By Hassan John
As Nigerians get ready to go to the polls to elect new leaders who will pilot the affairs of the country in less than two weeks, there are huge expectations on those that will be elected into different offices.
The expectations on the incoming leaders cut across different sectors, especially, giving the fact majority of Nigerians believe the current government did not meet their expectations in the past close to eight years of the President Muhammadu Buhari-led government.
The health sector is one of the worst hit as almost all indicators point to the fact that Nigeria is still far behind. For example, maternal and infant mortality is still high, family planning uptake is still low, immunization rates are not good enough and in many other areas.
This has also placed a dark cloud on Nigeria attaining the Sustainable Development Goals (SDGs) in area of healthcare delivery.
This creates huge expectations on the incoming political leaders to focus on some key areas of health so the country can, at least, reach a considerable level of attainment to the SDGs and also overcome some negative indices.
One of the areas the incoming President and other political leaders must focus on in the health sector is the Primary Health Care system.
Considering that quality health is a fundamental right of all citizens, it is also necessary for the healthcare services to be accessible and affordable. This can be achieved by having a viable and functional primary health care system.
It would be recalled that the goal of the National Health Policy (1987) was to bring about a comprehensive healthcare system based on primary health care that is promotive, protective, preventive, restorative and rehabilitative to all citizens within the available resources.
This is to ensure that individuals and communities are assured of productivity, social well- being and enjoyment of living.
The PHC is the first level of care that is closer to the people and it is meant to provide health services including education concerning prevailing health problems and the methods of preventing and controlling them.
It also promotes of food supply and proper nutrition, maternal and child care, including family planning, immunization against the major infectious and child-killer diseases, prevention and control of locally endemic and epidemic diseases and provision of essential drugs and supplies.
Even though the provision of health care at PHC level is largely the responsibility of local governments with the support of state ministries of health and within the overall national health policy, it, however, seems that most local government areas have abdicated this responsibility to the federal government.
This is because the federal government is seen to drive most of the activities in the PHC currently in Nigeria.
Over the years, however, the federal government has initiated some policies that will improve the infrastructure and human resource at the PHC level, but not much has been achieved.
This is because, either the policies were abandoned half way or were not thoroughly monitored to ensure implementation according to the blue print.
For example, the policy on revitalization of 10,000 PHCs across the country that was introduced by President Muhammadu Buhari-led government in 2017 was heralded with huge excitement and optimism; it however, did not yield the needed result.
It would be recalled that in January 2017, President Buhari kicked off a scheme to revitalize over 10,000 primary healthcare centers (PHCs) across the country.
Speaking while flagging-off the initiative, President Muhammadu Buhari said: “The goal of revitalizing the PHCs is to ensure that quality basic health care services are delivered to the majority of Nigerians irrespective of their location in the country.”
He called on state governors to adopt the initiative and make the revitalization of PHCs a priority in their state development agendas. However, six years after the flag-off of the initiative, the steam gradually cooled off and the initiative died off.
The incoming President, should, as a matter of priority, take a look at the policy with the aim of adding value to it and bringing it to life. This is because according to experts the initiative will fast-track the attainment of the Universal Health Coverage (UHC).
Another area that needs attention is the human resource for health at the PHC level. Most health experts don’t want to stay at the rural areas due to lack basic amenities and security.
This, the new government must work on in order to attract qualified human resource to settle at the PHC level all over the country.
Another area that deserves the attention and focus of the incoming president is how to reduce to the barest minimum the rate of medical tourism by health experts in the country.
The recent statistics of health experts leaving Nigeria to other countries of the world is, indeed, scary. If the trend is not addressed fast, the country may one day live with health experts not enough to take care of a quarter of the country’s population.
For example, the UK immigration report in 2022 put the number of Nigerian healthcare professionals granted working visas in the UK in 2021 at 13,609.
Also, between December 2021 and May 2022, a total of 727 Nigerian-trained medical doctors relocated to the UK. Nigerian-trained healthcare professionals also emigrate to Canada, the US, Saudi Arabia, Australia, and other developed countries.
Recently, at a summit in Abuja, the Director General of the National Institute for Policy and Strategic Studies (NIPSS), Professor Ayo Omotayo, disclosed that the doctor-to-patient ratio in the country has now nose-dived to 1:10,000 as against the World Health Organisation (WHO) recommendation of 1:1,000.
Currently, Nigeria is said to have the third-largest number of foreign medical doctors working in the United Kingdom after India and Pakistan.
According to Ayo, “Nigeria lost over 9,000 medical doctors to the United Kingdom, Canada, and the United States of America between 2016 and 2018. A total of 727 medical doctors trained in Nigeria relocated to the United Kingdom alone in six months, between December 2021 and May 2022.
“The data from the Register of the Nursing and Midwifery Council (NMC) of the UK shows that the number of Nigeria-trained nurses increased by 68.4 percent from 2,790 in March 2017 to 7,256 in March 2022.”
This revelation, no doubt, is a source of concern that needs the urgent attention of the incoming President.
Providing a conducive working environment, adequate security, state-of-the- art equipment and good remuneration for the health experts should part of what the incoming President will consider doing urgently to halt the trend of medical tourism in the country.
Universal Health Coverage (UHC) is another critical area the incoming President must consider a priority.
No nation can attain UHC without a workable health insurance for its citizenry.
As it is, now, the enrollment of Nigerians both at the formal and informal sector into the health insurance is not encouraging. With the current National Health Insurance Act in place, the incoming president must strive hard to ensure that the Act is implemented to the later.
The NHIA Act stipulates mandatory health insurance for every Nigerian and legal resident. This is to engender the achievement of Universal Health Coverage, UHC, Section 3(b) & 14.
The Act establishes States and FCT Schemes. This is to strengthen collaboration between NHIA and States for the achievement of Universal Health Coverage Sec 13(1).
The Act establishes the Vulnerable Group Fund, identifies the sources of the VGF, disbursement, management, investment, and expenses of the fund. The aim is to provide finance to subsidise the cost of the provision of healthcare services to vulnerable persons in Nigeria Sections 25, 26, 27, 28, 29, and 30.
Third Party Administrators (TPAs) and Mutual Health Association, MHAs are included in the 2022 Act for continuous Quality Assurance, community mobilization and sensitisation and any other roles that they are engaged to perform Section 34(4) & 35(1).
The new president must make efforts to prevail on the National Health Insurance Authority to take the needed strategies to ensure all Nigerians are captured in one form of health insurance or the other.
The incoming president must, in order to ensure peace in the health sector, understand the dynamics and intrigues which is triggered by rivalry among actors in the health sector.
It must be stated clearly that, currently, the health sector is sitting on a time-bomb due to a lot of unresolved agitations by actors in the sector including the Joint Health Sector Union (JOHESU) and the Nigeria Medical Association/National Association of Resident Doctors (NARD).
It would be recalled that late last year, the JOHESU suspended it industrial action over demands including adjustment of CONHESS as was done for CONMESS; payment of reviewed hazard allowances and other welfare packages as well as the implementation of Consultant Cadre for Pharmacists in the public service in order to give the president time to resolve all.
Since it is clear that President Muhammadu Buhari has not been able to lay all the issues to rest, the next President must prepare his mind to see a lot of these agitations coming up when he assumed office. He must prepare his mind and map out strategies to nip them in the bud so that there will be harmony in the sector for maximum productivity.
It is important to state clearly that the incoming president has a lot to do in the health sector. He, should, therefore, bring in capable and tested hands both as Ministers and heads of agencies to ensure that all challenges bedeviling the health sector are tackled fast. This is the only way Nigeria’s ugly indices can improve.
