Features
Transforming Nigeria’s Health Sector For Greater Livelihood
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
The persistent clash between farmers and herders in Nigeria has been a longstanding issue. These conflicts, often, over resources like land and water, have led to loss of lives, destruction of property, displacement of large numbers of people, deep-seated mistrust between communities and insecurity. Herders, traditionally nomadic, move their livestock in search of grazing land and water. Farmers, on the other hand, require the same resources for their crops. This competition often leads to clashes, especially in areas where land is becoming increasingly scarce due to population growth, climate change, and environmental degradation. As these clashes intensify, there has been a growing call for sustainable solutions. Two weeks ago, President Bola Tinubu took a bold step towards tackling the issue by inaugurating the Presidential Committee on Implementation of Livestock Reforms and creating the Ministry of Livestock Development.
The committee which has the president as the chairman and the former Chairman of the Independent National Electoral Commission (INEC), Professor Attahiru Jega as the deputy chairman has the mandate to address obstacles to agricultural productivity and open up new opportunities which benefit farmers, herders, processors, and distributors in the livestock-farming value chain as well as propose recommendations aimed at fostering a peaceful co-existence between herders and farmers, ensuring the security and economic well-being of Nigerians.The establishment of the Ministry of Livestock Development was part of the recommendations of the National Livestock Reforms Committee. Part of the 21 recommendations submitted to the president include: “This agenda should include the establishment and resuscitation of grazing reserves as suggested by many experts and well-meaning Nigerians and other methods of land utilisation.
“Create the Ministry of Livestock Resources in line with practice in many other West African countries. In the alternative, Federal and State Governments should expand the scope of existing Departments of Livestock Production to address the broader needs of the industry,” among others. Experts in the agricultural sector have posited that the livestock industry can create millions of jobs directly in farming, processing, and distribution, and indirectly in related sectors like feed production, veterinary services, and marketing. It provides livelihoods for rural populations, helping to reduce poverty and improve the quality of life in rural areas. It also increases the Gross Domestic Product (GDP) and foreign exchange earnings through the exports of livestock and livestock products such as meat, dairy, wool and leather.
According to them, a well-funded livestock industry supports the growth of agro-processing sectors, such as meat packing, dairy processing, and leather manufacturing, adds value to raw products and creates additional economic activity as well as stimulates the development of supply chains, including logistics, packaging, and retail, contributing to broader economic growth. It enhances economic resilience by diversifying the agricultural sector and providing a buffer against crop failures or other agricultural shocks and many more. Some other agriculturists have also opined that the livestock industry in Nigeria is currently underdeveloped and that by the creation of the ministry of livestock development will open up the industry which will be a huge money spinner for Nigeria.
Reports have shown that a Livestock Ministry can play a pivotal role in mitigating conflicts between farmers and herders by implementing policies and programmes aimed at fostering coexistence and sustainable resource management. The Ministry can work towards clearly demarcating grazing routes and farming areas. This would reduce instances of trespassing and accidental crop destruction, a common flashpoint for conflict. While introducing rotational grazing systems can ensure that land is used sustainably, preventing overgrazing and land degradation, establishing water points and boreholes specifically for livestock can reduce competition for water resources. Similarly, promoting the development of pasturelands through reseeding and controlled burns can improve grazing conditions.
According to a veterinary doctor, Dr Andrew Obadiah, by providing training for herders on sustainable livestock practices and for farmers on conflict resolution, both parties can understand the importance of coexistence. He said that extension services of the ministry can offer advice on improving livestock health and productivity, reducing the need for large herds and extensive grazing. “Setting up local committees involving both farmers and herders to mediate disputes can provide a platform for dialogue and peaceful resolution. Encouraging community-based conflict early warning systems can help prevent clashes before they escalate”, he emphasised.For Mrs. Stella Ugwu, a farmer, having a ministry dedicated to the development of the livestock industry can help in diversifying income sources for both farmers and herders and in turn reduce dependence on land.
”For instance, promoting agro-pastoralism can provide farmers with livestock and herders with agricultural produce”, she explained, adding that providing incentives for adopting sustainable practices, such as subsidies for fodder production or crop insurance, can ease economic pressures. Ugwu was however of the opinion that the creation of a new ministry to handle livestock affairs was uncalled for, since the job can effectively be done by the Technical and Service Department of the Federal Ministry of Agriculture and food security and its equivalent on the states level.In some countries, the establishment of a Livestock Ministry or similar bodies has shown promising results. For example, Ethiopia’s Ministry of Agriculture includes a dedicated department for livestock which has successfully implemented programmes to improve pastoral livelihoods and reduce conflicts.
In Kenya, the establishment of the National Drought Management Authority has helped manage resources better, thus reducing clashes between herders and farmers during dry seasons.The president of Miyetti Allah Cattle Breeders Association of Nigeria (MACBAN), Othman Ngelzarma, sees the Ministry of Livestock Development achieving the same feat for Nigeria in the near future. He told newsmen that, “MACBAN expresses its deepest appreciation to the Federal Government for creating a ministry of livestock to unlock the trillion-naira livestock economy and create qualitative and productive jobs across the value chain to improve the Nigerian economy. With this development, MACBAN believes the hope of the Nigerian pastoralists is now achieved under the Renewed Hope Agenda.
However, the Middle Belt Forum took a different view of the proposed Ministry of Livestock Development, saying it was not enough to sustainably resolve the decades-long farmers-herders crisis in the country. According to the National President of the association, Mr. Bitrus Pogu, what is needed to end the perennial farmers/herders clashes is a deliberate action by regulatory bodies and the government to stop criminal elements from carrying out deadly attacks on innocent Nigerians, mainly farmers. Hear him: “If the reason for creating the Ministry is to stop clashes, I think it is wrong because all of these attacks and killings that are happening have nothing to do with conflicts between farmers and herders. “Farmers have never connived at any given time to go and attack herders, but rather, criminals who happen to be Fulani gang up and attack farmers, kill, maim and chase them out of their ancestral homes.
“Then, the Fulani will come and occupy them. So, it is more about invasion, criminality, and terrorism. And the majority of those they hire to do these evils are not even those who have cattle. So, a deliberate action has to be taken by the government against the perpetrators, which will address the criminality.” Mr. Pogu suggested that the government should adopt ranching for productivity and enduring peace between the pastoralists and farmers in particular and the entire country in general.While the establishment of a Livestock Ministry presents a viable solution, it is not without challenges. Funding constraints, bureaucratic inefficiencies, and corruption can hamper its effectiveness. Additionally, deeply ingrained cultural practices and mistrust between farmers and herders can be difficult to overcome.
Critics argue that without a holistic approach that includes land reform, climate change adaptation, and broader economic development, a Livestock Ministry alone may not be sufficient. Therefore, it must work in tandem with other governmental and non-governmental bodies to ensure comprehensive solutions. “A dedicated Livestock Ministry, with its focus on sustainable resource management, conflict resolution, and economic incentives, offers a promising avenue to address the root causes of these clashes. However, its success depends on effective implementation, adequate funding, and the cooperation of all stakeholders involved. With the right strategies and commitment, devoid of any political or selfish interest, it can play a crucial role in fostering peace and prosperity in affected regions”, they advised.
Calista Ezeaku
Mrs Tamunobarabiye (not her real name) is an indigene of one of the riverine Local Government Areas of the oil-rich Rivers State of Nigeria, She was happily married to a man whom she described as her heartthrob. And the marriage thrived peacefully for ten years when suddenly there was a twist of events in the marital relationship. The relationship turned sour because of the absence of the fruit of the womb. The marriage was characterised by accusations and counter accusations compounded by pressures from external influences especially the husband’s relatives who blamed their son’s wife for not giving a child to their son. They described the woman as “another man in the house”, The union which started well with the Bible at the centre, was cat and rat, until medical procedures vindicated the woman. Such is the fate of many marriages and the unfortunate condition of many homes in Nigeria with the woman disproportionately blamed for lack of child bearing in marriage.
It is not saying something new that In most countries of the world, especially the African countries, infertility has posed great challenge to stability of marriage. Some marriages have failed because of inability of couple to have children. In a typical African tradition, where misguided myth and superstition hold sway, more often than not, women are speculatively and presumptuously blamed for the lack of procreation in the marital relationship while the husband is saintly in disposition and in the biased evaluation of his relatives. Gynaecologists however, have proven that either husband or wife or the both could be responsible for infertile challenges encountered in marriages. It is not exclusively an act of witchcraft as many African homes are prone to, and captivated by such superstitious belief. Gynaecologists and other medical experts have cited ignorance and the lack of awareness as major contributory factors to the rising incidence of infertility in marriages.
The specialists in women challenges spoke at the 2024 Fertility Conference, held recently in Lagos. The annual event, themed, “Infertility – Need for Knowledge and Early Intervention,” was organised by the Parah Family Foundation(PFF). The Lead Speaker, Preye Fiebai, a Professor and Specialist Obstetrician and Gynaecologist from the University of Port Harcourt, also noted that Nigerian men were unaware that the ability to ejaculate did not equate to being fertile. According to Fiebai, research has shown that 20-45 percent of women in Nigeria are infertile, but often, the cause of infertility in marriages is not the women.
The Specialist Obstetrician said research breakdown shows that 40 percent of infertility cases are due to male factors, 40 percent to female factors, 15 percent to combined male and female factors, and five percent are unexplained.
Fiebai listed causes of infertility in men to include: erectile dysfunction, impotence, decreased libido, psychogenic issues, endocrinopathies, age, and over weight, among others. For women, the medical expert pointed to cervical factors, uterine factors, diseases of the fallopian tubes, and problems with ovulation. Also, a professor of Surgery from the University of Lagos, Kehinde Habeeb Tijani, added factors such as age, weight, stress, excessive alcohol consumption, exposure to radiation, and constant exposure of the testicles to high temperatures as contributors to infertility. For his part, Managing Director, Lifeline Fertility Clinic, Kemi Alioje and Tony Akinyemi, while affirming the submission of the other speakers, offered various remedies to overcome infertility. They also advised women over the age of 54 to avoid aspiring for pregnancy due to the associated risks.
Also speaking, the Conference Convener, Dayo Odukoya described the infertility rates and causes as “alarming.” She emphasised the need for ongoing awareness to encourage couples experiencing infertility to seek solutions early in their marriages rather than delaying. According to her, “The foundation’s primary objective is to share vital information, enlighten and provide the relevant support system for families undergoing fertility challenges to eradicate ignorance, the misguided myths and social stigma associated with delayed fertility in our society. “The choice of the theme for this year’s conference; infertility- needs for knowledge and early intervention; is to further reiterate the importance of continued awareness, and knowledge about the challenges of infertility and more importantly, action to be taken as early as possible if not, it may cause further delays, especially in late marriage and aged women.
“The journey to parenthood is lonely and must not be treaded alone. There is a need for a support system on this journey and that is where the Parah Family comes in,” she said. The effects of infertility is better imagined than experienced. It is daunting, overwhelming and emotionally devastating. It triggers uneasy calm, quarrels, fighting, accusations, and divorce. The effects defy religious membership as some Christian marriages are not free from the attendant challenges caused by infertility..
Mrs Veronica, a victim of infertility induced crisis said infertility in marriage is a nightmare that a woman should not wish her enemy. According to her, it is stigmatizing, and leads to exclusiveness in a matrimonial home.”You know this thing called infertility is a bad thing that one should not even wish it happens to her enemy. It is a very bad experience. You are not free in your marital home.
Almost every member of your husband’s extended family sees you as the cause of their brother not having a child”. For Mrs. Beauty, infertility is a challenge that some women brought on themselves ignorantly when they were young. According to her, abortion may cause infertility. “You know that no woman knows her fertility status – that is the number of children a woman can give birth to, in a normal condition. Some women might have several pregnancy abortion and may still have a child or children. But some may abort only once, yet may not have any child”. She warned against the temptation of abortion of pregnancy. She said no pregnancy is “unwanted”. Rather than trading blames and accusations, married men and women should undergo medical checks to ascertain their fertility status even before marriage. Those who are medically deficient should access medical facility to solve the problem.
Igbiki Benibo
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