Nigeria’s health sector is one that has suffered all forms of neglect as other key sectors, such as education. At almost 62 years (by October 1), and blessed with enough resources, both human and capital, the country, by all standards, should have been more developed to the point of contending for a World Power status. But this is obviously not the case. Historically, though, Nigeria has undergone various forms of development: from the days of colonial rule, through self rule characterised by years of military dictatorship with intermittent civilian rule, to the present day democracy, the country could easily be said to have seen the good, bad, and ugly of its existence as a country.
Unfortunately, however, this has not reflected in what the country has become today by global consideration, compared to even some countries that have far less resources to boast of, and hence considered poorer.
Consequently, its history, particularly the nasty side, keeps repeating itself, and this manifests in virtually all sectors of the country’s being, one of which is the Health Sector. Like all sectors of Nigeria’s economy, the health sector has not been given the attention it deserves, resulting in not just those who have the wherewithal to seek effective and reliable health care outside the shores of the land, but also brain drain of the country’s finest health care providers to other countries. Nigeria, no doubt, currently faces tremendous health challenges. Experts have at various points sought to identify these challenges from different perspectives. In spite of the diverse reasons they arrived at, all are agreed on three: Corruption, Lack of proper funding, and Bad (or poor) management of resources.
Available statistics on Nigeria’s health sector paint a grim picture: an average of 20,000 Nigerians travel to India each year for medical assistance due to the absence of a solid healthcare system at home; and Nigeria is responsible for a high amount of under-five child death. In a recent report, the United Nations Children Education Fund (UNICEF) said “preventable or treatable infectious diseases such as malaria, pneumonia, diarrhea, measles and HIV/AIDS account for more than 70per centof an estimated one million under-five deaths in Nigeria”. The World Health Organisation (WHO) also stated in another report that nearly ten percent of newborn deaths in the world last year occurred in Nigeria, and that five countries accounted for half of all newborn deaths, with Nigeria third on the list.
These countries are India (24 per cent), Pakistan (10per cent), Nigeria (9per cent), the Democratic Republic of the Congo (4per cent) and Ethiopia (3per cent). Most newborn deaths occurred in two regions: Southern Asia (39per cent) and sub-Saharan Africa (38per cent). Although some other studies, like the Global Burden of disease, show steady improvements in child survival rates, the persistent rate of avoidable deaths in Nigeria truly calls for concern. The question that readily comes to mind is why Nigeria’s health sector is in such precarious state, given its human and capital resources, which are globally acclaimed as the best? Is it the result of lack of personnel? This is not likely, considering that about 77per cent of African American doctors in the United States (US) are Nigerians.
In fact, Nigerians have achieved notable feats in American medicine to the point that there is now a popular joke that if all Nigerians withdrew their services from the health sector in the US, the sector would collapse. In this wise, the story of the Nigerian Doctor, Oluyinka Olutoye, based in Houston, is still very fresh: he made history not long ago by bringing out a foetus from a mother’s womb, removed a tumour, and then successfully restored the unborn baby in the womb. there is hardly any top medical institution in the US or Europe where you will not find Nigerians managing at the top echelon. Universities, both in Nigeria and abroad, annually churn out hundreds of qualified medical doctors that could compete favourably with their peers in the globe to a reasonable extent, even with the disadvantage of a beleaguered educational system suffering from the same plague as its health counterpart.
This brings one to the issue of corruption in Nigeria’s health sector, which, not surprisingly, is only a manifestation of what all other sectors of the economy are and which ultimately points to the fact that those who are in governance have not deemed it necessary to improve the sector, knowing that they could afford the best treatment in the world. Government’s performance in the health sector in terms of creating the enabling environment for the development of the health sector, at best, has been abysmal. Investment in infrastructure has been poor and meager remuneration for health workers has resulted in a massive brain drain to the US and Europe, where they are highly taken care of. According to the President of the Medical and Dental Consultants Association of Nigeria (MDCAN), Dr Victor Makanjuola, more than 100 of its members left the country in the past 24 months. As at 2020, Nigeria had a doctor-patient ratio of 1:2,753, in sharp contrast to the World Health Organisation’s (WHO) minimum recommended ratio of 1:400 or 600. In his words, “the mass exodus of medical and dental consultants to more developed countries has brought significant disruptions to Nigeria’s health care ecosystem”.
Meanwhile, the annual budget of the government for the health sector is 4.17per cent of the total national budget, which is the equivalent to only $5 per person per year. Hardly does a year pass 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. Unfortunately, many Nigerians cannot afford services of private hospitals, because they are simply too expensive. Finance is obviously a major problem for patients. Consequently, it would not be out of place for one to think that management of the National Health Scheme (NHS) through the Health Maintenance Organisations (HMOs) would help people secure better quality health care. But, here, again, corruption has crushed this opportunity and made quality medical care inaccessible for people who contributed to the system, because they do not get the value of their contribution. In terms of funding, despite the myriads of healthcare issues experienced by Nigerians, the Federal Government has continued to pay lip service to funding the health sector.
With each subsequent Minister of Health in Nigeria, the country’s return to democratic rule in 1999 assumes office with high hopes of transforming the health sector, majority of them left the position with little or no positive effect to the sector, and, by extension, not making any significant impact on the health of Nigerians. Some even left the sector worse off. This is partly due to their poor policy formulations, leadership styles, or insurmountable challenges they met on ground, which also include the unwillingness of relevant authorities, such as the Presidency and National Assembly, to do the needful. Global economic and development experts have often said for any nation to be considered strong economically, and on human capital development, it must have given priority to the education, and health of its citizenry.
This seems to be why in April 2001, members of the African Union (AU), including Nigeria, met in Abuja and agreed to allocate 15 per cent of their national budgets to the health sector with the belief that if this was done, the poor health indices across the continent would be resolved in five years. Unfortunately, Nigeria could not use the same clout it exhibited in bringing these countries together to make that “Abuja Declaration” come alive: Nigeria had since then refused to honour an agreement it played host to 21 years ago, resulting in the poor health indices, high mortality rate and reduced life expectancy rate currently experienced in the country.
Since the declaration, the highest health allocation for Nigeria was in 2012 where 5.95 per cent was allotted to the health sector. In 2014, it allocated N216.40 billion (4.4per cent) , in 2015, it was N237 billion (5.5per cent), while in 2016 and 2017 it was 4.23per cent and 4.16per cent respectively. 2018 followed the same trend, with further reduction of the proposed health sector allocation from 4.16 per cent in 2017 to 3.9 per cent, even with the ever growing health sector concerns. Meanwhile, (WHO) says, for Nigeria to be seen to prioritise healthcare, it must at least spend a minimum of N6, 908 per Nigerian in a year. When multiplied by 200 million people it will amount to N1.4 trillion. WHO, also recommended a minimum of 13 per cent of annual budget for health.
Notably, the Nigerian Government has not tilted towards the WHO’s 13 per cent, not to talk about the AU’s 15 per cent, even as some countries have started raising their health budgetary allocation towards fully keying into the WHO recommendation of 13 per cent or the Abuja Declaration by the African Union of 15 per cent. Rwanda, for instance, reportedly devoted 18 per cent of its total 2016 budget to healthcare; Botswana budgeted 17.8 per cent; Malawi, 17.1 per cent; Zambia, 16.4 per cent; and Burkina Faso, 15.8 per cent. Nigeria, on the other hand, still lags behind in this regard, a situation that has had direct consequences on the funding capacity of the Health Ministry and its affiliated agencies and parastatals, thereby making the fight against poor healthcare very unrealistic. For instance, while N340 billion was allocated to the health sector in the 2018 national budget, how much was indeed released by the Federal Government to the sector at the end of the day, and how much was actually spent could not be ascertained. This brings to the fore the challenge of “bad management of resources”, which are even in adequate at the point of allocation, and possible release, which cannot be ascertained.
This scenario vividly captures the situation at the lower two tiers of the health sector – State and Local Government – which even spend far less in percentage. Here, however, Rivers State stands out, as the incumbent Governor, Nyesom Wike, made the health sector part of his priority. Since he assumed office in 2015, He has touched virtually all facets of the health sector from infrastructural development, through provision of equipment, and man power development for the sector. It started with the workforce in the primary healthcare community, which was on strike, and the secondary health care sector, which was either shut down or facilities dilapidated when he assumed office. Governor Wike quickly swung into action with what later became his characteristic energy and proactive leadership style by first recalling the striking Primary Health workers to work, and also paid House Officers at the then Braithwaite Memorial Specialist Hospital (BMSH) their outstanding dues and allowances, inherited from the previous administration.
The question likely to be playing in the hearts of keen observers of the health sector in the State may not be far from whether his successor can continue from where he will stop at the end of his tenure. At the Federal level, there have been calls for a way forward. Most of such calls harp on the need for policy makers in the country and health professionals in Nigeria and the Diaspora to come together and come up with a blue print for the sector. Such blueprint should have a time frame for each stage, and be genuinely followed to the letter. They also propose a genuine and deliberate effort by the Federal Government to meet either the WHO’s 13 percent or AU’s 15 percent of total budget to the development of the health sector in terms of infrastructural and human capacity development, and equipment, as well as ensure that such monies are put into the use they are meant for.
By: Sogbeba Dokubo
An Open Letter To FCT Minister, Chief Nyesom Wike
Dear Hon Minister,
First, a disclosure. You may not know me but we have met on two occasions in the house of our mutual respected Oga, first as a minister of state and second as a Governor, but l doubt if you can recognise me now. I am one of your admirers and critics.
As a two-term Governor of Rivers State, you did well in terms of infrastructure, for which l often commend you. I, however, sometimes disagree with you, particularly what l consider your streaks of high-handedness against those who disagreed with you politically.
I am writing this letter, with the hope that Don would send it to you, after watching your media interview with particular reference to your protégé and successor, Governor Siminalayi Fubara, a guy l have never met. No doubt, he would not have emerged as governor without your imprimatur. I do not have the details of your disagreement, and I am not even interested. What I am interested in is you to rise above the alleged offence.
Take a deep breath and have an introspective view of your political trajectory since 1999.
1999-2007: Obio/Akpor LGA Chairman
2007-2011: Chief of Staff, Rivers State
2011-2015: Education Minister (State)
2015-2023: Governor, Rivers State
2023-till date: Minister of FCT
And you are just 55!
I stand to be corrected, nobody from Rivers State has been so politically favoured and blessed by God as you are, not that you are the most politically-savvy politician from the State but it is just the Grace of God. I plead with you, do not take such grace for granted.
As governor of Lagos State in 2010, Governor Babatunde Fashola told me something that has stuck with me till today, regarding power and leadership. There was a three-month old strike by doctors in Lagos over pay increase. I stepped in to mediate between the doctors and the state, which by the grace of God, l was able to pull through after extensive negotiations with the doctors, and the strike was called off to the relief of millions of Lagosians. In the course of the mediation, Fashola told me that some people asked him to fire all the doctors but he made this profound statement: “Restraint is a powerful tool in leadership; the fact that you have the power to do something but chose to look the other way.” That statement has stuck with me till date. Why do you think American presidents, despite the temptation to press the nuclear button, when their interests are threatened, rather exercise restraint by refusing to go that route? It is leadership restraint.
Permit me to recall a story which you yourself regaled your audience with at the 70th birthday reception you held in honour of Dr Peter Odili. You said that when you wanted to contest for the Chairmanship of Obio/Akpor Local Government Council in 1998, you approached Dr Odili, whom you were meeting for the first time and sought his support. He obliged by giving you his support, and according to you, he gave you the first financial support towards your ambition, even when he himself was campaigning to run for the governorship of Rivers State. You became the chairman, and when you wanted to go for a second tenure, some political actors removed your name, and according to you, you ran to Dr Odili who was then the governor and he saved your political career by reinstating your name.
Fast forward to when you completed your tenure as the chairman of the local government, when your erstwhile friend, Rotimi Amaechi, who just became the governor, appointed you his Chief of Staff and that administration commenced a process to humiliate Dr Odili by setting up the Rivers State Truth and Reconciliation Commission, where your benefactor, Odili was the target and was put in the witness box.
Later when cracks began to emerge in your relationship with your boss, Amaechi, you ran back to your benefactor, Dr Odili to apologise for how your administration humiliated him. As a large-hearted person, he forgave you, and that began a wonderful relationship till date. Why am l making references to these incidents? If Dr Odili could forgive you and took you back, why can you not also forgive your political offenders, including Fubara, particularly since God has been so good to you?
Anyone who has traversed Ada George Road, Port Harcourt and seen the humongous, palatial estate you reside in, that takes a substantial part of that road, would know that you are not lacking materially. Coupled with that, you are a Minister in the current government and your wonderful wife is a judge. What else does any human being want?
My brother, please calm down, and let go of your ego and learn from history. Who would have thought that a whole General Shehu Yar’Adua (rtd) could die like a chicken inside prison; who would have imagined that a whole Bashorun MKO Abiola, the then richest man in Africa could spend five years in detention and die in custody, despite his international connections; who would have imagined that Major Hamza Al-Mustapher, the de facto Head of State during the junta of General Sanni Abacha, a man even Generals genuflected for, would spend 14 years in prison? Please, pause and think. This life is ephemeral. As the book of Ecclesiastes 1 states: life is vanity.
In Oyo State, there used to be the strong man of Ibadan politics, Lamidi Adedibu but his house in Molete, Ibadan is now desolate after his death. Adedibu was law as far as Ibadan politics was concerned. He was feared by all political actors across the nation. Before him, there was Busari Adelakun, otherwise known as “Eruobodo” in Ibadan politics. They have all been consigned to the dustbin of history. Learn from these because whether you like it or not, you would also pass away one day like all mortals.
God has been so good to you. Though I do not have the details of your feud with Fubara, you claim he is an ingrate, but this same “ingrate” took bullets for you as your Accountant-General when the EFCC was investigating your government. If you did not have confidence in him, you would not have put him forward to succeed you. Please, rise above political offences and be a leader. May it not be counted against you that since 1999, your successor would be the first governor of Rivers State to be impeached. No garland for such feat. It would be a pyrrhic victory and your new political masters in Abuja would even be wary of you. You are new to Bola Tinubu’s school of politics. Do not get carried away.
May God guide you right.
By: Richard Akinnola
Abbas Recommends Privatisation Of Nigeria’s Refineries
Speaker of the House of Representatives, Rep. Tajudeen Abbas, has recommended the privatisation of oil refineries in the country to enable them function optimally.
Abbas gave the recommendation yesterday, while receiving the management of NNPCL led by the Group Managing Director, (GMD), Mr Mele Kyari in Abuja.
He described the state of refineries over the years as shameful, adding so much money was being spent on workers as salaries and allowances for doing very little.
“There is need to make these refineries have multi -dimensional uses, if there is no crude oil, are there other activities that can make the workers to be active so that why they earn is deserved? I need you and your management to look at how we can turn around these decades of losses.
“One way to do so is to find a way to privatise these refineries; we have spent so much money and time deceiving ourselves that some businesses can be run by government.
“In the case of the refineries, we have now realised that some sectors of NNPC business can only be handled by the private sector and our refineries are one of those.
“The inadequacies will become manifest as soon as Dangote refinery comes on board because the competition will be there and inefficiencies of the refineries will become more naked.
“I want you to put it as part of your cardinal objectives; let us find ways to privatise our refineries so that they can be active ,so that in the near future, they will be able to compete with new refineries that will come up,” he said.
Abbas said that the NNPCL is central to the economic development of Nigeria, pledging the commitment of the House of Representatives to supporting the company to succeed.
According to him ,the House is concerned about the high rate of oil theft as it is draining revenue, affecting forex availability and causing inflation in the country.
The speaker said that the House had inaugurated a special committee on oil theft,to interface with stakeholders with a view to addressing oil theft in the country.
Earlier, Kyari said that all refineries would become fully operational and Nigeria would become a net exporter of petroleum products by the end of 2024.
He noted that subsidy was responsible for poor activities at government-owned refineries over the years ,saying that the removal of subsidy was already attracting a lot of private sector investments.
“I can confirm to you that by the end of December latest, we will start the Port Harcourt Refinery; early in the first quarter of 2024, we will start the Warri Refinery and by the end of 2024, Kaduna Refinery will come into operation.
“This is the commitment we are giving today and you can hold us accountable on this.
”In 2024, many initiatives, including the rehabilitation of our refineries, and also the efforts of small- scale refiners, and the coming of the Dangote Refinery, will make Nigeria a net exporter of petroleum products.
“We will no longer be talking about fuel importation by the end 2024, I am very optimistic that this will crystalise,” he said.
Kyari said that it was not the practice of the company to publish its financial statements some years back , but that the practice had changed, and all the company’s accounts from 2018 till date were now in the public space.
Kyari put the expected government revenue from the company by the end of 2023 at N4.5 trillion, saying that NNPCL was returning value to shareholders in line with the objectives of the Petroleum Industry Act.
Kyari said that the company had a robust supply plan assuring that there would be no shortage of fuel over the Christmas season and beyond ,and that no one could hold the country to ransom.
FAAC: FG, States, LGs Share N906.96bn
The Federation Account Allocation Committee says it shared N906.96billionn among the three tiers of government for October 2023.
FAAC disclosed this in a communiqué issued at the end of its latest meeting on Wednesday.
According to a statement by the Director, Press and Public Relations, Ministry of Finance, Stephen Kilebi, on Wednesday, the total figure shared for October was a slight increase of N3.48billionn compared to the N903.48billionn shared in September 2023, recovering from a decrease recorded in the previous month.
The total amount included gross statutory revenue, Value Added Tax, Augmentations from Forex and Non-oil Mineral Revenue, and electronic money transfer levy, among others.
The communique disclosed that although a gross total of N1.35trillion was generated, only N906.955billion was shared to the three tiers of government as Federation Allocation for October 2023.
The total revenue distributed for October 2023, was drawn from Statutory Revenue of N305.070 billion, VAT of N323.446billion, EMTL of N15.552billionn, Exchange Difference of N202.887billionn and Augmentation of N60.000billionn, bringing the total distributable amount for the month to N906.955billion.
From the total revenue from Gross Statutory Revenue, Value Added Tax, Electronic Money Transfer Levy, Exchange Difference, and Augmentation of N60bn, the Federal Government received N323.355bn, the States received N307.717bn, the Local Government Councils got N225.209bn, while the Oil Producing States received N50.674bnas Derivation, (13% of Mineral Revenue).
The Communique stated that “the Federation Account Allocation Committee at the end of the meeting indicated that the Gross Revenue available from the Value Added Tax for October 2023, was N347.343bn, which was an increase from the N303.550bn distributed in the preceding month, increasing to N43.793bn.
“From that amount, the sum of N10.894 billion was allocated for Cost of Collection and the sum of N10.003 billion was given for Transfers, Intervention, and Refunds. The remaining sum of N323.446 billion was distributed to the three tiers of government of which the Federal Government got N48.517 billion, the States received N161.723 billion, and Local Government Councils got N113.206 billion.
“Accordingly, the Gross Statutory Revenue of N660.090 billion received in the month was lower than the sum of N1,014.953tn received in the previous month of September 2023 by N354.863bn. From that amount, the sum of N38.942bn was allocated for the Cost of Collection and a total sum of N316.078bn for Transfers, Intervention, and Refunds. The remaining balance of N305.070bn was distributed as follows to the three tiers of government: Federal Government was allocated the sum of N147.574bn, States got N74.852bn, LGCs got N57.707bn, and Oil Derivation (13% Mineral Revenue) got N24.937bn.
“Also, the sum of N16.199bn from the Electronic Money Transfer Levy was distributed to the three tiers of government as follows: the Federal Government received N2.333bn, States got N7.776bn, Local Government Councils received N5.443bn and N0.647bn allocated for Cost of Collection.
“The Communique disclosed N262.887bn from Exchange Difference, which was shared as follows: Federal Government received N93.323bn, the States got N47.334bn, the sum of N36.493 billion allocated to Local Government Councils, and N25.737bn given to Derivation (13% of Mineral Revenue) while the sum of N60.000bn was for Transfers, Intervention and Refunds.
“It disclosed that N60.000bn Augmentation was shared as follows: the Federal Government got N31.608bn, the States received N16.032bn, while LGCs got the sum of N12.360bn.”
Also, the balance in the Excess Crude Account stayed at $473,754.57 as of November 22, 2023.
FAAC revealed that N50.674bn was given for the cost of collection, and N386.081bn was allocated for Transfers Intervention and Refunds.
Petroleum Profit Tax, Import Duty, VAT, Customs External tariff, and EMTL increased significantly.
However, Excise Duties, Oil and Gas Royalties, and Companies Income Tax recorded a decrease.
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