National Bureau of Statistics (NBS) and the United Nations Children’s Fund (UNICEF) estimate neonatal mortality rate was 39 per 1,000 live births, while infant mortality rate was 70 per 1,000 live births.

This implies that 1 in 15 live births in Nigeria die before their first birthday.

Also, under-five mortality rate is estimated to be 120 per 1,000 live births – that is 1 in 9 live births die before their fifth birthday.

According to the World Health Organisation (WHO), the maternal mortality rate of Nigeria is estimated at 814 per 100,000 live births. The lifetime risk of a Nigerian woman dying during pregnancy, childbirth, postpartum or post-abortion is 1 in 22, in contrast to the lifetime risk in developed countries estimated at 1 in 4,900.