A giant with clay foot in health

Nigeria is not only the most populous country in Africa, it is also the eighth most populous country in the world.

It is listed among the ‘Next Eleven’ economies. International Monetary Fund (IMF) has announced that Nigeria is the third fastest growing economy in the world after China and India, as a result of the increase in the rate of growth of the nation’s economy from 6.9 per cent in 2009 to 7.4 per cent in 2010.

It is also the largest exporter of oil in Africa. But its citizen’s life expectancy is 49 years for males and 45 years for females.

Health indicators include life expectancy, diabetes rates, surgery wait times, income levels and household crowding. These are important in monitoring population health, factors that influence health and the effectiveness of health services.

Nigeria is yet to get it right as it citizens still suffer and die from different diseases yearly. Heart attack, a cardiovascular ailment, has been identified by medical experts as one of the leading killer diseases. Other top leading diseases killing them are cancer, kidney (renal) failure, diabetes, HIV/AIDS and infant and maternal mortality.

This is despite the fact that Nigeria has been reorganising its health system since the Bamako Initiative of 1987 which promoted community-based methods of increasing accessibility of drugs and health care services to the population, in part by implementing user fees.

The new strategy dramatically increased accessibility through community-based health care reform, resulting in more efficient and equitable provision of services. A comprehensive approach strategy was extended to health care, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost. This is what the new National Health Insurance Scheme (NHIS) attempts to sustain but for potholes such as ‘Global Capitalisation’ and enrollees being short-changed by service providers, especially in pharmaceutical services.

The draconian reign of military rules and uncompassionate leaders maimed the progress of the Bamako Initiative.

These led to Nigeria health care system being continuously faced with a shortage of doctors known as ‘brain drain’ due to the fact that many highly skilled Nigerian doctors emigrate to North America and Europe.

In 1995, it was estimated that 21,000 Nigerian doctors were practising in the United States alone, which is about the same as the number of doctors working in the Nigerian public service.

Attempts to look at the accessibility level of Nigerians to available medical practitioners will further give an idea about the deplorable health situation.

Out of a population of about 89 million in 1991, Nigeria had only 20,210 medical doctors which give a ratio of one doctor to about 4,400 people. Similarly, with only about 106,453 hospital beds in 1991, bed space per head in Nigeria was at the ratio of one bed to 800 persons.

Poor funding and neglect of the health sector account for a lot more deaths of Nigerians. Teaching hospitals cannot boast of wheel chairs and stretchers. Other amenities available will claim vintage position in any Museum of repute. Though the medical expertise is available, the unavailability of the medical and epileptic power supply or cut throat diesel cost is frustrating to the management and workers of these facilities, be public or private.

The move by the Federal Government to put in place VAMED Project is commendable but for a government that does not believe in perfection but putting the cart before the horse, the project is yet to achieve an ovation in spite of the huge resources committed to it.

Statistics from the National Agency for the Control of AIDs, (NACA), indicates that out of the 2.9 million Nigerians living with the virus, 650,000 are in need of treatment but only 350,000 are actually receiving the drugs.

The crude death rate and infant mortality rates are still very high at in deaths per 1,000 population and 119 deaths per 1,000 live births.

To reduce the current high rate of maternal mortality in Nigeria, the National Primary Healthcare Development Agency, (NPHCDA), assigned 2,819 midwives to rural communities. The midwives were trained on life saving skills, integrated management of childhood illnesses and other initiatives to improve quality of care. The agency is yet to evaluate the step.

It is daunting when would be patients and out-patients have to wake up early to pick numbers or queue up to see doctors. Many hours are lost for services that are not impeccable.

This is riddled by industrial actions by doctors and other health workers intermittently across the country, both at federal state levels.

This is exemplified by the Ibadan chapter of the Association of Resident Doctors (ARD), University College Hospital (UCH), Ibadan, Oyo State.

Its President, Dr Amaechi Nwachukwu, had asked the Federal Ministry of Health to withdraw its circular that excluded some cadres of medical doctors from receiving teaching allowances.

Dr. Nwachukwu said the Federal Ministry of Health needed to redefine what was meant by teaching allowance because different cadres of doctors teach despite their primary assignments.

According to him, the job of medical doctors is not primarily to teach. But every cadre of doctor no matter how junior they are in medical profession teaches at one level or the other. The consultants teach senior registrars, who go for Part Two fellowship examinations and even the medical officers teach house officers who go for their final MBBS examination.

"That is exactly what we are saying. If they want to go by the circular that they wrote, then every cadre of doctors must be paid."

He stated that without the review of the circular dated December 6, 2010 and signed by the Minister of Health, Prof. Onyebuchi Chukwu, industrial crisis in the health sector might occur in the New Year.

Nigeria is known for its paper work, implementation remains its challenge. Going by the launch of the National Strategic Health Development Plan (2010 to 2015) in Abuja, the health sector may however, scale the hurdles.

The document, which incorporates a clearly defined Framework with which to measure performance based on eight priority areas to be given attention: Leadership and governance for health; health services delivery; human resources for health; financing for health; national health information system; community participation and ownership; partnerships for health research is to ensure alignment and harmonisation of efforts between the government (federal and states) and development partners.

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