Challenges of health care delivery for all ages in Nigeria (1)

Being the text of a paper presented at the 19^th Bassey Andah Memorial Lecture by MC Asuzu, professor of Public Health & Community Medicine, College of Medicine, University of Ibadan; consultant, Clinical Epidemiologist, Community & Occupational Physician, UCH, Ibadan; director, Ibarapa Community & Primary Health Care Programme, UI/UCH, Ibadan; president, Society for Public Health Professionals of Nigeria (SPHPN).

Extended abstract

Professor Bassey Andah was the Deputy Vice-Chancellor (Administration) of the University of Ibadan at the time I left for my sabbatical leave in the university in July 1997 and died while still holding that office. He had the reputation of versatility in his chosen discipline of anthropology and archeology; and applied these to the widest realms of knowledge and its seeking, for the human mind; with emphasis on the African person. Such depth and breadth, as he pursued, is in the very nature of health and its pursuit for the humankind; the subject of this lecture -health for all the Nigerian people of every age.

Every normal human endeavour without any exception, would fairly easily be seen if looked at closely enough, as seeking nothing else than the health, happiness, well-being and fulfillment of the human person – the very meaning of health, and its services. However, in practice, it is only those activities and services that are immediately seen to be directed to relieving sickness or preventing it, that are usually referred to as health care and services. Organisationally also, health care is provided in any country at the three levels of the national or tertiary; the regional, state, or secondary; and the local government, “district” or primary health care (PHC) systems.  In spite of all those, in 1978 at the Alma Ata Conference on primary health care, the whole world agreed that the purpose of all health care services must be to achieve health for all (HFA) the people in the given polity, and eventually, of the world. The world was further reminded that in order to do so, such national health services must be based on a proper primary health care system that is properly linked up with and supported by all the higher levels of the three-tier health system; in a two-way referral system. Apart from those directly recognised health services, all the other howsoever else health-related systems and services should be linked up with these health services through a programme of inter-sectoral collaboration and integration for PHC and HFA. This later inter-sectoral collaboration, as of the first sentence of this paragraph, literally, means every human endeavour!

Nigeria and her various leaders have made great efforts at this new understanding of the health services, with some reasonable and sometimes most celebrated things to show for it, especially in terms of numbers and “statistics”. However, in spite of all these, the national health system has failed to deliver the PHC and HFA agenda and targets. In this lecture, and in the humanitarian spirit of Professor Andah, we are going to again highlight these great efforts of past Nigerian health care leaders to praise them duly; and thereafter only, we will point out some of the principles as well as the remaining things to do in order to more reasonably pursue the true PHC & HFA agenda in Nigeria, the topic of this lecture. This will essentially mean the understanding of the different medical and health professions and their specialisations, the understanding of the difference between all the public service programmes involving any and all of these in the usual vertical programmes of “public health” and the application of these in the single specialisations of community medicine, nursing and midwifery as constitutes community health and primary health care; and then linking these up properly with all the other vertical public health and down with all the auxiliary community health extension services of the local governments. Obviously, it is not yet anything near “uhuru” here, in these regards!

Introduction

It is obviously a valued privilege for me to be invited to give the 19^th Professor Bassey Andah Memorial Lecture. I sincerely thank those who thought of doing this to me. Having seen the many excellent people who had been given this honour in the past, I am indeed filled with some trepidation as to whether I will be able to satisfy what perhaps a sizeable number of people here may be expecting to get out of me in the exercise. So, I trust God alone to help me do so!

Professor Andah was professor of anthropology and archeology as well as the Deputy Vice-Chancellor (Administration) of the University of Ibadan at the time of his death. He was someone that all of us who valued academics, the African spirit and service to humanity as a whole, cherished. I was not able to be part of his obsequies, physically, at that time; being out of the country then. Therefore, being asked to give a memorial lecture in his honour can only be a great privilege indeed!

All fields of human learning and services are related to human health; and are actually servants thereof (i.e., of wellbeing and happiness of mankind).¹All humanity must now begin to realise this fact. There is not a single area of human learning that cannot be applied openly and officially to the public’s healthand well-being in the modern world – education, agriculture and nutrition, public works, technology, information, security and safety, government, industry, law, sociology, psychology, anthropology, physics, forestry, etc. In a similar but obviously reverse order, there is no aspect of the human being or his life and civilisation that cannot be studied by anthropology. Such was the versatility of Professor Andah with his application of his anthropology and archeology; as he demonstrated during his lifetime in all his endeavours, including those documented in his over 100 published works.

The choice of providing health care and achieving health for all Nigerians, and for all their ages, as the subject of this 19^th memorial lecture, is obviously in keeping with this holistic approach of Professor Andah in all his pursuits. Therefore, in preparing and delivering this lecture, it is important for me to observe that Nigerian leaders have put in great efforts in establishing many agencies and programmes in these regards. We, in Nigeria, have also produced far more health workers of all categories per capita than most African countries have done. We are by far very much more endowed with natural resources than many of these other African or other developing countries are. Yet our health indices are far lower than that of many of these, even poorer and/or even war-torn, countries. Indeed, the group within which Nigeria finds itself when these indices are given is invariably in the circle of the very worst; mostly, the war-torn countries. Does this ever begin to say something to Nigerians about their country? I wonder!

With all these seemingly good numbers, volumes and “statistics” in our favour and yet the worst health indices, it should be obvious to anybody with any true desire to pursue the health-for-all agenda in Nigeria through a nationally well-organised health system as recommended at Alma-Ata, that there must be some basic things that we have not gotten right. It will be clear that it is something that requires not much more of quantities, volumes, numbers and “statistics”, as we have had in the past. On the contrary, what we will need now will be more of understanding of some basic principles and practices that exist or are used by these other countries, as best practices, in these regards; and so, to apply them to our own situation! Figure 1 below shows some of the most common community or merely overall health care indices in some countries around the world.

Table 1. Sample of community health indices of countries across the world for 2015

Data is from WHO Global Observatory Data.

*Countries with district or zonal community nursing and midwifery services.