Nigeria’s health sector reels under subpar expectations 58 years after
Health systems worldwide share unified policy and regulatory goals: to ensure quality, accessible and affordable healthcare. Fifty-eight years after Independence, however, Nigeria has fallen far below expectations. OBOKOH ANTHONIA writes on the way forward to improve health sector and service delivery.
As Nigeria celebrates its 58th Independence anniversary on October 1, the country’s ambition to give universal health coverage to its estimated 198 million populations may once more be a mirage. But, that is hardly Nigeria’s only challenge.
The health-care workforce is facing a critical shortfall of professionals as the brain drain in the sector has reached alarming proportions. About 50 percent of Nigerian doctors are working aboard. Patients are facing increasing wait times, limited access to providers, reduced time with caregivers, and decreased satisfaction.
Worse still, many of the private hospitals functioning are not sustainable as they lack the proper structure to run profitable healthcare businesses.
Nigeria has also not been able to meet the commitment it signed with other members of African Union 17 years ago – the Abuja Declaration – to allocate at least 15 percent of its budget to improve the health sector.
Since the declaration, Nigeria’s highest percentage in a budget was in 2012 when 5.95 percent of the fiscal allocation was allotted to health.
In comparison, other Africa countries such as Botswana, Rwanda, Zambia, Togo, Liberia, Madagascar and Malawi have all reportedly hit the target, spending between 13 per cent and 18 per cent of their annual budgets on health, according to data compiled by the UN World Health Organisation (WHO).
Nigeria’s health system is beleaguered by challenges like poor funding and governance, inadequate infrastructure, high maternal and child mortality, poor primary health facilities, malnutrition, poor health emergency responses. It is not likely that these will change in the near future given the quality of interventions so far.
“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, told BusinessDay.
The health sector is a critical aspect of any economy anywhere in the world. Hence, more efforts need to be directed at achieving Universal Health Coverage by putting proper policies in place and the National Health Act signed in December 2014 needs to be implemented.
Various statistics also show that Nigeria has one of the worst health care delivery records in the world.
In February this year, Nigeria was ranked 187 out of 191 countries in the world’s health systems, showing the country has a lot to do in improving its health system and making healthcare affordable and accessible to the millions of its citizens.
According to the World Health Organisation, Maternal mortality rate in Nigeria is 814, per 100,000 live births only outperforming Chad with 856, Central African Republic; 882, and Sierra Leone; 1360. War torn countries like Somalia and Democratic Republic of Cong even outperformed Nigeria.
Also, while Botswana and Mauritius have the proportion of births attended by skilled health personnel as 100 percent, Nigeria is again down the pyramid with 35 percent, competing with countries like Eritrea, Ethiopia, South Sudan, and Chad.
The statistics get worse, for every 1000 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.
Underfunded overtime, the problem of lack of uniformed data has also remained a clog on the wheel of progress of governments at various levels, thereby hindering provision of adequate, effective, affordable and efficient healthcare services to Nigerians.
Health experts says that financial protection is robust where public payments on health is high and it also suggests that it is important to put in place coverage policies that are carefully planned to minimize out-of-pocket payments and protect poor people and other vulnerable individuals from co-payments.
With out-of-pocket payments for health causing households to incur catastrophic expenditures, which in turn can push them into poverty, key to protecting people is to ensure prepayment and pooling of resources for health, rather than relying on people paying for health services out-of-pocket at the time of use.
Findings reveal that with more than half of Nigerians leaning on hospital facilities for the most minor of ailments, there is a clear need for improved access to primary care practitioners, local health facilities, tracking health indicators and a wider availability of information about health, nutrition and fitness.
Doyin Odubanjo, chairman, Association of Public Health Physicians of Nigeria, Lagos Chapter, said there was a need to make the primary healthcare centre functional so as to make them available to provide some level of delivery services when needed.
“The current backdrop and next steps for improving the quality of health care in Nigeria is through collaboration and addressing the gaps in the primary healthcare,” said Odubanjo.
The Federal Government, on January 10, 2017, through the Saving One Million Lives Initiative, desirous of reversing the poor health indices and ensuring universal health coverage initiated the revitalisation of 10, 000 primary healthcare centres (PHCs) nationwide by inaugurating Kuchigoro Clinic, Abuja.
This model which was supposed to be financed by NHIS since attaining universal health coverage was one of the core mandates of the scheme.
The NHIS management is embroiled in a corruption probe, there is poor awareness of the scheme and funding required to cover Nigerians adequately is still a mirage.
“At the moment both the NHIS and the HMOs have covered less than 5 per cent of the population,” said Tunde Ladele chairman of Health and Managed Care Association of Nigeria (HMCAN), the umbrella association of private health insurers.
This compares poorly with Ghana, who began its health care insurance in 2003, and has seen access to healthcare grow from 6.6 per cent to 38 per cent of the population, according to data from the World Bank.
This situation fuels the perception that healthcare is a non-viable business and sees Nigerians spend over $1bn annually on medical tourism according to estimate by the Nigerian Sovereign Investment Authority (NSIA).
Progress path
Experts say the current backdrop and next steps for improving the quality of health care in Nigeria is through continuous adoption of technology and increase in public private partnerships to spur growth and address the gaps in the healthcare system.
Muntaqa Umar-Sadiq, chief executive officer, Private Sector Health Alliance of Nigeria (PHN), said there are unrealized synergies in mobilizing domestic resources and private sector capabilities to contribute towards the achievement of the Nigeria’s health priorities.
“There is the need to understand public and private sector initiatives towards achievement of the SDGs with the aim of developing a multi-sectoral package of interventions to catalyse transformative solutions to reducing maternal mortality; and systemically advance improvements across the healthcare system building blocks. The need for collaboration with cross-sectoral partners is critical to ensure no woman dies giving life,” Muntaqa said.
According to Clare Omatseye, president, Healthcare Federation of Nigeria said that lack of investments in critical health infrastructures still remains a major challenge confronting healthcare delivery in the country.
“Government need to provide a pool of funds, advocate for mandatory universal healthcare and to spend more time on prevention rather than cures.”
“With technology being a major driver of change, especially today when patients are digitally empowered, healthcare solutions must be incorporated into everyday innovations and meet patients where they are” Omatseye said.
Similarly, Kunle Elebute, chairman, KPMG West Africa said Nigeria healthcare is underserved and under-consumed, it has not gotten enough human resource and it is the most desperate sector in all sectors in the country.
“Nigeria has to start for somewhere by implementing the necessary policies in the healthcare and by so doing in four to five years, the country will make a huge success,” he said.
Jide Idris commissioner of Health, Lagos State, said that effective communication, training and behavioural change initiatives are very important in order to leapfrog education to ensure that technologies are well understood and applies are available in communities for health promotion and preventative solutions.
Larne Yusuf, a medical practitioner based in Lagos said, “To give Nigeria healthcare system a new era, it requires strong governance of the health system at all levels and to achieve Universal Health Coverage in the country, we must improve the quality of our healthcare services,”
“Political will are also hindering the success of the Nigeria healthcare system, more effort should be made to increase the budgetary allocation to the health sector, in order to stem the tide of increase in mortality and morbidity rate” he added.