Sixty years after Nigeria’s independence, the progress it has recorded in the healthcare services delivery sector is still far below the expectations of the citizens, and indeed the barometer of global health rating agencies.
The country is still bedeviled with a lot of challenges which have hampered effective health service delivery.
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Nigeria ranks 187 on the World Health Organisation’s (WHO) recent ranking of the world’s health systems.
It is only ahead of the Democratic Republic of Congo, Central Africa Republic and Myanmar in the list of 191 member states.
Neighbouring African countries like Ghana, Cote d’Ivoire and Gambia rank 135, 137 and 146 respectively on the list.
The country’s health sector suffers from poor budgetary allocation, brain drain, medical tourism, inadequate and dilapidated health infrastructure and equipment, huge diseases burden, poor health policies implementation and poor medical waste disposal among others.
Some experts opine that the country’s health system was good within the first two decades of nationhood but began to degenerate and then worsen from the last three decades.
- Budgetary allocation
Funding for the health sector has been very poor over the years and accounts for the country’s inability to provide requisite infrastructure, equipment and services in the sector.
In April 2001, the African Union countries met in Abuja and pledged to set a target of allocating at least 15% of their annual budgets to the health sector, popularly called the ‘Abuja Declaration’.
However, 19 years down the line, Nigeria that hosted the conference has never met the 15% budget line; instead, it recorded 5.95% as the highest percentage allocated to the health sector in 2012 till date.
The 2020 National Budget only allocated 4.14% to the health sector, which is grossly inadequate.
However, countries like Rwanda, Botswana, Ethiopia, Malawi, Gambia, Swaziland and Zambia have met the 2001 Abuja Declaration target of 15% budgetary allocation.
- Universal Health Coverage (UHC)
Over 70 per cent of Nigerians still pay health bills from their pockets, which makes it difficult for many citizens to access healthcare.
So with low per capita health spending, the country records high out of pocket expenditure by citizens.
WHO defines Universal Health Coverage as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.
Some identified barriers to UHC in Nigeria include low political will to adequately fund healthcare, poor governance, mismanagement of resources and lack of coordination among federal, state and local governments.
Till date, very few Nigerians, mostly in the formal sector, are enlisted in the National Health Insurance Scheme (NHIS).
A former health minister, Prof Eyitayo Lambo, who is described as the father of the NHIS following his work in the early days of the scheme, said no country can achieve universal health coverage without risk pooling, “Because you have to minimise out of pocket spending.
Until we can make repayment schemes work, forget about universal health coverage,” he added.
- Brain drain
Many Nigerian doctors and other health personnel have continued to leave the country in droves for other countries as a result of poor remuneration and other challenges in the health sector.
Moji Makanjuola, Chief Executive Officer of the International Society for Media in Public Health (ISMPH), said it does not augur well for the country to continue to train health workers for other countries to use.
“There is hardly any advanced country you go to for medical care that you wouldn’t find Nigerian medics working in the hospitals,” she said.
- Poor research culture
Research is an essential tool for improving human development, health, and health equity.
Successive governments over the years have not provided the enabling environment and resources for medical research.
- Poor state of primary, tertiary levels of care
There is poor primary healthcare service (PHC) delivery in Nigeria with many communities without health facilities, and where they are found, lack standard infrastructure, equipment and personnel.
The problems of the PHC affect all its tiers; secondary and tertiary.
- Emergency preparedness
Preparation and services for emergencies during disease outbreaks is still poor.
This accounted for the unacceptably slow response during the initial days of the COVID-19 pandemic as well as for diseases like Lassa fever, and meningitis among others.
- Dependence on donor funding for diseases
Nigeria has a huge burden of diseases such as malaria, maternal and child mortality, TB, HIV and Severe Acute Malnutrition (SAM), among others.
Yet domestic funding for them remains very poor, with national response mostly dependent on donor funding.
- Industrial actions and rivalries
The country has been faced with recurrent industrial actions and rivalry by different medical professions thus leading to needless loss of lives and poor service delivery.
- Medical tourism
As a result of the country’s dysfunctional health system, many Nigerians have continued to seek care outside the country, thus causing the country to lose billions annually to capital flight.
Dr Ifeanyi Casmir, a public health expert said the Nigeria health system was fashioned from the British healthcare system at independence.
He said it initially served the country well but that Nigeria refused to keep pace with advances in the British system and others across the globe.
He said: “In the 1960s and late 1970s the Nigerian health system was second to none in the entire African continent.
“The infrastructure and services were of high quality, dependable and well-coordinated even in the rural areas.
“Access was guaranteed no matter how remote.
“There were efficient PHCs available called dispensaries, run by middle-level health workers.
“Essential medicines and care were available at minimal cost.
“In the ’60s the University College Hospital, Ibadan, was comparable to any hospital in London and was among the first best five hospitals across the Commonwealth.
“Nigeria was also a hub of vaccine production in the 60s and 70s.”
However, he said at some point in the 80s, the concept of director of administration was introduced instead of executive secretaries of health institutions that were obtainable in the past.
He said that was when the country lost it and got the administration wrong by merging clinical leadership with administration.
He said, “Nobody can discuss Nigeria’s health sector without recourse to Decree 10 of 1985.
“It laid the foundation that decimated our health system to date. Until that is addressed, the Nigeria health system will never recover.
“All the neocolonial ideologies of privatization will never be able to revamp Nigeria’s health system.”
Dr Casmir said the way forward is to address it systematically with a big health reform derived from a legal framework.
He said to get it right, the president has to come up with an executive bill that will lead to the reform of the entire health sector, and lay to rest the obnoxious effect of Decree 10 of 1985.
However, some milestones recorded in the area of health care by Nigeria include its removal from the list of polio-endemic countries.
Nigeria held Africa back from achieving polio-free status for some years
