60 Years Of Nigeria’s Health Sector: Challenges And Way Forward

Like every other sector of the Nigerian state, the country’s health sector has evolved from one stage to another, up to the present state.
From the pre-colonial era, when treatment for ailments was based purely on traditional medicine as it relates to different parts of the country, through the emergence of the first modern medical services in Nigeria, then during the various European expeditions in the early, to mid19th century, to the era of organised healthcare services, and finally to the present era of deliberate and planned brain drain in the sector, the development in Nigeria’s heath sector has been one that requires more attention than is given it.
There is no doubt that the profession of medicine has been quite active in terms of changing for the better in accordance with global demands. For instance, the Health care systems have undergone changes, and, except for a few exceptions, the changes are for the better:
The way in which physicians are trained has changed. The management of disease entities has also changed at various points. The change has also cut across disease entities that have been treated and available therapeutic modalities, which have also undergone continual changes.
On attaining independence in 1960, the health sector, like other sectors, inherited the centralised health care services format of the colonial era, which vested the authority to take key decisions in the sector in the hand of the central government.
Then, while medical services developed and expanded with industrialisation, most medical doctors were civil servants, except those working for missionary hospitals, who combined evangelical work with healing.
Among the civil service doctors, one was appointed the Chief Medical Officer, who became the principal executor of health care policies in Nigeria, along with several other junior colleagues comprising senior medical officers and medical officers, who formed the nucleus of the ministry of health in Lagos. The detail of centralised administration of health services then was complex and reflected the complex political transformation of the whole region.
The health care services in Nigeria have been characterised by short-term planning, as is the case with the planning of most aspects of the Nigerian life. The major national development plans are “The First Colonial Development plan from 1945-1955″, “The Second Colonial Development plan from 1956-1962”, and “The First National Development Plan from 1962-1968”.
Others are: “The Second National Development Plan from 1970-1975”, “The Third National Development Plan from 1975-1980″, “The Fourth National Development Plan from “Nigeria’s Five year Strategic Plan from 2004-2008″.
All of these plans formulated goals for nationwide health care services.
The overall national policy for Nationwide Health Care Services was clearly stated in a 1954 Eastern Nigeria government report on “Policy for Medical and Health Services.” This report stated that the aim was to provide national health services for all.
The report emphasised that since urban services were well developed, going by the country’s standards then, the government intended to expand rural services. These rural services would be in the form of rural hospitals of 20-24 beds, supervised by a medical officer, who would also supervise dispensaries, maternal and child welfare clinics and preventive work, such as sanitation workers.
The policy made local governments contribute to the cost of developing and maintaining such rural services, with grants-in-aid from the regional government. This report was extensive and detailed in its description of the services envisaged. This was the policy before and during independence. After independence in 1960, the same basic health care policy was pursued, and still is the case.
By the time the Third National Development Plan was produced in 1975, more than 20 years after the report mentioned above, not much had been done to achieve the goals of the Nationwide Health Care Services policy.
This plan, which was described by General Yakubu Gowon, the then Head of the Military Government, as “A Monument to Progress”, stated: “Development trends in the health sector have not been marked by any spectacular achievement during the past decade”.
As far as development of the health sector was concerned, this development plan appeared to have focused attention on trying to improve the numerical strength of existing facilities rather than evolving a clear health care policy. This, in a nutshell seems to have been the lot of Nigeria’s development in the health sector, and, in fact, all other vital sectors of the economy.
Health care in Nigeria has been prone to so many problems which are attributable to the fact that health services are in great demand following what could be tagged astronomical increase in population but accessibility to health services been very low. The cause of this has been related to factors such as socio-economic, cultural, political as well as poor planning and/or poor implementation of health policies and programmes by the government. There are also problems of availability, accessibility, affordability, sustainability of health services and weak referral system.
In 2000, World Bank noted that “deprivations that lead to ill health are common in developing countries, especially in Nigeria, and the poor in Nigeria are particularly at risk”.
According to Adam Wagstaff, a Research Manager of the Human Development team in the Development Research Group of the World Bank, ”the relationship between poverty and access to health care can be seen as part of a larger circle where poverty leads to ill health and ill health maintains poverty”.
The implication is that to effectively address health care, other relevant sectors that directly or indirectly contribute to poverty, which is a key factor in enhancing provision of health care and accessibility of same has to be addressed.
Unfortunately, policies in these sectors, especially for the negative impacts, are often not based on health criteria because the health sector itself tends to focus its interventions within the health care delivery system, not necessarily in other relevant sectors that constitute the sources of the problem.
For instance, to ensure totally effective health care delivery system, regular power supply is required to power all necessary equipment at all times. In the same vein, to totally prevent mosquito-borne diseases, environmental planning should ensure adequate provision of drainages avoid water stagnation, however little. As a result, the enormous health benefits accruable from interventions outside the health sector are not realized.
The education sector is another key long-established determinant for quality health and health care in any development-oriented society, but which has pitiably been bastardized, knowing that better education allows individuals to be more effective in converting health care and other health-enhancing goods into health.
The challenges facing the health sector in Nigeria, in sixty years of the country’s existence are, to say the least, numerous. But it can be summarised to include inaccessibility of quality health care, poor hygiene, corruption, malnutrition, lack of access to safe drinking water, poor health infrastructure, fake drugs, insufficient financial investment, and lack of sufficient health personnel.
Government’s performance in the health sector has been at best abysmal. Investment in infrastructure has been poor and meagre remuneration for health workers has created a massive brain drain to the US and Europe.
The annual budget of the government for the health sector is 4.17% of the total national budget, which is equivalent to only $5 per person annually.
In more recent Nigeria, the expected lofty goals in the health sector have not been achieved. The capacities of the facilities that emerged from previous efforts have been stretched and infrastructure broken beyond repair. Primary health care services now exist only in name. The common man has virtually reverted to the herbalist and traditional healers for care because of access to quality health care and affordability issues.
The elites have perfected medical tourism to India, Singapore, South Africa and even Ghana. This is in the face of a rapidly changing disease patterns in which infectious diseases have been replaced by behavioural, environmental and poverty-related diseases.
Hardly a year passes without a major national strike by nurses, doctors, or health consultants. The major reasons for these strikes are poor salaries and lack of government investment in the health sector, and this is in the face of many Nigerians not being able to afford private hospitals which are simply too expensive.
Unfortunately, again, the management of the National Health Scheme (NHS) through the Health Maintenance Organisations (HMOs) which should ordinarily help people to secure better quality health care, had been bedeviled by corruption, crushing the opportunity and further making quality medical care inaccessible for people who contributed to the system.
The situation becomes worse when one considers the fact that the problem has nothing to do with lack of medical personnel. Certainly not! This is because about 77 per cent of black doctors in the United States of America are said to be Nigerians, and Nigerians have achieved tremendous feats in American medicine.
A good example is Doctor Oluyinka Olutoye, a Nigerian based in Houston, who made history recently by bringing out a fetus from a mother’s womb to remove a tumor, and then successfully restoring the unborn baby to the womb. In fact, there is rarely any top medical institution in the United States or Europe where you won’t find Nigerians managing at the top level.
The health sector, no doubt, has failed largely due to inept leadership. Despite the huge talents of Nigerians, which are on display in health sectors all over the world, Nigeria’s health system is failing. Donor countries and multilateral organisations are aware of these challenges, but there’s little they can do to improve the situation.
The key solution, therefore, is for Nigeria’s policymakers and health professionals, including Nigerians in Diaspora, to come together and create a long-term blueprint for the sector. The term should not only be ideally realisable in the context of the country’s peculiar socio-cultural and economic reality, but should also include a strategy for success in the next 25-35 years with timelines and key performance indicators.
If this can be judiciously done, Nigeria can truly and easily be moving towards its dream of attaining that “Giant of Africa” status it has so much desired but truly failed to achieve in it in reality.

By:  Sogbeba Dokubo