Health Sector Challenges In Nigeria: What Our Leaders Must Do

 

By AKOR SYLVESTER-Abuja

 

The saying that, health is wealth is true of any nation of the world that wants its economy to be healthy and strong. In other words, for any country to develop economically and otherwise, such country’s health sector must be vibrant and made to be at the fore front to achieve the feat. Yes, of course, developed countries with robust economies are known for making robust public health policies that enhance the delivery of measurable health care to their citizens. That has helped them cater for their citizens’ well-being effectively. It has also made it easy for them to monitor and control the epidemic outbreaks in their country. Became of the importance of the sector, one can describe it as the life wire of other sectors of the economy. Many countries of the world are known to be great today because of the strength of their health sectors.

 

A critical look at the Nigerian Health Sector, one will observe  that the Sector, although a very important aspect of the country’s economy, has suffered lots of setback over time. This means that the sector has not lived up to expectation of Nigerians. It is associated with challenges such as inadequate funding, disease outbreaks, lack of modern equipment, inadequate health personnel, frequent strikes by health worker and others.

 

Nigerians can still remember that, in 2001, all member countries of the African Union (AU), including Nigeria, at An Abuja Declaration, arrived at a recommendation that for the continent to be at par with other nations of the world in terms of healthcare provision, at least 15 percent of their annual budget, should be allocated to the health sector. This declaration, till date has not been followed in Nigeria, as reverse is the case. Nigeria’s health budget has continually fallen short of the recommended threshold: In 2015 – 5.78%; 2016 – 4.23%; 2017 – 4.16%; 2018 – 4.4%; 2019 – 4.75%; 2020 – 4.14%. 2021 and 2022 are not left out in this shortfall of the nation’s budget. The highest Nigerian budgetary allocation to the health sector since the 2001 Abuja Declaration was 6.08% in year 2012, giving an average of 4.69% in 20 years, falling a 10.31% short from 15% commitment.

 

It is pertinent to note that the lack of adequate funding has a multiplier effect on the health of the people whose survival depends on the strong and robust health system. This results to lack of enough health facilities across board and dearth of modern equipment in the existing facilities. The health workers on ground are bereft of adequate welfare packages thus leading to the flight of a substantial proportion of home grown health professionals seeking greener pastures abroad. Today the issue of brain drain has become so worrisome. The former President of the Nigerian Medical Association (NMA) Professor Innocent Ujah, has, in an interview with Daily Champion in Abuja expressed dissatisfaction over exodus movement of Nigerian Doctors to abroad seeking for greener pastures. He said until the federal government begins to look at the plight of Doctors and other health professionals and create a conducive environment for them to strive, the movement of good hands to oversees will continue. He maintained that a situation where a medical Doctor, who spent many years studying in school, can not meet up with the family responsibilities as a result of poor pay, was uncalled for, hence, the movement abroad to look for reasonable and attractive packages. So, the issue of Doctors and other health professionals relocating to other countries continue to threaten the health system. Those staying behind embark on strikes on agitation for better welfare package thus leaving the sector worsened. The near comatose state of health facilities in Nigeria is boldly reflected in the lack of confidence in the sector by the populace. The high ranking members of the populace, including leading political figures and the bulk of the middle class (prior to the current Coronavirus pandemic) embark on medical tourism in Europe, USA, India and South Africa. A large portion of the rest of the populace who lack the capacity for foreign health treatments resort to self-medication and traditional medicine for their health needs.

 

Our politicians do not see the need to put the health sector in a proper position for the benefit of the common people. No wonder they take delight in purchasing N100m party nomination fee for the post of President of the country when Nigerians are facing a lot of health challenges that such money could be channeled to, to better the situation. Imaging the amount of money that went in to the purchase of nomination forms across parties, seeking for positions in various levels of government. If this millions were sucked into health sector, the nation would be good for it. Politicians need to be more aware of the importance of health as a cross-cutting priority, regardless of their focus sector.

The disturbing situation of the Nigeria Health Sector is better captivated in a 2019 rating by the World Health Organization (WHO). WHO had rated Nigeria 187 out of 191 countries in terms of health care delivery. One third of more than 700 facilities across the country were indicated as having been destroyed with more than 3.7 million people in need of critical health assistance. WHO had placed Nigeria at 3rd highest in infant mortality rate in the world.

 

The National Health Insurance Scheme (NHIS), now National Health Insurance Authority (NHIA) established in 2005 has not made the expected significant impact. The Authority has been bedeviled mainly by lack of proper marketing to the bulk majority of the populace, most of whom are illiterates and resident in the rural areas. So also is the lackadaisical attitude of the Health Management Organisations (HMOs) and dearth of medical practitioners to effectively implement the scheme. Nigerians are hoping that, now that the scheme, by law, has transformed to authority, Nigeria will achieve the acceptable universal coverage. Available statistics, as at 2017, indicated that Nigeria had about 80,000 registered doctors with more than 50,000 of them practicing abroad. A large percentage of those in the country were at the verge of seeking greener pastures abroad.

 

However, today, the situation of Nigerian health sector is not without achievements.

 

Nigerians saw a green light in health sector when polio was totally kicked out of the country. This became possible through enlightenment, sensitisation and other initiative by government to tame the virus.

 

Also, the manner and the commitment shown during the outbreak of the Ebola virus equally shows that given the right atmosphere, the Nigeria health sector could tackle arising health challenges.

 

Similarly, the ongoing efforts towards eradicating COVID-19 pandemic from the country, is a wake-up call on the Nigerian health sector to be properly positioned to cater for the teeming population of the country. Nigerians, no doubt can survive any out break of epidemic, if the health sector is rightly positioned.

 

From the experience of the lockdown during the heart of COVID-19 in the country, and the fact that our politicians could not travel for medical attention abroad, Nigerian health sector can serve its purpose when given proper funding, equipments, personnel and political will.

 

The time is now for all tiers of government in Nigeria to invest hugely in the health sector by ensuring that adequate health infrastructures are put in place coupled with attractive welfare packages for health workers across board.

 

To ensure a viable health services in the country, Federal Government and those of the federating units must provide an enabling environment for medical research that would include local input by enhancing a synergy between orthodox and traditional herbal medicines. The time is ripe for the Department of Traditional Complementary and Alternative Medicine, in the Federal Ministry of Health, to partner with the National Institute of Pharmaceutical Research and develop vaccines, curative medicines and relative antidotes to the diseases facing the society including Covid-19 pandemic.

 

The federal government had through its relevant agencies announced that it has set to develop its vaccine to tackle outbreak like the COVID-19 pandemic. Nigerians are still waiting for the breakthrough.

Nigeria can do well when it makes use of the God given Orthodox medicine as proven by studies and undertaken by experts. What  Nigeria needs most, at this critical moment, is a virile home-grown medical approach. We can do it if the will is there.

 

Thank God that the National Health Insurance Authority, recently signed into law, has been made all-encompassing to adequately cover the Nigerian populace.

With the present status of the health insurance authority, Nigeria can get there interns of acceptable health insurance coverage that would benefit the rural populace. The significance of the Newly Assented NHIA Act includes that; it makes Health insurance Mandatory for all residents in Nigeria. This will increase the pool of funds to deliver health care, provide access to health care for all at affordable costs, reduce to the minimum the out of pocket expenses with its catastrophic effects and increase the quality of health care available to residents. It defines the roles and responsibilities of the Health Insurance Authority(NHIA), with this, they would be able to deliver these roles of promotion, regulation and coordination of health insurance in Nigeria.

A Vulnerable Group Fund will be created to cater for the over 83million Nigerians that are vulnerable and can’t pay for their premium. It also provides for the coordination of public and private health insurance as well as federal/state coordination and relationships. These would ensure effective and efficient health insurance services. It provides for the use of technology to drive health insurance systems and processes in the country. it provides for better regulation of Health Maintenance organizations third party administrators, and mutual health organizations to ensure quality and efficient service delivery by these organizations. It provides for the framework that will strengthen the capacity and functionality of the Health Insurance Agency. It also makes investment in healthcare in Nigeria very attractive by giving a sizeable population coverage and good negotiating power to Nigerians for healthcare services. It has the possibility of putting a stop to medical tourism if properly implemented, thereby improving the economy and serving to position Nigeria as a hub for medical services in the region. In addition, attitude of health workers must be strictly checked if the nation must better it’s health services too.