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A state of emergency in the health sector

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The statistics are startling, scary and indeed scandalous-talking about the human capital development challenge currently bedeviling Nigeria’s much-neglected health sector. Think about these frightening figures, for a moment: Nigeria needs over 237,000 doctors to achieve Universal Health Coverage. But there are about 40,000 doctors that are practising in the country now, whereas, the Medical and Dental Council of Nigeria register contains about 91,000 names. So, where are the remaining 51,000? That is the pertinent question.

According to Professor Adetokunbo Fabamwo, Chief Medical Director, Lagos State University Teaching Hospital(LASUTH), Ikeja, “Eighty percent of those 51,000 are abroad, while 20 percent have been affected by internal brain drain. Internal brain drain is where a doctor stops practising medicine and starts doing something else. This was made known at the Ordinary General Meeting of the Medical Guild, Lagos State chapter, held recently in Lagos, with the theme: ‘Challenges of Inadequate Human Resources in the Health Sector: Way Forward.’

Although, globally, the World Health Organisation (WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers worldwide, especially in many developing countries, “statisticians have calculated that it is going to take Nigeria 100 years, at the rate we are going, to produce all the doctors we need,” Fabamwo admitted.Contrary to the recommendations of the World Health Organisation (WHO), of one doctor to 600 patients, Nigeria currently has a ratio of one doctor to 6,000 patients. This is according to the Head of the Ear, Nose and Throat (ENT), Department, University of Abuja, Professor Titus Ibekwe, the former Vice President of Nigeria Medical Association (NMA). He pointed out that to worsen the situation, a lot of healthcare facilities in the country are outdated while many are also dilapidated.

My dear compatriot and reader, you must be worried about this sordid situation, like yours truly; aren’t you? The country’s authorities must first accept the gross inadequacies in the health sector for us to move forward in solving the problem. The obvious challenges facing the critical sector include inadequate funding or low budgetary allocation, infrastructural decay, low ratio  of medical personnel to the citizens, inaccessibility to quality primary healthcare delivery down to the rural areas,   lack of requisite training and of course, the self-decimating wave of brain-drain.

In spite of the pledge which Nigeria made in 2001 through the “Abuja Declaration” to commit at least 15 percent of the annual budgets to improving their health sector it has failed to keep to its promise.  That was made when it hosted the Heads of State of member countries of the African Union (AU). The highest percentage since the declaration was in 2012 when 5.95percent of the budget was allotted to health.

In the 2018 Budget proposal President Muhammadu Buhari presented to the National Assembly, he allocated N340.45 billion, representing 3.9 percent of the N8.6 trillion expenditure plan to the health sector. The allocation was less than the 4.16 percent and 4.23 percent made to the health sector by the administration in the 2017 and 2016 budgets, respectively. The percentage allocation to the health sector in the 2019 Budget of a recurrent expenditure of N 315.62 billion for the ministry of health is about 46.3 billion increase from last year’s recurrent expenditure, which was N269.3 billion. Yet, it remains a far cry from all earlier agreements reached and promises made by the country before the international community.

Furthermore, Nigeria’s health situation has become of increasing concern as it has been compounded by the insurgency-ravaged North Eastern region where access to medical care has diminished. Only recently, the citizens were outraged by the torrid tale of Nigerians in IDP camps feeding on onion leaves!

Several statistics also reveal that Nigeria has one of the worst health care delivery records in the world. As at 2017, Nigeria was rated 187th out of 191 countries in terms of health care delivery, according to WHO. It said that one-third of more than 700 health facilities have been destroyed in the country and about 3.7 million people are in need of health assistance.

The global health body placed Nigeria at third highest in infant mortality rate in the world. Medical experts described as worrisome the recent figure released by international agencies which put Nigeria’s maternal mortality rate at 58,000 in 2015. This showed that Nigeria recorded the second highest maternal death rate in the world. Exacerbating the sad situation is the series of industrial actions by health workers over unpaid salaries and other administrative anomalies.

It is understandable therefore, that the Nigerian Medical Association (NMA), the National Association of Resident Doctors (NARD) and the Socio-Economic Right and Accountability Project (SERAP), human rights groups took a swipe at the Minister of Labour and Employment, Chris Ngige, over his comment that the country had enough medical doctors.

He said, “No, I am not worried (about doctors leaving the country). We have surplus. If you have surplus, you export. It happened some years ago here”. That was one avoidable gaffe, against the grains of the harsh reality on ground. So, what is the way forward?

We must learn from other countries with better health facilities and medical personnel. For instance, the countries with the most doctors per capita (doctors per 10,000 people) include Qatar with 77.4, followed by Monaco with 71.7, Cuba with 67.2 and Greece with 54. In Africa, Algeria and Morocco are ahead of Nigeria. Our political leaders should muster the political will to do the needful as India has done.

 The Indian medical education system has been able to double the numbers of MBBS graduate (modern medicine training) positions during recent decades. With more than 479 medical schools, India has reached the capacity of an annual intake of 67,218 MBBS students at medical colleges regulated by the Medical Council of India.

Policy makers should muster the political will to do the needful. Nigeria should keep to the pledge it made to the AU to give 15 percent of its annual budget to the health sector. Restructuring and true fiscal federalism will enable states to control their resources and pay more attention to the people’s healthcare. Brilliant students wishing to go for medical studies should all be placed on state and Federal Government sponsored scholarships.

No effort should be spared to upgrade the infrastructural facilities in all clinic and hospitals. More training of the personnel is required. And we should borrow from India that produces medical graduates in the “traditional Indian system of medicine,” regulated through Central Council for Indian Medicine.

The time to declare a state of emergency in the health sector is now!

 Ayo Oyoze Baje

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