Nigeria @ 58: Unfulfiled Promises in Health Sector

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Posted on: Tue 02-10-2018
  Fifty-eight years after  independence, the Nigerian health sector is  bedevilled with challenges it didn’t experience before 1960.  Each year, it has become the norm on October 1st for Nigerians to hear unending promises about plans to revitalise the country’s ailing healthcare system and provide better life espectations as a whole.   Unfortunately, 58 years down the line, there are unfulfiled promises than at any time in the past It is no longer news that Nigerians  waited, worked and prayed for independence and obtained it on a platter of gold. As an independent nation, expectation is usually high that all will be well.   To the more discerning however, the lack of positive and productive activity is an omen – an indication that all is not well. Beneath the apparent calm, unmitigated chaos rages.    Promises made over the decades remain fulfilled, and the bulk of  beautiful policies and laws lie dormant without implementation. Undeterred by  unfulfilled promises,  Nigerians continue to hope and wait. In 2015 more  promises entered the existing lonng list of promises.   There were promises to ensure Universal Health Coverage; contruction of 10,000 Primary Health Centres to ensure effective healthcare delivery at all levels;  implementation of the National Health Act that was  signed into law by the past administration, and  revitalisation of seven cancer treatment centres among others.   Despite these promises without action, Nigerians continue to wait for something to happen. But as far as the average  Nigerian is concerned, nothing tangible has happened, not because it isn’t meant to happen, but more because nobody is making it happen.   This depicts the state of affairs of the health sector today. Long before Independence Day on October 1, 1960, in the 1940s and 1950s, Nigeria, with its population of around 34 million (at that time), was already considered the giant of Africa. It was the dawn of the oil boom and there were great expectations for the affluent, former British colony.   The whole world had great expectations for the young nation. At that time, every relevant resource imaginable was present. Medical supplies were in abundant supply. There were few (if any) centres of medical excellence in healthcare, but they were patient-focused.   There weren’t as many experienced and well-trained health workers as there are today, but they thronged the local healthcare centres that were equipped with up-to-date, if not state-of-the-art medical equipment.   Brain drain was virtually non-existent because there was enough motivation for health workers in the form of good remuneration and almost unlimited career opportunities.   In the face of such efficient and effective coordination, the future was bright, rosy, almost fulfilled. Today, the picture has changed considerably, unfortunately, for the worse. As Nigeria marks its 58th, it is a sad commentary that the country’s position in Africa and on the global healthcare index has gone from bad to worse.   According to the Nigerian Medical Association, the country is yet to make an impressive mark in the health sector 58 years after. Today, Nigeria’s population is growing at an exponential rate and right now, the country is said to be the headquarters of poverty in the world.    It cannot be overstated that the health sector has, post-independence, suffered several false starts and downfalls, but how did an outlook that was so bright and promising become one so grim and uncertain?   The transformation is so palpable the whole world feels it. Now with an estimated population of over 200 million, coupled with insurgency in the North, insecurity, bigotry, gluttony and other forms of deep-seated political instability, the elements of discord have conspired to rob the nation of its once-great potential.   Lack of coordination, fragmentation of services, dearth of medical resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care, have been the hallmark of this sector over the past 58 years.   However, although other developing countries are faced with such challenges, the dividing line has been the level of political attention. Critical health observers say absence of a reliable referral system from Primary Health Care, to Secondary Health Care and finally Tertiary Health Care, is partly to blame.   Today, apart from the Non-Communicable Diseases, NCDs, such as cancer, diabetes, hypertension, stroke and coronary heart disease plaguing Nigerians, 58 years after, communicable disorders such as tuberculosis, malaria, cholera,  typhoid amongst others are still a threat.   No thanks to the unending but unfulfilled promises of both past and present administration. In the last few years, Nigerians have been battling with several outbreaks of diseases such as Ebola, Lassa fever, cholera, monkeypox, amongst others, yet it is still impossible to track outbreaks of diseases and step up medical treatment and preventive measures even before there is a spread.   Sadly, many of these issues would have been addressed if there are adequate health facilities, personnel, and medical equipment especially in the rural areas. Obviously, spending and implementation have not matched policies. For instance, Nigeria spends only 6.5 percent of its budget on health care as against the World Health Organisation’s recommendation of 15 percent. The nation’s high maternal mortality rate remains worrisome. It is among the highest in the world.   One Nigerian woman dies in childbirth every10 minutes. Nationally, the maternal mortality rate is 545 deaths per 100,000 live births, nearly double the global average. Children are hardly better off because more children die before their fifth birthday in Nigeria than any other country in Africa. Worse still, the problem of counterfeiting, faking and cloning of drugs is compounded by poor regulation and enforcement.    Capacity utilization is a hindrance and there is serious problem with the handling, storage and distribution of drugs which remains chaotic, with attendant ability to promote loss of confidence in all drugs whether imported or manufactured locally. Today, drug abuse is order of the day. This is evident in the rampant misuse of drugs such as codeine and tramadol.    Essential functions are still desirable to protect members of the public from major health threats. More efforts are also required at strengthening the health work force through planning, management, and training to have a positive effect on the health sector performance. The bottom line remains an unpleasant commentary that the state of the Nigerian health care system is worsening.   The nation is not even on track to meet any of the targets of the 17 Sustainable Development Goals. Year after year, the indicators of health and life continue to go from bad to worse. A new report by Bill and Melinda Gates also showed that by 2050, about 152 million Nigerians will be living in extreme poverty.   By Sola Ogundipe & Chioma Obinna  Vanguard News

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