Every independence anniversary is time for stock taking. Hence WINIFRED OGBEBO, in this piece talks to stakeholders on the gains and successes recorded over the years. They also assess progress in the health sector in the past 52 years if any. Here are their views.
Senior Assistant to the Senior Special Assistant to the President on MDGs, Dr Christopher Otabor.
Well since independence, Nigeria has made modest development in terms of health sector delivery to its citizens. You will agree with me that the population has increased tremendously since independence and alongside also, new health challenges have evolved over the years. So there has been a gap.?
The gap is in terms of human resources, infrastructure, technology and financing for the health sector. Successive governments have done their best to ensure health delivery to it’s citizens. But by and large, quite a large number of people have been left behind, especially the poor and the vulnerable. That’s actually the reason why the United Nations came up with the Millennium Development Goals. These discrepancies or inequalities are not only in Nigeria alone, it’s everywhere in the world.
That’s why the 189 countries all over the world came together and say, let us tackle the basic health issues that can send little children, under five to the grave. Although they are little health issues but they are very important that they can cause a pregnant woman to die? as a result of the pregnancy or issues that border on infectious diseases like HIV, Tuberculosis and infestations like malaria because if these issues are solved, then we would have taken care of a large chunk of the healthcare challenges of our time.
So coming back to how far we’ve come as a country, Nigeria, one is tempted to see the challenges more than the achievements but the truth is that there have been landmark achievements. If you look at the number of doctors in Nigeria in 1960 and compare it with the number of doctors now, it’s miles apart. There is no basis for comparism. If you look at the number of nurses and other medical personnel, the difference is very clear, we have made tremendous progress.?
We also have health institutions, the teaching hospitals. We have teaching hospitals springing up everywhere, medical and federal medical centres even specialist hospitals and in that we can say that the governments over the years have tried. But the problem is that the development is not keeping pace with the population growth and the current realities, challenges and the current technological advancement as obtainable in most other developed parts of the world. We have been faced with the problem of brain drain.
It is a major issue. The propensity is for people especially professionals to gravitate towards a place that is friendly to them, so Nigeria seems to be hostile to many professionals, especially medical professionals. It is hostile in terms of availability of conducive environment to practice their profession. There should be availability of good income so that these health professionals after all the rigours of training are able to secure modest living. That has not been very present and that is the reason for the various strikes. If people are not going to be going on strike then people are going to be leaving the country.
MDGs?
What I can say about that is that there is a definite commitment on the part of the federal government to attaining the MDG and Nigeria is on course. But to say that we are going to attain X, Y, Z in 2015, I cannot say because there are so many factors involved. For instance, if you read the United Nations report on the MDGs in 2010, it clearly stated that countries that are crisis prone or areas that are crisis prone are least likely to attain the MDGs.
The office of the Senior Special Assistant to the President on MDGs, the President himself and other people who are working together to ensure that the country meet the MDGs, don’t have control over this. If there are crisis in the Niger Delta, the MDGs is not likely to be achieved in those areas. If there are security issues in the north, chances are that it will hamper the attainment of the MDGs. So there are many factors contributing to a country attaining the MDGs. There are many things on ground that we can say yes, the country as a whole, the government at the highest level is committed and focused on attaining the goals.
I can give you some examples. For instance I was in Washington this June at the instance of the United States government, India and Ethiopia. They brought the whole world together to discuss on Child Survival; a Call To Action. In that meeting, the Minister of State for Health, Dr Muhammad Ali Pate? on behalf of the federal government made a commitment to the whole world that we are going to? save one million lives; women and children before 2015.
There is a definite commitment of funds from the SURE-P programme to reduce maternal and child mortality. It’s not just saying, but it’s being actioned.? $100 million is being earmarked for this project to save children and mothers all over the country. We are keying into the integrated maternal and child health programme and the Midwifery Service Scheme. 4,000 midwives have been sent all across the country to help women deliver so that complications will not arise.
That is a mega project and it’s getting accolades all over the world. We have the Community Health Insurance Scheme where over 600,000 women and children have benefitted from.? With this, you don’t have to have money to access healthcare. Immunisation is going on, sponsored by the MDG office. So there’s so much going on. The MDG office is engaging several states in terms of the conditional cash transfer where pregnant women who go to health facilities to access care are given money.
The condition is that they must come for ante natal care,? and when they go, they are given money and that is going to stimulate a lot of attendance in our ante natal care, so we can pick up complications early make sure that they are treated and that would reduce maternal mortality. So much is being done all over the country to impact on the health-related MDGs.
President, Nigerian Medical Association (NMA), Dr Osahon Enabulele
It is sad to say that in the last 52 years of Nigeria’s history, Nigeria’s health sector like other sectors has had a chequered past with uninspiring national health indices. It is worrisome that Nigeria, the supposed giant of Africa with enormous tangible and intangible resources, has a health system that is still struggling with those of less endowed countries. Indeed, it is pathetic that Nigeria is still struggling with some war-torn countries in Africa for the gold medal in polio eradication following her inability to eradicate it.
Evidently, Nigeria’s health indices are still poorer than those of most other African countries, including Ghana, South Africa and Kenya. Little wonder that Nigeria was ranked 187th out of 191 member countries by the World Health Organization in 2000. The situation in 2000 has not markedly changed, despite the commendable efforts of the current Minister of Health, Prof. Onyebuchi C.O. Chukwu .?
Sadly, many factors and challenges have conspired against the realization of this laudable objective. Some of these factors include: (1) Poor governance at all levels of government; (2) Political instability, policy inconsistency and evident lack of political commitment to health by most governments in Nigeria; (3) Monumental corruption and infrastructural decay; (4) Undue politicization of the health sector coupled with declining professionalism; (5) Poor constitutional and legal framework for health in Nigeria, particularly the absence of a National Health Act that clearly defines the roles and responsibilities of healthcare professionals, as well as the roles and responsibilities of Local, State and Federal Governments in the management of the three levels of healthcare; (6) Weak co-ordination, integration and implementation of health policies, programs, projects and donor support;and? (7) Poor funding and budgetary provisions for health, far less than the stipulated 15% of the National budget as conveyed in the 2001 Abuja declaration of African Heads of State;???
Inspite of the challenges befuddling Nigeria’s health sector coupled with the unacceptably poor health indices, it is important to note that there have been some achievements recorded over the years in the health sector. For instance, whereas most other public/government parastatals and banks have either collapsed or are at the verge of collapsing, the managements of most public and private hospitals in Nigeria have survived the travails and systemic decay of the Nigerian society.
This is an achievement in itself. Of course, one cannot forget the tremendous milestones recorded in Nigeria’s health sector in the 80’s and early 90’s with general improvements in Primary Health Care, as well as noticeable improvements in institutional and human resource development.
This hope is further strengthened by some improvements recorded in Nigeria’s health indices as reflected in the results of recent health surveys. These include improvements in the Maternal Mortality Ratio from its 2003 figure of 800/100, 000 live births to the current figure of 545/100,000 live births.
Similarly, the Infant Mortality Rate is said to have improved from its 2003 figure of 100/1000 live births to 75/1000 live births, while Under-five Mortality Rate is said to have improved from its 2003 figure of 201/1000 live births to 157/1000 live births.?
As Nigeria celebrates her 52nd Independence anniversary, the following strategic imperatives and recommendations are essential for the repositioning of the healthcare delivery system:
(1) Sincere commitment to electoral reforms and enthronement of good governance, credible, committed, accountable and people-centred leadership at all levels; (2) Political commitment to health by all levels of government; (3) Transparent implementation of poverty reduction schemes to reduce household poverty; (4) Expansion of the National Health Insurance Scheme and commitment to Universal Health Coverage by government at all levels. This will substantially reduce catastrophic health expenditures by Nigerians; (5) Improved budgetary provision for health of at least 15% of Nigeria’s national budget. This should follow with adequate release and effective utilization of the funds/health resources; (6) Provision and maintenance of health infrastructure and facilities; (7) Strengthening of the Primary Healthcare System with employment of an adequate and appropriate mix of health manpower, with at least one Medical Officer of Health per Local Government Council and strengthening of health-related sectors such as Power, Transportation/Roads, Water, Agriculture, Security and Housing.
With sincere consideration and implementation of the above recommendations in addition to sustenance of the current re-engineering efforts by the present administration, I am sanguine that in the next 30 years, Nigeria’s healthcare delivery system should be able to compare favourably with that of other developed countries.
National President,? Association of Medical Laboratory Scientists of Nigeria & Chairman,Assembly of Healthcare Professional Associations, Abuja, Dr Godswill C.Okara.
It is an understatement to say that the Nigerian health service has performed woefully 52 years after independence. It has never been this bad since the history of Nigeria as a nation. Whereas it was ranked 4th in the Commonwealth in the 1960s and 1970s, it is now at the lowest ebb in every known assessment and ranking in recent times. The World Health Organization (WHO) in 2006 rated the Nigerian health service 197th out of 201 countries.
The 2011 Mo Ibrahim African Governance Index rating similarly ranked the Nigerian health service 51 out of 53 countries in Africa. In the December 2012 ranking, it will not be surprising if Nigeria’s health service ranks 54th out 54 countries in Africa including Southern Sudan, the youngest African independent country. The irony is that you never hear any of our leaders in the health sector say anything about this shameful international and continental rating of Nigeria’s health sector. They choose to pretend not to know, like the proverbial ostrich that buries its head in sand.
The growing loss of public confidence in the system is reflected in the large number of top officials of government and ordinary citizens that have continued to seek medical attention abroad. The gross mismanagement and leadership of the health sector is at the root of the problem. The management and administrative leadership of hospitals is a professional undertaking globally.
They mouth global best practice and do the very opposite in Nigeria. Professional healthcare practitioners (doctors, medical laboratory scientists, pharmacists, nurses, radiographers, physiotherapists etc ) all over the world are trained to devote their energies and expertise to attend to the sick and the wounded, while the management of materials, money and manpower is left to professional health service administrators who are are skilled in the art and science of management.
This is the norm and current practice in Europe, America, Asia and other parts of the world that Nigerians go to seek medical attention. Rather than institutionalise this global best practice in the Nigerian health sector, it has been usurped and politicised by the Nigerian Medical Association for parochial interest.
Another suicidal adventure currently being contemplated by the Nigerian Medical Association in collaboration with the Minister of Health is the outsourcing or so-called privatization of medical laboratory services, pharmaceutical services, radiography and physiotherapy in government hospitals. In modern management theory and practice, outsourcing of anciliary areas of business is encouraged to enable organizations concentrate on their core areas of business.
In hospital or healthcare practice which is multi-professional and multidisciplinary in nature, the core business is Clinical service, Nursing service, Medical Laboratory service and Pharmaceutical service. Nothing else will dramatise the abysmal managerial failure of our health sector in Nigeria like outsourcing the core area of business. It will totally betray the inability and lack of capacity of those who have usurped managerial functions they are neither trained nor have professional mandate for.
As Nigerians and healthcare professionals we have a major stake in the health service of this country. No one can claim to love Nigeria or the health sector more than we do. No one is more Nigerian than we are. We will not stand aloof and allow managerial misadventurers toy with our collective destiny in the Nigerian health sector. We call on members of the society, all men and women of good conscience to stand and rescue the health sector from the brink of avoidable collapse.