The Challenges Of Nigeria’s Healthcare System

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On Oct. l, 20 1 0, dignitaries from countries across the world converged on the Eagle Square in Abuja to celebrate Nigeria’s 50th independence anniversary.

However, the epoch-making event turned sour when two car bombs exploded some metres away from the square, leaving some people dead and others injured.

In the ensuing pandemonium, the casualties were ferried to hospitals with security patrol vans and private cars, including taxis, because of the dearth of ambulances.

The public-spirited acts of individuals and agencies such as the Nigerian chapter of Club 25, whose members regularly donate blood under the aegis of the National Blood Transfusion Service (NBTS), on that fateful day, were very commendable.

The NBTS’s doctrine of making available safe blood for transfusion saved the hospitals from the added trouble of looking for blood to treat the bomb victims.

Some observers, nonetheless, say that the Abuja bombing somewhat exposed some of the shortcomings in Nigeria’s emergency and health care systems.

Mrs Ladidi Bulus, a nurse at Garki Hospital in Abuja, says that the incident exposed some deficiencies in Nigerian emergency services, adding that inadequate ambulances are usually stationed at public events.

“Most of the well-equipped ambulances are privately owned. Therefore, the people who are predisposed to use them are those who are willing to pay the fees,” she says.

Dr Badejo Olawage, a surgeon at the National Hospital in Abuja, says that another major problem has to do with the actions of well-meaning but ignorant bystanders in crisis situations.

“These people sometimes cause more damage to patients when they attempt to administer first aid.

“Outside those in medical schools and first aid clubs in schools, the average Nigerian is not knowledgeable about basic first aid practices,” he says.

Olawage expatiates that knowledge of first aid issues is very essential in a community because “when attempting to save a life, whatever a person does in the first few minutes can be very important” .

The surgeon, however, concedes that the country’s health system is experiencing some structural changes.

Sharing similar sentiments, Dr Ibrahim Oloriegbe, the Executive Secretary of the Health Reform Foundation of Nigeria (HERFON), says that Nigeria is currently undergoing some epidemiological transition.

He says that there is a perceptible change in disease burden from communicable to non- communicable diseases.             Oloriegbe, however, insists that over 50 per cent of all non-communicable diseases are due to poor or sedentary lifestyles of the people, including drug and alcohol abuse, bad diet, low stress management and lack of exercise.         

He says that Nigeria is also saddled with coping with the effects of demographic transition, which is evident in increasing number of older persons and decreasing child mortality.

Observers say that diseases and health conditions such as HIV and AIDS, malaria, diabetes, hypertension and hypotension have been oversh-etching the country’s health care system.

For instance in 2005, former President Olusegun Obasanjo noted that HIV and AIDS, malaria, tuberculosis and child and maternal health problems had cost the country so much.

“However, it is less well understood that diseases such as heart disease, stroke, cancer and diabetes already have a significant impact on our country and that by 2015; it is projected that these diseases will be a leading cause of deaths in Nigeria.

“Most of the diseases are preventable and they are undermining our efforts to increase life expectancy and economic growth,” Obasanjo said.

Dr Olusegun Ajuwon, a former Chief Medical Director of the National Hospital, shares similar sentiments.

He says that medical conditions such as obesity are fast becoming a global menace, adding that Nigeria is not immune to the emergent health problem.

Ajuwon says that the lifestyle of the average Nigerian has appreciably changed because of the advent of jobs that require less physical activity and a habit of eating whatever is available because of busy work schedules.

“Nigerians believe that issues like obesity, diabetes and kidney failure are alien to the country; so, they are not as aware of them as they are of other diseases,” he says.

“It is now up to the government to deploy more resources toward the prevention and treatment of these diseases,” he adds.

However, Nigeria’s revised health policy document states that preventable diseases account for 70 per cent of the country’s disease burden and identifies poverty as a major cause of the development.

Observers say that poverty has been a major factor behind rural-urban migrations in Nigeria, as many of the rural dwellers migrate to cities in search of better living conditions.

Dr Orne de Idris, the National President of the Nigerian Medical Associations (NMA), says that there are several health issues stemming from urbanisation.

“Apart from the highly topical issue of climate change, a rising population in the cities will have adverse effects on public health.

“There are not enough trained physicians in localised areas because they have no guarantee of compensation,” he says.

Besides, Prof. Shima Gyoh, a retired Permanent Secretary of the Federal Ministry of Health, says that the increasing population of Nigeria is exerting a lot of pressure on all its social services.

Gyoh, nonetheless, stresses the need for a health care system that focuses on preventive measures, rather than curative measures.

He says that the public expenditure on health is currently less than eight U.S. dollars (NI, 200) per capita, a far cry from the 34 U.S. dollars per capita recommended internationally .

This, in essence, means that Nigerian hospitals have very little resources for maintenance and running curative services because they spend over 80 per cent of their income on the salaries of their personnel.

The infrastructure deficit in hospitals and the poor working conditions of medical doctors have been part of the bane of the country’s health care system, says Dr Charles Cudjoe, the National President of the Guild of Medical Directors (GMD).

He says that the doctors often go on strike because of these two problems, adding, however, that the doctors usually call of the strikes whenever the income aspect of the problems is resolved.

“As a result, the infrastructure of the health sector has continued to deteriorate, while the pay of doctors has improved,” Cudjoe says.

This explains the rationale behind HERFON’s decision this year to focus its attention on persuading political parties to place health on the front burner of their manifestoes in the lead up to the April elections.

The Foundation has been calling on political parties to be more specific about the health care delivery plans they intend to put in place to guide the electorate in deciding and voting on the issues.

As part of efforts to meet the Millennium Development Goals (MDGs), Nigeria has recorded some feats in reducing maternal mortality.

Gyoh says that the country achieved a 30-percent reduction in maternal mortality in 2003, adding, however, that the current progress is slow.

He says that the slow progress is mainly due to cultural myths, illiteracy, poverty, inadequate access to health services, stressing that these are compounded by inadequate water and electricity supply.

However, the country’s health sector will receive a boost this year, says the Minister of Health, Prof. Onyebuchi Chukwu.

He says that the Federal Government and the 36 state governments have agreed to dedicate 15 per cent of their annual budgets to the health sector from this year to 2015.

Also, President Goodluck Jonathan pledged while addressing the 16th session of the Joint Action Forum (JAF), that the Federal Executive Council, the National Council of States and other stakeholders were making efforts to further improve the country’s health care delivery system.

“We are determined to focus, not only on disease prevention, control and cure but also on the social, environmental, educational and economic factors that affect the health of our communities and population,” Jonathan said.

 

Olayemi Okeniyi, writes for News Agency of Nigeria (NAN).

 

Olayemi Okeniyi