WHY HEALTHCARE IS NEGLECTED IN NIGERIA
Our healthcare system is not working because leaders and health professionals have alternatives, reckons Obinna Oleribe
Have you ever wondered why healthcare systems and structures are neglected in Nigeria? Health is wealth, and a healthy nation is a wealthy nation. This is not just a saying, but a reality as it takes healthy people to generate wealth. In Nigeria, where agriculture is seen as the next best alternative to oil, only healthy people can engage in meaningful agricultural practices. Mining of solid minerals will also require healthy individuals. Only healthy individuals can go to school, pass their examinations, and contribute to national development. Yes, health is wealth!
But our healthcare systems are not working across the three levels of care. The healthcare workers are not working – and almost always on strike. There are ineffective healthcare administrative systems. The equipment in our healthcare establishments are obsolete, functional ones are not properly maintained, and procurement of new ones are fraught with politics and corruption. The infrastructure is dilapidated. Moreover, the hospital drug shelves are empty. Thus, in Nigeria, patients are commonly referred from government-owned tertiary hospitals to privately-owned primary facilities for care, surgery, and investigation.
It is therefore not surprising that Nigeria, with a population of over 180 million people, has one of the worst health indices with high deaths rate (12.9 deaths/1,000 population); high infant mortality rate (72.7 deaths/1,000 live births); maternal mortality rate (814 deaths/100,000 live births), and unacceptable low life expectancy at birth (53.02 years). Malaria and other easily preventable diseases are still killing millions of Nigerians annually. Lassa fever is still ravaging eight states 10 months after the outbreak was discovered killing over 89 persons including healthcare workers. Fake drugs and untested traditional herbal remedies still found in the market and hospital pharmacies are destroying kidneys, livers, and lives of hundreds of thousands. Hospital-acquired infections remain responsible for the majority of complications following surgeries and invasive procedures in hospitals. Several of the healthcare workers in Nigeria are seeking escape routes in Europe and America where they believe they will be better valued and rewarded. Today, people die from common and easily treatable diseases because of three key factors; (1) absence of services (including emergency services) even in functional healthcare facilities; (2) delay in receiving care due to financial and or structural factors; and (3) negligence in delivery of healthcare services by healthcare workers resulting mainly from poor healthcare administration and management. But these factors can easily be corrected if the nation desires to. Why is nobody doing anything about them?
Globally, there is a drive towards Universal Health Coverage. This is far from becoming a reality in Nigeria where less than six million people have access to health insurance. The truth is that nobody truly knows the real number of individuals enrolled into this service! The world recently adopted the Sustainable Development Goals (SDGs) with Goal three focusing on health. Nigeria failed to achieve the Millennium Development Goals (MDGs) but has adopted the SDGs, even though she is yet to do a ‘post mortem’ on why she failed to achieve the MDGs. We should recall that the errors of the past, if not corrected, will easily deny the country success in her drive towards SDGs.
In 2001, the Abuja declaration demanded a 15% allocation of national resources to health. Till date, less than 5% is achieved at the national level and between 3 – 9% at various states. Many of the comments have blamed this singular factor as the reason the healthcare system is in her present moribund state. Although the lack of funding has played a significant role in the decadence seen in the healthcare system, I am not sure it is the primary reason. For instance, can anybody actually account for what the current budget allocation to health is being used for? In the next few paragraphs, I will take you through a few other reasons why the healthcare system is where it is in Nigeria. I choose to call this the alternative syndrome.
The first reason is that policy makers have alternatives. They have alternative healthcare services in Europe, America, Asia, and even South Africa. Since the days of Alhaji Shehu Shagari (and I mean in the late 1970s), political and military leaders have always turned to other nations all over the world for healthcare. They are easily evacuated to these nations (where things work) for minor illnesses like common cold. Our past three presidents – Alhaji Musa Yar’ Adua, Dr. Goodluck Jonathan and now, President Muhammadu Buhari all depended on external healthcare services in Europe for their wellbeing. Since they can afford it – from private and public funds – why should they repair the national healthcare systems and make them work? The use of these external healthcare facilities usually extends to their wives, children and even friends. Following the footsteps of the national leaders, the state governments, ministers, commissioners, national and State Assembly members and all top level public servants prefer to seek healthcare services in these countries rather than make the national healthcare system work. Where there is an alternative, there is never the will to do the right things. If we must get the healthcare system right in Nigeria, we must destroy this alternative. We must legislate against it. This is the true change that we need in Nigeria.
If Europe and America can have functional healthcare systems, why not Nigeria? If we lack the capacity (which is not true), we can import the technology and work towards technology transfer in the next 10 – 20 years. It is amazing that, why salaries of workers are not paid, roads are not maintained, darkness is everywhere, Lassa fever is still killing healthcare workers, malaria is causing unnumbered untimely deaths of children and women, pregnant women are dying at delivery and healthcare workers are going on incessant strikes; the federal government which recently claimed that Nigeria has no money, has enough resources to export people to Europe for healthcare services that could easily be obtained in Nigeria at a fraction of the required cost in Europe.
The second reason is that healthcare workers have alternatives. The majority of doctors, nurses, pharmacists, dentists and laboratory scientists working in the public healthcare system have personal and private practices and businesses. To them, the fall of the public healthcare system is their personal and private gains. Strikes are encouraged because they result in patients seeking healthcare in their private facilities and shops. The absence of medications and drugs leads to clients buying products from them. Sometimes, it is amazing that the hospital workers’ facilities and pharmacies are cited just across the hospital building – making them the place of choice for patients in the absence of functional public health services. Not only this, healthcare workers sometimes are seen selling their own drugs and hospital consumables in public healthcare facilities – even while on duty! With their personal interest at heart, a majority of these professionals sabotage the public healthcare system – ensuring that it never works! Few years ago, in one of the states of Nigeria, the Commissioner for Health had his private practice in the state. Even when I had an official appointment to see him, I was referred to his clinic. How could he manage the state healthcare system with his eyes on patient care and at the same time on policy development? How could such a commissioner develop policies that will make the public healthcare systems functional? We need to revise the system and ensure better commitment of healthcare workers to the national healthcare system.
The third reason the system is failing is that patients have alternatives. However, unlike the politicians and rich public servants, the majority of the masses cannot afford the best care seen in Europe and America. So they seek healthcare services from traditional birth attendants, patent medicine vendors, and even roadside drug hawkers. Those who can afford them, turn to herbal medications from Asia and South Africa. The damage these alternative healthcare providers have caused our people is unquantifiable. There is currently a rising prevalence of renal failures (acute and chronic). No one has tried to investigate the cause of this level of renal diseases. Could it be linked to some of these untested and unresearched medications and supplements?
The final reason I will like to share here is the fact that nobody really cares. Recently, I had a lunch date with a friend in the health industry who I admire so much. We spoke at length on how to improve the national healthcare system. When I raised some suggestions on what could be done, he responded… “do they care?” I am yet to recover fully from this statement – because it is so true. When in 2012 I had issues with my project which if not funded would result in the death of HIV patients in the state, a state officer said to me, “If 1000 people die because of this change, Nigeria will not miss them. We are already too many.” No wonder people are killed daily, and nobody cares. Communities are razed down, and nobody cares. People are kidnapped and used for rituals, and nobody cares. People get missing, and nobody cares. We live in a country where nobody cares as the lives of people (other than themselves) have little or no value.
These must change. We must begin to build a nation based on the principles of equity, justice, and fairness. We must provide healthcare services to all – young and old, rich and poor. We must make quality healthcare services accessible and available to all – irrespective of their locations and their income. We must begin to be our brothers’ keepers.