At Nigeria’s independence in 1960, the agenda on healthcare had begun to shift from expanding urban services to the development of rural health infrastructure and services.
The national policy for health care services targeted the establishment of rural hospitals of about 24 beds, under the supervision of a medical officer who would look after dispensaries, maternal, and child welfare.
As healthcare management evolved into complex structures in the years leading up to independence, the control of healthcare services moved from the colonial office in London to regional governments in the east, west and northern Nigeria but with funding from the federal government.
By 1981, the Fourth National Development Plan had been birth to address three components of the Basic Health Services Scheme (BHSS): Comprehensive Health Centers (CHC) for communities of more than 20, 000 people; Primary Health Centers (PHC) to serve communities of 5000 to 20, 000 persons; and Health Clinics (HC) to serve 2000 to 5000 persons.
According to that plan, each local government area (LGAs) would have a minimum of 7 PHCs and 30 HCs with at least one CHC at the apex of the health care services. The larger LGAs would each have, at least 12 PHCs and 50 HCs feeding into one or more CHCs.
But 60 years later when Nigeria should be parading world class hospitals driven by innovation towards patient-centric care, only about 20 percent of 30,000 PHCs is functional. Most PHCs facilities lack the capacity to serve their core essence due to poor staffing, inadequate equipment and poor essential drug supply.
Several general hospitals today cannot confront emergencies with prompt clinical intervention. The culmination of their poor performance has consistently piled undue pressure on underequipped tertiary hospitals struggling to focus on more complex medical urgencies.
The layout and performance of public healthcare management in Nigeria has been sullied and unconnected to the string of promising policies, strategic development plans and acts that have trailed the sector for decades.
From independence till date, the giant thorn to health security for Nigerians remain lack of prioritization by the federal government a challenge that has dovetailed into weak health infrastructures, loss of skilled manpower to better countries and poor health quality for Nigerians, particularly for the over 200 million poor population who depend on less than $1.9 per day for survival amid an inflation rate of 12.8 percent.
In 2020, dearth of beds still determines the survival rate of Nigerians as the country operates with 0.5 percent hospital beds per 1,000 people for a population of roughly 200 million.
Diagnosis and treatment of non-communicable disease within the country is still a hassle. The largest economy in Africa faces dearth of storage facilities for health commodities. National health coverage remains far short of population, mounting the out-of-pocket burden on Nigerians by 77 per cent.
While the population continues to expand, health expenditure has averaged 3.7 percent of annual budgets in the last five years. The N315.7 billion allocated to health in the 2019 budget marks 3.54 percent of a total of N2.1 trillion. Yet, neither full release nor implementation was achieved for the fund-starved sector.
Nigeria’s record of spending inconsequentially on healthcare is not an offshoot of recent decline in economy flourishing. It dates back to the 90s.
From 1975 to 1980, N689 million was allocated to healthcare out of a total expenditure of N43 billion. This amounts to just 1.6 percent of the total proposed expenditure. The naira in 1975 was almost equal to $2 and Nigeria’s population hovered around 75 Million. It means per capita expenditure on health therefore was about $18 in 1975.
In the 2004 federal budget of N99.8 billion, the health sector got a record high N26.4 billion, 26 percent. However, with recurrent expenditure gulping the larger lion share, the population dangling around 130 million and naira at $0.007, the per capita expenditure was only about $1.42, against $18.
Since 2000, the highest level of spending was at 7.3 percent of total government expenditure in 2006. From 5.3 percent in 2015, it plunged to 4.5 percent against the 2001 African Union agreement that member countries will commit at least 15 percent of their annual budget to improve the health sector.
At 60, the bottom line of stakeholders’ concerned is that the political will to overhaul the healthcare system needs to be stronger to strengthening the health security of Nigerians.
Innocent Ujah, national president of the Nigeria Medical Association (NMA) says much more needs to be done in terms of improving the quality of hospitals available to common people at the grassroots level.
“The capacity development is improving but we need more. By and large, Nigeria has come a long way but we can do more with more staff,” he told BusinessDay.
Doyin Odubanjo, former chairman, Association of Public Health Physicians of Nigeria, Lagos Chapter, said the COVID-19 pandemic has pointed to the fact that the health sector needs the highest attention possible which will be shaped by a strong political will to deal with all the issues.
