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Lara Adejoro
Stakeholders in Nigeria have issued healthcare advisory to the incoming Federal Government. LARA ADEJORO reports
The just concluded high-stakes elections in Nigeria heralded 24 years of uninterrupted democracy in the country, but the dividends of democracy seem not to reflect in the healthcare sector which continuously follows a declining trend over the past decades.
Nigeria’s fraying health and care services are still under extreme strain with Nigerians struggling to have healthy and productive lives.
Among the problems bedevilling the sector are a poor primary healthcare system, high out-of-pocket health expenditure, poor maternal health, malnutrition, flooding, and disease outbreaks, including the huge problem of brain drain.
Yet, the government has not ceased giving assurances it would ramp up the push toward Universal Health Coverage and strengthen the health System.
The President-elect, Bola Tinubu of the All Progressives Congress had reeled out his manifestoes on tackling the myriads of challenges in the health sector, but experts say his proposed plans must go beyond words on paper.
The experts say to have a Nigeria where its citizens can achieve healthy and productive lives irrespective of where they live, there is a need for unswerving commitment and adequate investment.
They say strong health systems are fundamental to economic security. The expert concerns run through the following subheads.
While pregnancy should be a time of immense hope and a positive experience for all women, it is still a shockingly dangerous experience for many Nigerian women.
Nigeria’s maternal death rate shows the urgent need to ensure every woman has access to critical health services before, during, and after childbirth.
A new report by the United Nations agencies reveals that Nigeria, South Sudan, and Chad recorded extremely high maternal mortality rates in 2020.
The report titled, “Trends in maternal mortality”, notes that Nigeria has the highest absolute number of maternal deaths, reflecting its larger population size.
According to the report, “Nigeria had the highest estimated number of maternal deaths, accounting for over one quarter (28.5 per cent) of all estimated global maternal deaths in 2020, with approximately 82,000 maternal deaths.
“Three other countries also had more than 10,000 maternal deaths in 2020: India (24,000), the Democratic Republic of the Congo (22,000), and Ethiopia (10,000) – 8.3 per cent, 7.5 per cent, and 3.6 per cent of global maternal deaths, respectively,” the report reads in part.
Setting the agenda for the incoming government, the President of the Association for Reproductive and Family Health, Prof Oladapo Ladipo, says maternal health should be a priority.
Ladipo says the government must make maternal health services free for every woman of reproductive age.
“Health is a basic human right and making maternal health a priority will go a long way to reduce the challenges in the health sector. It’s a shame that we are still having three digits, roughly 512 per 100,000 deliveries, which is very shameful in 2023. Yet, family planning can help us to reduce that within a short period. This is why every woman must plan a family.
“My recommendation is that the government should budget $1 per woman of reproductive age to meet the reproductive health needs. It is not too much to do,” he asserts.
Nigerian-trained healthcare workers have maintained a steady stream of migration out of the country to places where they could find job satisfaction. Successive governments have failed to prioritise the health sector, and the conditions of service of healthcare workers have worsened.
Already, no fewer than 10,934 Nigerian-trained doctors are practicing in the United Kingdom, alongside 8,891 Nigerian-trained nurses.
Nonetheless, reversing the situation will mean concerted efforts in improving the push factor, which is not limited to poor employment rate, working environment, salary, and low standard of living.
The Chairman of the Medical Advisory Committee, Lagos University Teaching Hospital, Idi-Araba, Prof Wasiu Adeyemo believes improving the remuneration of healthcare workers will reverse the brain drain in the health sector.
“We need to keep our healthcare workers in the country and work on the push factors,” he says.
On his part, the President of the Nigerian Association of Resident Doctors, Dr. Emeka Orji also agrees that the push factors must be unequivocally addressed.
According to him, “We have poor remuneration, poor infrastructure, poor motivation packages and inadequate personnel to take care of Nigerians, affecting the health indices”.
He notes that collaboration with the healthcare unions can also help in solving the challenges.
“They should see us as partners because we know what is happening, and we can give them first-hand information on what is happening and the best way to address them. No playing politics with healthcare,” he emphasises.
The budgetary allocation in the health sector is too low to improve the quality of life of Nigerians.
To allocate a paltry total below six per cent of the budget to the health sector in the 2023 budget at a time it is faced with numerous challenges is saddening, not just on the state of the health sector, but also on how the government views the needs of the sector.
A Professor of Public Health at the University of Ilorin, Tanimola Akande says that aside fulfilling the 2001 Abuja declaration commitment, budgetary provisions must be spent efficiently.
Referring to the decision of Heads of State of African Union who met in April 2021 and pledged to set a target of at least 15 per cent of their annual budgetary allocation to improve the health sector, Tanimo holds that
“If we get it right, other things will go well. The 15 per cent is the minimum agreed upon; it will be a good thing to jump up to that but that will be a tough call from crawling from five per cent to 15 per cent but that is not impossible”.
He also notes that it is also about “managing resources that are available, it is not just about throwing in money”.
Dr. Orji also charges the incoming administration to increase the budgetary allocation for it to be able to tackle the challenges in the sector.
To revive the health sector from its crumpling state, he emphasised that the incoming government must not pay lip service to the sector.
“The health sector is important in any country, and for any administration to claim to have delivered on its office, it must pay attention to the health sector because Nigeria’s health sector is collapsing,” Orji submits.
Akande, who is a former national chairman of the Association of Public Health Physicians of Nigeria, said the blueprint for attaining a Universal Health Coverage is readily available.
“There is a committee already working on the health sector reform and there is no need to reinvent the will. They should just do the needful concerning those policies and reports,” he says, noting however that “It’s more than just enough to do the right thing in the health sector.”
Prof Adeyemo said the new government should also solidify the gains of the COVID-19 pandemic.
He hopes that the new government will continue in that trajectory and in the next four years Nigeria will have a wonderful public health sector.
“I also hope that the next government will reinforce the gains that we have had in the introduction of public-private partnerships, which has also helped to improve our health sector,” he says.
Experts say for the primary health system not to be brought to its knees, its challenges—fragmented governance and coordination, poor and dilapidated health facilities, shortage of human resources, and poor funding—must be addressed, especially if Nigeria is to achieve the set target of universal health coverage.
A 2022 report titled, “The State of Primary Healthcare Service Delivery in Nigeria” revealed that health systems in the states are weak, resulting in poor healthcare service delivery, especially in public facilities.
The report carried out by ONE Campaign, in partnership with National Advocates for Health, Nigeria Health Watch, Public and Private Development Centre, and partners, showed that 18 Nigerian states perform poorly on health systems indicators and are unable to provide adequate primary healthcare services.
The report shows that Zamfara state is Nigeria’s worst-performing state in PHC service delivery.
Other states that rank poorly are Sokoto, Taraba, Kebbi, Katsina, Borno, Yobe, Kogi, Jigawa, Rivers, Gombe, Cross-River, Edo, Bayelsa, Akwa-Ibom, Plateau, Imo, and Kaduna.
According to Prof Adeyemi, “The federal government and the National Council of State need to appeal to the state governments to wake up to their responsibilities. Most of the states’ primary healthcare centres have very little to write home about.
“There are so many health cases we see in our teaching hospitals but should not be, most of these cases should rather be attended to at the primary health centres, and the General Hospitals that belong to the subnational are not optimal,” he bemoans.
He further observes that countries with sustained investments in primary health care, with communities at the centre, can identify cases and carry out an effective public health response to the pandemic more quickly.
Other experts say there is no economic security without health security, and investments in the primary healthcare system are the most efficient and equitable approach to achieving universal health coverage.
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