Insufficient ‘access’ to healthcare kills more Nigerians than poor quality care

Lacking access to healthcare leads to more deaths than poor care quality in Nigeria as an estimated 253,000 people die annually due to insufficient access, approximately twice as many as due to poor quality of healthcare services which cause 123,000 deaths every year.

Nigeria is among the worst among 136 nations when it comes to poor-quality care and insufficient access to health care, says a new analysis published in The Lancet.

In February, Nigeria was ranked 187 out of 191 countries in the world in assessing the level of compliance with the Universal Health Coverage (UHC), as very few among the populace are health insured, whereas even government provision for health is almost negligible.

“For too long, the global health discourse has been focused on improving access to care, without sufficient emphasis on high quality care. Providing health services without guaranteeing a minimum level of quality is ineffective, wasteful and unethical,” says  Muhammad Pate, co-Chair of the Commission and Chief Executive of Big Win Philanthropy and former Minister of State for Health in Nigeria.

According to the first study, to quantify the burden of poor quality health systems worldwide, “an estimated 8.6 million deaths in low- and middle-income countries every year are due to conditions treatable by healthcare, of which 5 million result from poor quality of care and with a further 3.6 million being the result of insufficient access to care.”

These deaths led to economic welfare losses of $6 trillion (Rs 429 lakh crore) in 2015, the commission estimated.

Nigeria supposedly holds the title of the continent’s largest economy, only N1, 800 ($5) is what the 2018 budget provides for the health over 190 million citizens, when the N340 billion health budget is calculated on per capita basis.

The study said 253,000 Nigerians die due to insufficient access, showing up that of India (838,000 deaths), China (653,000 deaths), Brazil (51,000 deaths) as worse countries with epidemic.

“The terribly low doctor-patient ratio is one of the reasons why we have a lot of quacks within the medical profession. And a lot of Nigerians are dying in the hands of these quacks,” said Francis Faduyile, president, Nigeria Medical Association, in response to BusinessDay.

The statistics get worse, for every 1,000 births in Nigeria, 108 infants (and children) die before the age of five, and again, the country sits comfortably close to the bottom of the ladder in Africa.

The World Health Organisation (WHO) statistics for 2017 further shows that over 72 million Nigerians are at risk of malaria, with 380.8 at risk, out of every 1,000 Nigerians. Whereas malaria has ceased to be a health concern for many other countries. Yet, Africa’s largest economy shares the three bottom slots on the continent with Burkina Faso and Mali.

Given the current global focus on universal healthcare (UHC), the commission found that expanded healthcare coverage does not always mean better quality. “The central role of quality is not yet sufficiently recognised in the global discourse on UHC and is underappreciated in many countries,” the report says.

The report further reveals that there are approximately one million deaths from neonatal conditions and tuberculosis occurred in people who used the health system, but received poor care.

This highlights the need to increase access to care for these conditions, alongside improving quality.

 “An estimate of 89 per cent cancer deaths, 85 per cent of mental and neurological conditions and 76 per cent of chronic respiratory conditions were due to insufficient access to care.”

Apart from insufficient access to care,  poor quality care caused a major share of  deaths, 81 per cent of cardiovascular, 81 per cent of vaccine-preventable diseases, 61 per cent of neonatal conditions and half of maternal, road injury, tuberculosis, HIV and other infectious deaths.

Just access to healthcare is not enough and good quality care is needed for better outcomes, the report says.

However, the commission says public accountability and transparency on health system performance are two ways to improve quality of health.

“Commonly used health system metrics such as availability of medicines, equipment or the proportion of births with skilled attendants do not reflect quality of care and might lead to false complacency about progress.

“Better measures of health systems quality, and a proposed a dashboard of metrics should be implemented by counties by 2021 to enable transparent measurement and reporting of quality care,” it says. 

Pate asserted that “the vast epidemic of low quality care suggests there is no quick fix, and policy makers must commit to reforming the foundations of health care systems.

“This includes adopting a clear quality strategy, organising services to maximise outcomes, not access alone, modernising health worker education, and enlisting the public in demanding better quality care,”

Tedros Adhanom Ghebreyesus, director-general of WHO, adds that, “We cannot talk about quality without placing them at the centre. When people are actively engaged in their own health and care, they suffer fewer complications and enjoy better health and wellbeing.”

ANTHONIA OBOKOH