Rebuilding Nigeria’s public health system

Access to basic health-care services in Nigeria remains an uphill task owing to stag­gering inadequacies in the nation’s health care system. Issues of lack of access to quality healthcare, prevalence of quack hospitals and doctors, fake or substan­dard drugs, poor funding and inadequate health resources, inefficient utilisation of scarce health resources, poorly performing health systems, among others persist. As a result, Nige­rians continue to die of treatable illnesses.

Part of the problem is that about 40 percent of doctors who train locally go overseas to practice after graduation because of better remuneration and better working environment. Medical schools in the country graduate between 2,500 and 4,000 doctors annually, which is rather too low for a country with a population of over 170 million.

Nigeria’s medical personnel-to-patients ratio falls far below the World Health Organisation’s (WHO) recommendation. As at 2013, Nigeria’s doctor-to-patient ratio was 1:6,400 as against the WHO standard of 1:600. The WHO recommends a nurse-to-patient ratio of 1:700, but the total number of registered nurses in Nigeria is less than 150,000, according to the Open Journal of Nursing 2014.

In the face of this, patients seeking health-care services in Nigeria’s public hospitals have to contend with long waiting hours, bureaucracy, and impoliteness of nursing personnel, according to a recent survey by BusinessDay’s Research and Intelligence Unit (BRIU), which polled the opinion of almost 3,000 Nigerians.

The report notes that the most prominent among factors responsible for the dissatisfaction respondents face with public hospitals is the long waiting hours 85 percent of respondents experience as they try to access care. “Also prominent is the impolite behaviour of nurses and ancillary staff at public health institutions (61 percent). Excessive bureaucracy was identified as a big problem by 53.1 percent of respondents, while unavailability of doctors was also pointed to as an issue with the system,” says the report.

Least among the concerns of respondents who patronise public hospitals, according to the report, is pricing of services which respondents consider as very cheap and affordable. However, this relative affordability of care in the public health system could be partially responsible for the long waiting hours patients have to endure. It could also explain the behaviour of nurses and ancillary workers who have to process a long retinue of patients daily, the report adds.

The survey shows a direct contrast between the experiences of those who patronise private and public hospitals. According to 88 percent of respondents, the major turn-off for patients with reference to services in private hospitals is high cost. They also express concern about the unavailability of the right drugs within private hospitals as patients have to get what is required from pharmacies. Also, compared to the public health system, nurses in the private system are more polite, bureaucracy is less, and the state of hygiene is better.

The BRIU report provides a guide for the Buhari government regarding what needs to be done in the health sector as it also focuses on key aspects of the sector including HMOs, efficiency of NAFDAC’s drug authentication system, medical tourism, the disease burden, federal medical budget, and the economy.

Indeed, no country can maintain a steady economic growth in the absence of an adequate health care system backed by a robust health-care infrastructure. Simply, health is wealth, to repeat the known aphorism. The onus is on the Federal Government to engage in meaningful collaborative effort with state and local governments to rebuild Nigeria’s health-care system in order to save Nigerians from needless deaths and, ultimately, set the country on a steady path of economic growth and development.