THE STATUS OF THE NIGERIAN HEALTH SECTOR

BY GODSWILL AGUIYI (+2348038708562)

Email: godswill.aguiyi@gmail.com

One of the key elements of public policy is the promotion of good health care system that
supports the achievement of the national health objective of providing health for all and the
attainment of a broad based economic growth and development with healthy citizens. Based
on the foregoing, many developed countries of the world prioritizes the issue of health and
devote huge budgetary allocation to the health sector, but in Nigeria, healthcare financing is
low (even when compared to other African countries) and the expenditure on health has failed
to translate into better health status for the citizens. For instance, the deplorable state of the
public health facilities prompts the rich to seek for adequate medical attention overseas.
According to figures quoted by the Nigerian Medical Association, more than 5,000 Nigerian
patients travel abroad for medical treatment every year and Nigeria losses N120bn ($800m)
annually to foreign medical trips.

It can be argued without mincing words that the public health care system is inefficient in all
ramifications and the provision of adequate health care services to the ordinary Nigerian and
particularly those in rural areas and those who cannot afford the cost of private hospitals or
travel overseas has left much to be desired. What is observed in many public hospitals is that
critically-ill patients that should be managed in intensive care units are treated on benches at
the corridors or doorsteps because there are no bed spaces for them. Aside the dilapidating
state of the atio ’s health i frastru tures, the i essa t i dustrial a tio of do tors a d a y
medical unions/associations deals its own blow on healthcare delivery in the country. Badly
enough, the response of the government to the recent industrial action embarked upon by
medical practitioners was suspension and sack; even with the cry of shortage of medical
personnel in the country. This informs that the health sector needs critical reform not only in
terms of structure and policy but also in view of the increased burden of diseases that is
bedeviling the nation now. The recent Ebola crisis that is almost causing a regional pandemic is
a case in point. Nigeria government must come to terms with the fact that access to adequate
health care is the right of every citizen irrespective of status, location and ability to pay.

There is therefore the need for decision-makers, stakeholders and relevant audiences to
support and implement actions for the holistic reform of the health sector in Nigeria. What this
implies is that the Nigerian health sector needs to be repositioned to meet the health and
development needs of Nigerians. This can be achieved when stakeholders pay critical attention
to the following:
Firstly, it has been noted that funding to the sector "is grossly inadequate. Recent reports
pointed Nigeria as one of the countries that spend the least per individual for healthcare.
Therefore, there must be clamor for increased budgetary allocation to the health sector as
stipulated by the AU Abuja Declaration. It should be recalled that since 2001, the allocation to
the health sector in Nigeria has been nose-diving and has barely achieved 6% despite several re-
affirmations by governments both past and present to commit to the allocation of 15% of the
national budget to the health sector.

Secondly, the health sector has been operating without a signed healthcare bill that would
provide a road map for healthcare delivery in Nigeria. Nevertheless, light has just shown at the
end of the tunnel as the president recently signed the National Health Bill in December 2014.
The health policies and programs are supposed to influence improvements in the health of the
population, inspire confidence in the health care delivery system and empower the workforce
to deliver quality care. The health bill will also increase indigenous health care research and
development, foster capacity development and cultivate greater institutional capacities for the
health sector. Our concern for the health bill is that it does not end up in the shelves like many
other policy documents in the country.

Another case in point is the issue of poorly developed data base and Health Management
Information System, coupled with poor use of Information Communication Technology in
advancing access to healthcare. Before now, many stakeholders have decried the issue of the
status of the ou try’s health statisti s and its effect in the policy structure of the health sector.
It should be noted that data is very vital for policy formulation and implementation; Nigeria’s
health statistics are in a very bad shape, just like in other sectors of the economy, they are
generally uncoordinated, incomplete, unreliable and untimely. It has been widely noted that
adequate health statistics (data) is necessary for planning and monitoring of relevant programs
in the health sector. Data are also needed to estimate health statistical indicators which are
required for making geographical (inter-regional and international) comparisons of the health
situations as well as for research purposes. Therefore, the duty bearer in the health sector with
mandate to collect, collate and manage information must step up to be on top of the game of
database management.

The exodus of Nigerian medical personnel to foreign countries with better working
environment and better pay is a critical issue that must be addressed for the health sector to
move forward. This is because the strength of the health sector also depends on the
proportions of human resource available and not only funds and infrastructure. According to a
recent survey by the Nigerian Medical and Dental Council of Nigeria, it was revealed that at
least 40,000 Nigerian medical doctors are practicing in the United States alone. The council
stated that though it has registered over 71,740 medical and dental practitioners since its
inception, only 25,000 are currently practicing in Nigeria. This acute shortage of doctors is the
reason Nigeria has a discreditable doctor to patient ratio of 1 to 6,400. The push factors
includes: poor remuneration, poor working conditions and poor motivation of the health
workforce. This inadequacy of medical personnel has contributed to the upsurge of quackery in
the Nigerian health system. There must be focus on improving the working conditions of the
atio ’s medical personnel.

With regards to implementation of special health programs and schemes such as child
immunization, distribution of mosquito nets etc., international organizations (e.g. WHO) and
donor agencies are the key players in that respect. It is also worthy to mention that many
health projects and schemes do not record maximum success as a result of lack of stakeholder’s
support and participation in their design and implementation. Critical stakeholders such as
health professional associations, community and private sector operator have to be involved at
all the level of health project design and implementation. It is important to emphasize that
stakeholder’s parti ipatio is an important factor in achieving high levels of uptake and
continued success in projects and schemes.

Recalling that the ou try’s health i di ators are ot really attra tive, Nigeria needs to work
toward meeting some of the health related MDGs; though analyses of recent trends show that
Nigeria is making progress in cutting down maternal and infant mortality rates and fighting
HIV/AIDS, to meet some of the health related MDGs. For example, the save one million lives
initiative launched in 2012 was a coordinative mechanism to cut down maternal and infant
mortality before the 2015 deadline. Other efforts of the government are the conditional cash
transfer scheme of the SURE-P which is contributing to the ante-natal care, immunization and
facility delivery. It should be noted that i the id to i prove the status of the ou try’s health
indicators, the federal government has put in place some programs such as National Health
Insurance Scheme (NHIS); Health Sector Reforms (HSR); introduction of Midwifery Service
Scheme (MSS) etc. This is an attempt to i prove the situatio a alysis i Nigeria’s health
indicators.

Also, many state governments are implementing different kinds of programs targeted at the
most vulnerable segment of the population especially those in the hard to reach rural areas.
Meanwhile, in terms of the provision of primary health care services, the National Primary
Health Care Development Agency (NPHCA) which was established in 1992 coordinates the
process to achieve sustainable primary health care (PHC). This level of healthcare delivery is the
most critical as it affects the majority of the Nigerian population who do not usually have access
and ability to pay. The NPHCA is in charge of resource mobilization, collaboration, partnership
and development of community-based systems and functional infrastructure as well as ensure
that infants are fully immunized against vaccine preventable diseases before attaining the age
of 12 months.

It is noteworthy to mention that the Nigerian National Health Care system is based on the three
tier system of Primary, Secondary and Tertiary care. The federal government coordinated the
health sector through the federal ministry of health and their roles involves developing policies,
strategies, guidelines, plans and programs and providing overall direction for the National
Health Care Delivery System. The state government manages the various general hospitals
(secondary health care) and the local government focus on dispensaries (primary health care),
which are regulated by the federal government through the NPHCDA. The LGAs are the
implementers of the Primary Health Care Services including immunization. The organization of
the health system includes both public and private sector providers.

The roadmap to a better healthcare system in Nigeria must see private investment as a
strategic ally; this involves creating an enabling environment for them to operate. For example,
a private investor in pharmaceuticals will have difficulties operating drug manufacturing plant
in view of the epileptic power system of the country. This informs that adequate funding is
critical to the development of the health sector. According to the World Health Organization
(WHO), adequate healthcare financing is very critical for reaching universal health coverage.
That is to say that the transformation of the sector will commence with the commitment of the
government to adequate funding of the sector in terms of increasing budgetary allocation in
line with the Abuja declaration of 2001. Recent consideration is proposing the assessment of
funding of the health sector based on considering per individual expenditure on health.

Secondly, there is need to ensure massive investment in infrastructure, expansion and upgrade
of medical facilities, research and human capital development, otherwise, the country will
continue to bear losses from capital flight running into several billions of Naira by Nigerians
travelling abroad for medical check-ups while the poor and those living in rural areas will
continue to be excluded from accessing adequate health care services. There is also the need
for the expansion of the health security covers to all Nigerians and not just those in the public
sector. For example, the national health insurance scheme (NHIS) practically covers only those
in the formal sector while many people in the private and informal sector are left to their fate.
And besides, in many Nigerian public hospitals, medical attendant hardly attend to patients on
NHIS.

The focus of every health policy reform must target ordinary people who do not have access
and who cannot afford the cost or private hospitals. Ordinary Nigerians need access to
affordable quality treatment and care. The government must continue to reduce the threat of
TB, Malaria and HIV/AIDS, and contain the spread of new diseases. Nigerian women need
universal reproductive health services including access to qualified attendant at birth. Finally,
government must make sure that the attendant problems that cause incessant strike actions by
the Nigerian medical associations are solved to forestall harmony in the system.