Going by the Constitution of the World Health Organisation (WHO), which came into force on April 7, 1948, health is defined “as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Healthcare delivery that is accessible, affordable and available to the people is, therefore, seen as one of the cardinal objectives of Human Rights.
The whole international community had agreed both at the Alma Ata and the following Riga Conference, that primary health care is the only viable way to go in order to produce optimum health for the people. But the million-naira question is how well it is organized and delivered in different countries, to lift their citizens from all manner of diseases and factors of ill health.
With regard to Nigeria’ssituation, the 2000 World Health Report ranked the country as the187th of the 191 member nations for its health system’s performance. According to the Journal of Community Medicine and Primary Health Care, 16 (1) 1-3 past and present the poor ranking “speaks a whole lot about the fact that our health system is not working.”
Most important among the factors responsible for this is the inadequacies of the community or primary health care services. Another is the recurring issue of inadequate budgetary allocation to the critical sector, reflecting of course, in the lack of funding to build and maintain stable infrastructure.
There is also a gross lack of properly trained and compensated staff, including nurses and doctors, leading to massive brain drain involving some of our best brains from the sector leaving the country for greener pastures.
“It is no secret that the state of primary healthcare in Nigeria is poor. Decades of neglect by state and local governments, whose responsibility it is to provide primary healthcare services, have resulted in inefficient and poor-quality primary healthcare service delivery across the country.”
-Bashir Abubakar (Nigeria Health Watch)
In fact, the Canadian Medical Association stated that no fewer than 632 Nigeria-trained doctors were practising in Canada as of 2020. Reports as at March 2023 claimed that there were over 4,000 Nigerian doctors, excluding other health workers, practising in the US. Nigerian-trained doctors rose in the UK rose from 10,824 to 10,986.
Apart from healthcare being too expensive for most Nigerians, not a few of the patients are uninformed, leading to self-medication with its negative consequences.
Making quality and affordable healthcare delivery as a national priority has, therefore, become imperative for the newly sworn-in Tinubu-led government. Hence, our clarion call is for him to assemble a team of experts in the field to have a deeper look at the journey so far and articulate a master plan to revive the near-comatose sector. Members of the think tanks should proffer pragmatic solutions to the persisting problems and fashion the way forward.
It was not as if the previous administrations did not at one point or the other come up with some notable initiatives and made some reforms. No, they did. But the fact that the listed challenges still stare us in the face underscores the need to learn from the past. That, from hindsight goes to health policies in 1999, 2004, 2014 and 2016.
For instance, the National Health Insurance Scheme Act 1999 came with the National Health Insurance Scheme Decree (No. 35 of 1999). The objective was to establish a National Health Insurance Scheme for the purpose of providing good quality and cost-effective health services.
Next to this was the Revised National Health Policy in 2004. It was meant to improve access to primary, secondary, and tertiary healthcare services to reduce under-five mortality, maternal mortality, the spread of HIV, and the burden of malaria and other major diseases.
That of 2014 was set up to provide a platform for efficient coordination of the Health System and the delivery of a Minimum Package of Essential Health Services. It also makes provision for social inclusion, addresses the issue of equity in health and seeks to protect families from catastrophic health expenditure within the country’s overall macroeconomic framework called National Economic and Empowerment Development Strategy (NEEDS).
After that came the National Health Policy 2016. The objectives included: (a) To foster behavioural change, reduce stigma and improve access to quality care and support services for persons living with HIV/AIDS; (b) To promote an integrated approach to the control of communicable diseases; (c) To reduce the malaria burden to pre-elimination levels and bring malaria-related mortality to its barest minimum. How well these policies have impacted on people’s health status is not hard to guess.
Let us consider some figures of the ratio of doctors to patients. In Nigeria the ratio of 1:10,000 is a national average against the World Health Organisation (WHO) recommendation of 1:600.” But in most states, the situation is palpably worse with one doctor is incredibly available to treat 30, 000 patients in some states in the south, while states in the North are as worse with one doctor to 45,000 patients! This is unacceptable when compared with what plays out in other countries.
For instance, the UK has 2.8 doctors for every 1000 people. Germany, Italy, Lithuania, Norway, and Switzerland all have more than 4 doctors for every 1000 people. The United States has 2.6 per 1,000. China and India recorded even lower numbers at 2.4 and 0.9 doctors per 1,000 people, respectively. The average across the 33 countries is 3.0. Austria has 5.1 doctors for every 1000 people. These figures were made available in October 2022. Going forward, how to reverse this obvious drift to having a country of sick people that are unattended to?
As a reminder, back in 2015 the All Progresses Congress (APC)-led government made several mouth-watering promises, one of which was the ban on its political leaders from travelling outside our shores for medical treatment. Unfortunately, that was flagrantly violated, beginning of course, with former President Muhammadu Buhari going on medical tourism, especially in the United Kingdom. One hopes, and fervently so that his successor, Tinubu will change the narrative.
According to the International Centre for Investigative Reporting (ICIR) with its report on October 20, 2021 payment of workers’ salaries, training of staff, cost of running offices and related matters were to consume 73 per cent of the budget proposed for health in the 2022 fiscal year. The average since 2010 stood at72 percent.
Despite the increase in the proposed budget for health, with over one trillion naira proposed in the 2023 budget only 5.75 percent of the total budget was allocated to the health sector!
With regards to the payment structure, according to the Nigerian-born Dr. Ogirima, Saudi Arabia pays Nigerian professors of medicine between N5m and N7m monthly while the Federal Government pays their counterparts in the country between N420,000 and N500,000.
As a way forward therefore, a new database is required so that the National Bureau of Statistics (NBS) will avail the policymakers on how many clinics, doctors, and nurses we have on the ground, by a local government and state basis. How many more do we need, the equipment is available, the real quantity needed and the cost implications? The private sector can assist with the enabling environment of good access roads, and purchase of drugs and relevant equipment.
We need long, medium and short-term plans to get our doctors and nurses back from foreign lands to meet a rejuvenated health sector. We have had enough of always sending our crude oil, raw agric products, solid minerals and human resources to benefit other countries, instead of us. The time for a paradigm shift is now, because health is wealth.