On 6th December 2023, Prof. Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare, represented by Mrs. Daju Kachollom, Permanent Secretary in the Ministry flagged off the launch of the eighth edition of the Nigeria Demographic and Health Survey (NDHS) in Abuja, with the incisive observation that the NDHS: “does not only aim to serve as a collection of statistics; rather, it represents a profound step to understanding the health landscape as well as providing the baseline against which performance can be measured.” Furthermore, he noted that: “The NDHS will provide invaluable insights into healthcare needs, enabling us to allocate resources effectively and invest in initiatives that promote health and well-being, consequently fostering economic advancement….This knowledge will enable us to implement inclusive policies that address the unique needs of every individual, ensuring that the benefits of our programmes reach all corners of our nation”.
Almost, eleven months to the day the 2024 NDHS was launched, summary findings are now available to stakeholders and the citizenry. What do the findings show and tell? What are the implications for policy makers? Moreover, how should NDHS findings be interpreted, especially since the study period was also one where allocation to the health sector in the Annual National Budget hovered between 4% to 5% in 2022 and 2023 and then grew to 5% in 2024?
A deep dive into the 2024 NDHS Summary indicates that here is good news and some not so good news. First, the good news. The good news is that for the first time since the NDHS rolled out in 1990, Non-Communicable Diseases (NCDs) are being tracked as a data point and health metric for Nigerians. This is coming at a time when NCDs are now threatening to replace communicable disease as drivers of mortality in the country, claiming close to 600 lives for every 100,000 Nigerians. The milestone inclusion of NCDs in the 2024 NDHS has generated important findings on diabetes and hypertension. Findings reveal that 53% of women who were told by health care workers that they have high blood sugar or diabetes were taking their medication to control blood sugar at the time of the Survey. However, only 39% of men who were told they had high blood sugar or diabetes said that they are taking medication. Similar sex differences in adherence to treatment for blood pressure or hypertension for men and women who were told of this diagnosis by a health care worker. The 2024 Summary found a total of 54%of women reported that they are taking medication to control blood pressure while 51% of men reported that they are taking medication to control blood pressure.
A second area of good news is the large numbers of women and men, 15-49 years, reporting to having had HIV Tests – 32% for women and 30% for men in Nigeria. NDHS Data on HIV testing and retesting prior to ARTs, is a positive thing as it reflects the Nigeria government’s alignment with WHO Guidelines and constitutes an advancement over old data tracking of HIV/AIDS-Related Knowledge, Attitudes and Behaviour in previous NDHS, prior to the 2024 Survey. Maternal health metrics are also good. For the first time in the 34 years of NDHS history, the % of women giving birth in health facilities is at its highest level, 43% compared to 32% in 1990. Yet another first in NDHS history, is that more women had skilled birth attendants at their delivery than before. The 2024 Survey shows that 46% of women age 15-49 who had a live birth in the 2 years before the 2024 data collection were delivered by a skilled birth attendant. In the 2013 NDHS, only 31% of Nigerian women were delivered by a skilled birth attendant. In terms of child health, the 2024 NDHS identifies a slight improvement in the % of children under 5 years, with diarrhoea, who were given the recommended treatment protocol of ORS/Zinc – 24% of children in the 2024 NDHS and 23% in the 2018 Survey. The 1% increase, though minimal, is significant given challenges of Co-pack availability; low awareness of ORS/Zinc among providers; and lack of uniformity of manufacturers Co-pack production. ORS/Zinc interventions contributing to this modest achievement were projects led by the Clinton Health Access Initiative, Inc (CHAI) and programs by the Pharmaceutical Society of Nigeria (PSN), the latter of which was supported by the Gates Foundation through the 8-year PAS grant to the development Research and Projects Center (dRPC).
Now, to the not so good news. What did the NDHS Summary findings say about what is not going so well? The first finding to note from the Summary is the low levels of diagnosis of Nigerians with high blood sugar, diabetes, and/or high blood pressure by health care workers. Despite the International Diabetes Foundation (IDF) warning that more than five million Nigerians may suffer from diabetes by 2030, the NDHS Summary shows that only 1% of women and 1% of men, aged 15- 49 were ever told they have high blood sugar or diabetes by a healthcare worker. One per cent defies the reality of 5.77% or 1 in 17 adults in Nigeria with diabetes as shown by both meta-analysis and case studies of diabetes prevalence in Nigeria. With regard to high blood pressure and hypertension, the 2024 Summary shows, further, that only 8% of women and 5% of men aged 15- 49 were ever told that they have high blood pressure or hypertension by a healthcare worker. Again, the reality is different as meta-analysis and case studies point to a hypertension prevalence rate of between 28.9% and 38.1% in Nigeria.
For the maternal health community in Nigeria, the 2024 NDHS Summary findings are worrying. Data shows that the
% of women who received ANC care fell sharply in 2024 to 63% from 67% in the 2018 NDHS. This downward trend in ANC coverage takes Nigerian women’s maternal health risks back to 2013 levels when the figure stood at 61%. Concerning child health, the 2024 Summary report shows an alarming 11% increase in children receiving no vaccinations in Nigeria (zero dose children) as the % of children receiving no vaccination increased from 19% in 2018 to 30% in 2024 NDHS. Equally alarming, 5% fewer caregivers sought treatment for children under 5 years with diarrhoea in the 2024 NDHS compared to caregivers covered in the 2018 Survey. The 2024 figure stands at 60% while the figure in the 2018 NDHS stood at 65%.
In terms of nutrition, the 2024 Summary found 29% of infants, age 0-5 months were exclusively breastfed. This figure represents no increase over the 2018 figure of 29% and falls short of the 2025 national target of 50% as contained in the National Policy on Food and Nutrition and WHO global target. The NDHS 2024 Summary presents even more worrying findings as it advances upon the old 9-point indicator focus on Infant and young child feeding (IYCF) in the 2018 NDHS. By introducing the new indicators – sweet beverage consumption; unhealthy food consumption; and minimum dietary diversity, we now learn that of the children, age 6-23 months covered by the 2024 NDHS – 41% consumed sweet beverage and 24% consumed unhealthy food. Only 12% had minimum dietary diversity. This is a worrying finding, providing evidence for the sugar tax advocacy constituency and the child nutrition awareness creation community.
What are the implications of these early NDHS Summary findings for the Honourable Coordinating Minister of Health and Social Welfare? This important question must be asked given, the Honourable Coordinating Minister’s expectations of knowledge from the 2024 NDHS: – “This knowledge will enable us to implement inclusive policies that address the unique needs of every individual, ensuring that the benefits of our programmes reach all corners of our nation”. Findings suggest that the Federal Ministry of Health may well consider sharpening the intentionality and design of its strategies and guidelines, to incentivize states and local governments to increase investment in – health promotion, health education and health mobilization. Such an approach will no doubt, increase end-user demand for ORS/Zinc Co-pack, uptake of rotavirus vaccines, and other new treatment options as well as innovative family planning commodities and technologies. Delivering more effective health promotion, health education and health mobilization functions is fundamentally a grassroots endeavour, best rolled out at primary health care level, within the redesigned BHCPF funding framework as the foundational basis for the sector-wide approach. However, these functions must now come with increased innovation, dynamism and commitment for expanded engagement; stakeholder policy socialization; and the creation of new platforms for bottom-up/top-down interactions with communities, health professional associations, faith and community leaders, women, men and youth.
Notwithstanding the community engagement mandate of the NPHCDA under the able leadership of the ED/CEO Dr. Muyi Aina, the Federal Ministry of Health, needs the help and support of health stakeholders, community rightsholders and primary health care champions to develop and deliver new routes for health policy translation, policy diffusion and dissemination of the Ministry of Health’s new PHC reforms and strategies. Such an approach, when put in place, may well address the troubling finding from the 2024 Summary of pregnant women having inadequate ANC support; of mothers and fathers receiving inadequate education on implications of under 5s consuming unhealthy food; and low levels of diagnosis of high blood pressure and diabetes. These findings, taken together, point to suboptimal human resources for the health, an undesirable feature of Nigeria’s 2024 health landscape which can only be address through collective actions of all stakeholders, including health private sector providers and especially health professional associations as well as health-facing CSOs and communities. These stakeholders should all work together to support the Federal Ministry of Health and Social Welfare’s PHC facing policies, especially the National Health Sector Renewal Investment Initiative 2023-2026, and the Health Sector Strategic Blueprint for 2023-2027. As the Federal Ministry of Health and Social Welfare proposes and defends its annual budgets in the coming years, in line with its funding commitments to the BHCPF, for least 1% of the Consolidated Revenue Fund, with estimates to receive at least $2.5 billion in pooled and non-pooled financing up to 2026 for PHC strengthening, CSOs, communities and other health-facing stakeholders may well play major roles as advocacy partners.
Judith-Ann Walker is a specialist in localisation and CSO effectiveness. She holds Master’s and PhD Degrees in Development Studies from the ISS, the Hague, Netherlands. She is a Brookings Scholar, a consultant to BMGF who conducted the milestone Nigeria CSO Landscaping study, and the ED of the dRPC. She can be contacted at [email protected]
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