The World Health Organization ranked Nigeria 187 out of 191 countries in its ranking of the world’s health systems. This means the country’s health care system is only better than that of three countries, Democratic Republic of the Congo, Central African Republic and Myanmar.
Our neighbouring countries such as Ghana, Togo, Niger, Mali, Chad ranked better than Nigeria with 135, 152, 170, 163 and 178 respectively.
This shows Nigeria has a lot to do in improving its health system and making healthcare affordable and accessible to the millions of Nigerians who are not getting the health services they require.
It is very much expedient to do so now with the coming in of the Minister of Health, Prof. Isaac Folorunso Adewole and the Minister of State for Health, Dr. Osagie Ehanire , who were both inaugurated last month.
There are major challenges in the health sector that the ministers need to contend with and address.
Primary health care: Our primary health care system is bedeviled with challenges , and there is urgent need to improve the quality of service delivery and also expand it to many communities who still lack the presence of any health facility till date.
Many primary health care centers, clinics or posts in the country are just mere dilapidated structures without the presence of any staff or manned by inadequate manpower and unskilled personnel.
They lack drugs and equipment and have poor referral system. Some of them are located so far away from some communities that the people cannot afford to go there at all or resort to traditional medicine practitioners or private hospitals.
One very important means of addressing the health challenges in Nigeria is to ensure that we have a functional and effective primary health care system because most Nigerians live in the rural areas.
National President of the Nigerian Medical Association (NMA,) Dr. Kayode Obembe, who has also practised as a gyneacologist for 30 years in the primary care level said healthcare does not exist at all at the grassroots.
He advised that clinics or health posts should be established in every ward and that there must be mapping of all the health posts in the country. He said doctors under the National Youth Service Corps(NYSC) should be posted there to man the centres.
Chairman of the Board of Health Reform Foundation of Nigeria (HERFON) Dr Benjamin Anyene said 70 per cent of the burden of diseases in Nigeria is primary health care. “If we solve the problem of primary health care, you will discover that less work will be done at higher levels. Primary health care is not just curative but also preventive and thereby helping the government to pay less and improve on national wealth creation,” he said.
The federal government needs to work with the state and local governments to achieve this .
Healthcare financing/ Budget: In April 2001, heads of state of African Union countries met and pledged to set a target of allocating at least 15% of their annual budgets to improve the health sector.
Nigeria country representative of ONE campaign, Edwin Ikwuoria said in spite of this commitment, the federal government has been allocating between 5 % to 6% of its budget to health, and it has never exceeded that at any point in time, adding that each country needs the minimum 15% to get best results.
According to him, the states too have not been allocating 15% to the health sector. “Lagos tried with 9% this year which is still very far from the pledged 15%. Kano State this year just had 4 % budgeted for health and there are states allocating worst percentages,” he said.
Donor dependence for health projects and diseases: The new ministers of health need to seek innovative ways of reversing the trend of the country majorly depending on donors and NGOs to finance its health projects and response.
Many of the country’s health system strengthening and delivery programmes are donor driven or funded by donors. For example, Nigeria has depended majorly on foreign partners and donors in the fight against HIV/AIDS and many of them are now pulling out or stopping some services .This is seriously affecting the lives of people living with the diseases.
There have been heightened calls by stakeholders to the federal government to take full control and ownership of HIV/AIDs management and treatment services in the country.
Also government has abandoned the preventive care and management of diseases to NGOS. The NGOs initiate and sustain these programs with little or no input from the government.”
Health governance and coordination: Dr Emmanuel Sokpo of Health Partners International (HPI) said health systems have been fragmented and there is no coordination between the various levels of government and organizations thereby leading to duplication and ineffective delivery.
For you to improve the health of a people you need to address all the elements by striking a balance between different components.
Industrial harmony in the health sector: There is need for the new ministers to ensure harmony among professionals in the health sector by bringing to an end the hegemony, union rivalry, marginalization and disparity in agreements amongst them.
This disharmony in the sector has contributed to the several strikes that have left in their wake negative effects on the health of Nigerians.
There have been calls before now to stop making the position of ministers of health the exclusive preserve of medical doctors. Now that two medical doctors have been appointed again by the Buhari administration, the onus is on them to carry other health professionals such as medical laboratory scientists, pharmacists and nurses among others along.
They should give others a sense of belonging, particularly where there have been marginalization in policies and welfare or tilted in favour of clinicians/doctors by previous leaders.
The National President of the Nigerian Union of Allied Health Professionals (NUAHP) Dr. Obinna Ogbonna, said the federal government is to blame for discriminatory treatment between members of medical and dental professionals and their counterparts in the allied medical sector.
Reproductive health: Nigeria still lags behind in the area of reproductive health. President, Society of Gyneacology and Obstetrics of Nigeria (SOGON), Prof. Brian Adinma said: “Nigeria is still one of the ten countries responsible for 60% of maternal mortality in the world, and so I think the new minister should focus on area related to the health of the mother and child and we are ready to assist him to make an impact in that area.”
Partnership with the private sector: Nigeria’s health system can be greatly improved if the government enhances partners the private sector and also engages in other multi-sectoral partnerships.
Medical tourism: Nigeria loses N250 billion yearly to medical tourism says National President of NMA, Dr. Kayode Obembe. He said the solution to the problem is for all the tertiary health institutions to be well equipped with modern equipment to replace the obsolete ones.
Chairman Association of Medical Laboratory Scientists of Nigeria, FCT chapter, Ndubisi Ebitea said last year alone over one billion naira was spent by Nigerians on treatment abroad saying that what we need to do is to improve our services. He advised the new ministers to pay huge attention to medical diagnosis saying ‘when you know a problem it is half solved.’
Also former chairman Association of Medical Laboratory Scientists of Nigeria, FCT, Dr Casmir Ifeanyi said the United Kingdom once had the same health situation as Nigeria but was able to overcome it by introducing an innovation called ‘Agenda for change in the health sector’ and advised the new ministers of health to emulate the same innovation saying it will serve as a panacea to the health challenges in Nigeria.
Finally, the new ministers should also evolve strategies for the proper implementation of the National Health Act and other challenges in the sector.
