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Improving Healthcare Delivery Through NHIS

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There is no gainsaying the fact that access to quality health care in Nigeria today is somewhat limited to affluent citizens.

Observers, however, note that the poor quality of most of the health services and facilities in the country could be attributed to inadequate finance.

Such concerns are rational and justifiable because many health care facilities in the country are dilapidated, poorly equipped or dysfunctional.

The poor management and deployment of the available health personnel also contribute to the menace of inefficient health care delivery across the country.

As part of efforts to reposition Nigeria’s health system for effective health care delivery, the Federal Government initiated the National Health Insurance Scheme in 2006.

Like all insurance schemes, the NHIS entails the setting aside of funds to cater to people’s health care needs whenever they are sick. It entails contributions from the government, employers of labour, workers and other prospective beneficiaries.

The NHIS is aimed at providing unfettered access to quality health care services to Nigerians at affordable costs.

The NHIS is primarily designed by the Federal Government to complement sources of finance for the health sector, while improving the citizens’ access to health care delivery.

The idea of initiating a health insurance scheme for Nigerians was first mooted in 1962, when the Halevi Committee, set up by the then Minister of Health, Dr Majekodunmi, proposed such a scheme.

A bill on Health Insurance Scheme was introduced to the then Parliament in Lagos. It was, however, opposed for reasons which included the dearth of health care providers in the country.

The concept, however, resurfaced in the early 1980s. In 1984, the National Council on Health, under the then health minister, Vice Admiral Patrick Koshoni, set up a committee to advise the government on the desirability or otherwise of an health insurance scheme.

The committee recommended the adoption of the health insurance scheme.

In 1985, Dr Emmanuel Nsan, the Minister of Health, set up a committee on National Health Review that was chaired by Mr Yemi Lijadu. The committee also agreed that health insurance was viable in Nigeria.

However, the implementation of the health insurance scheme started on June 5, 2005.

Commenting on the NHIS mode of operation, Mr Waziri Dogo-Muhammad, the Executive Secretary of NHIS, said that the agency was a regulatory body mandated to scrutinise the services being rendered to patients by health care providers.

He stressed that the scheme’s primary objective was to ensure the satisfactory treatment of patients accessing health care via the scheme.

Dogo-Muhammad stated that the scheme regulated health care providers, pharmacists; Health Maintenance Officers (HMOs), among others, so as to ensure the provision of quality health care services to the patients.

He said that the scheme covered the public sector, the organized private sector, the armed forces, the police and allied organisations and students of tertiary institutions, among others.

Nigerians are increasingly becoming aware of the purpose of the health insurance scheme, as many people are signing up for the programme.

The NHIS says over five million public servants are already accessing health care through the scheme, while Cross River and Bauchi states have already commenced similar health insurance schemes.

It says that plans to initiate health insurance schemes in 20 states have reached various stages of implementation, while about 7,850 health facilities across the country have been accredited with 61 accredited HMOs to run the scheme.

Other programmes of the NHIS include the informal sector health insurance programme, the community-based health insurance programme and the tertiary institutions’ health insurance programme.

Besides, the NHIS has secured approval to implement the MDGs Office’s subsidy funding for the health care of pregnant women and children under the age of five, generate employment for new HMOs and expand the capacity of health care providers.

The NHIS has almost completed its IT platform — e-NHIS — to drive the agency’s operations, while plans are underway to establish a national call centre and a central data centre.

Furthermore, a new NHIS Act has been drafted, the NHIS is being re-organised and restructured to meet future challenges, while a potent monitoring and evaluation system is being put in place for HMOs and health care providers.

Almost six years after the NHIS began operations, the scheme is still fraught with some challenges, as many beneficiaries complain about the poor service delivery of the HMOs, in particular.

The NHIS is, however, aware of such complaints, as its Executive Secretary warned the HMOs at a recent meeting in Abuja that anyone found to be working against the objectives of the NHIS would be sectioned.

“The aim of the NHIS management is to provide quality healthcare to Nigerians and anyone who distorts this will be sanctioned,’’ Dogo-Muhammad said, adding that an enforcement division had already been created within the agency to specifically monitor activities of the HMOs.

He encouraged Nigerians, who were not satisfied with the services of the HMOs or health care providers, to always lodge their complaints with the NHIS, which would investigate the matter.

In line with the executive secretary’s warning, some HMOs were suspended for non-performance some months ago.

Dr Sambo Abdulrahman, General Manager (Standards and Quality Assurance) of the NHIS, said that three HMOs were suspended early in the year for non-performance, as part of the agency’s efforts to stem bad service delivery of HMOs.

He said that the suspended HMOs were performing below expectation because they felt that they had attained the minimum requirements for accreditation.

Abdulrahman stressed that the NHIS had now realised that the initial requirements for HMOs’ accreditation were no longer feasible, hence the need for an upward review of the conditions.

“Paid-up share capital was N5 million when we started, it was later increased to N10 million but now it will be increased to N750 million and we are going to compel each HMO to have offices in each state of the federation.

“They must also have ICT facilities to enable them to interact with us and the enrollees.

“We are also separating them into two groups; there would be National HMOs and there would be Zonal HMOs.

“National HMOs can be anywhere in the country but must have offices in all the states.

“Zonal HMOs will limit their operations to their specific domains and if they have adequate resources to operate beyond the boundaries of their zones, they can then move up,’’ Abdulrahman said.

“We are also going to establish what we called Mutual Health Associations (MHAs) and these associations will operate on a community level,’’ he added.

Abdulrahman, nonetheless, noted that those HMOs who could not perform well at the national and zonal levels would be advised to operate at the local community or village level.

As part of its efforts to cover all Nigerians, irrespective of their social status or other considerations, the NHIS designed the Community-Based Social Health Insurance Programme (CBSHIP) to take care of people living in rural communities.

Dogo-Muhammad stressed the need to develop a home-grown approach to tackling health care issues which would take cognisance of economic and population peculiarities.

He said that the CBSHIP was also targeting the urban self-employed and cooperative societies.

The executive secretary said that other similar groups within the Nigerian population were also covered by the new programme.

“ The Voluntary Contributory Health Insurance Programme is designed to target political appointees, employers and employees of micro and small enterprises, and other Nigerians who do not fit into the other NHIS programmes,’’ he said.

The Minister of Health, Prof. Onyebuchi Chukwu, who commended the CBSHIP initiative, noted that the people of the rural areas were facing harrowing times in accessing quality, affordable health care.

“The rural dwellers bear 60 per cent of the country’s disease burden, struggling with financial and physical barriers to quality health care,’’ he said.

The minister said this at the NHIS workshop on “Improving Financial Access to Health Services for the Poor in Nigeria’’ in Calabar early in the year.

Chukwu described the CBSHIP as a practicable option of easing the burden of paying for health services on indigent citizens.

“CBSHIP is about the fastest way of creating access to health services for Nigerians at the community level; it is the most appropriate option, pending the time when more states adopt the substantive NHIS scheme.

“So, while we are trying to convince more states to join the NHIS, we can always take the benefits to the people through the CBSHIP,’’ the minister said.

As the NHIS is examining other innovative ways of caring for vulnerable groups, particularly women and children, analysts hope that the high maternal and infant mortality rates in Nigeria will be reduced significantly via the CBSHIP.

 

Bola Akingbehin

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 Malaria Burden And Public Health In Nigeria 

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It is worrisome that Nigeria has  the largest  Malaria deaths in the world. According  to the  2022  World.Malaria Report, Nigeria  contributes about  27 percent of  the global burden of Malaria disease, and about 31.3 percent of deaths , the highest in the world.
Malaria accounts for 30 percent of childhood deaths,.60 percent  of outpatient visits to health facilities   across Nigeria.
According  to statistics  reeled out by the Federal Ministry  of Health and Social Welfare,  “Globally,  there are an estimated 249million  malaria cases  and 608,000 malaria deaths among 85 countries.
Such reports leave much to be desired in a nation so blessed  with natural resources and manpower. While Nigeria  is struggling  with Malaria burden, Cape de Verde, today live Malaria-free, according to the
World Health Organization (WHO) certification  and rating.
This declaration by the global health Organisation about Cape Verde  is very cheery and means so much to me considering the economy, size and polity of the country.
Unlike Nigeria with more than 44 mineral resources spread across 500 locations  in the country,  Cape de Verde, has no natural resources. Its developing resources is mostly Service-oriented with growing focus on tourism and foreign investment.
My worry is that even with abounding natural and human resources of unimaginable quantity in Nigeria,  Malaria programmes are either grossly underfunded, misappropriated or   embezzled with impunity.
According  to a Senior Associate  at the John Hopkins Bloomberg  School of Public.Health, Soji  Adeyi, Nigeria  should begin  to increase internal funding.for malaria elimination.
Nigerian citizens still wallow in the orgy of leadership-induced pain, poverty and sorrow more than 63 years after political independence.
Malaria that is alien to the natural resources-barren Cape de Verde is endemic in Nigeria and is one of the leading causes of death of children under the age of six and pregnant women. Malaria is an household name in Nigeria so much so that its drugs and treatment have skyrocketed like a phoenix and outrageously outside the reach of the teeming less privileged citizens of Nigeria. The situation was so alarming that the National Assembly, some time last year urged the Federal Government to declare Malaria an emergency in Nigeria as matter of urgent national interest. Because it is an ailment that only the poor and vulnerable suffer, that motion is treated with levity and perhaps consigned to the trashcan of not-feasible declarations.
Without any iota of doubt, Nigeria has the resources to fight and conquer malaria. If Cape de Verde could, Nigeria can as well if the leadership of the country is committed to do so.
At.an event organised  by.the Federal  Ministry of Health and Social Welfare recently,  themed “Ministerial  Roundtable  Meeting: Rethinking  Malaria Elimination in Nigeria “representatives of national and international  health organisations, analysed the country’s  anti-malaria strategies  over the past years.
Experts recommended new approaches to fighting  the malaria epidemic in Nigeria which seems to have defied continuous attempts to reduce the Malaria burden in Nigeria to zero.
Adeyi of the John Hopkins Bloomberg  School of Public Health advocates increased internal funding.of all Malaria programmes to eliminate Malaria. According  to him,, “Each year reliance on external funding  needs to be reduced. I looked at the summary of  Malaria reports from 2008 till now and what has been common is the complaint about the lack of funding.  If this is a  recurring  problem, what should be done is to  find  a new approach.”
In his view, Abdu Muktar,  National  Coordinator  of the Presidential  Healthcare Initiative,  called for the local production  and manufacturing  of medical supplies as well as reducing Nigeria’s  dependence on drugs imports.
According to him, the local production  of anti-malaria and.related.medication will consider.the peculiarity of the country’s  terrain, population  and burden  and.would improve access to effective  treatment.
For his part, the regional. Director of World Health Organisation  (W.H.O.),  African Region, Matshiddiso  Moretti, advised Nigeria  to accelerate  its efforts to end Malaria  by relying  on  adequate data for the implementation  of health policies.
It has been rightly  said that Nigeria is rich but its people are abjectly poor because of the abysmally poor leadership that has characterised governance in the country since the inception of self-rule.
If the millions of public funds stashed in private and foreign accounts, misappropriated and or embezzled are judiciously used, no doubt, the issues of malaria, unemployment, decaying and dilapidated infrastructure and marginal underdevelopment with the attendant multi-dimensional socio-economic challenges, would have since been addressed.
How will Nigeria ascribe to herself “Giant of Africa” when she has not been able to achieve the healthcare demands and requirements of Nigerians? How can Nigerian leaders audaciously lull its citizens to believe that they are working for the welfare of Nigerians when the seeming little things that matter are not attended to. Even welfare-oriented programmes are being truncated by greed and inordinate desire to amass wealth at the expense of the public.
The  anomaly of diversions, misappropriation, outright embezzlement, and several others are the reasons Nigeria’s present and successive governments could not win the fight against malaria which health and medical practitioners say  poses the greatest threat to life than the dreaded HIV/AIDS. This suggests to me that the mortality rate caused by HIV/AIDS is grossly disproportionate to deaths caused by malaria.
Malaria is commonly believed to be caused by mosquitoes which breed in  dirty environment, especially where there is stagnant water. A lot of communities in Nigeria even the Sandfilled area of Borikiri in Port Harcourt is so mosquito-infested that residents cannot sleep without nets. It is a nightmare to sleep without a net.
The Federal, State, and Local Government should initiate programmes to end malaria scourge in the country. They should intentionally and proactively channel the people’s money to their welfare. Malaria eradication is a public welfare-oriented programme so government at all levels must prosecute it with adequate funding that must be supervised and accounted for, to avoid the unfortunate incidents of the Humanitarian Affairs Ministry and several other Ministries, Departments and Agencies that have used programmes and projects as smokescreen to siphon public funds.
While there should be a dedicated funds to fight malaria and defeat it over  a period of time, environmental sanitation exercises, to clear the drains, gutters and grass should be stepped up. This consciousness should be cultivated and imbibed by all.
The legitimacy of any Government is derived from the people, so Government exists for the people. No amount of money spent on the welfare of the people is too much for them. After all, the people remain the benefactors that those in Government, who in an ideal situation are stewards, are supposed to be accountable to.
The administration of President Bola Ahmed Tinubu should ensure that no stone is left unturned in achieving this lofty and laudable project.

Igbiki Benibo

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Curbing Substance Abuse Among Nigerian Youths

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In September 2023, a 24-year old lady had a birthday party in a South-West state where one of the guests offered to sell sachets of ‘Milo’ for N1,500 each. The guest, a young lady, had mixed marijuana with Milo and put same in Milo sachets, which had been so expertly sealed that no one would have suspected what the content of the sachets was. The guests at the party rushed the ‘Milo sachet’ and went on a binge, drinking and smoking themselves to get ‘high’. After getting high, fight eventually broke out among them and security operatives had to be brought in to maintain the peace. It was at that point that unsuspecting members of the public got to know that the party guests had gone on a marijuana trip. According to the World Health Organisation (WHO), substance abuse, or misuse, is the harmful use of psychoactive substances, including alcohol and illicit drugs. A psychoactive substance is a drug that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behaviour. Examples of psychoactive substances include alcohol, caffeine, nicotine, marijuana and some pain relievers. Other substances abused by Nigerian youths include, ice, molly, cannabis, tobacco, cigarettes, cocaine, sedatives, kolanuts, analgesics, glue, heroine, energy drinks, miraa, tramadol, tranquillisers, cough drops,antimalarial and antibiotics.
Substance abuse is detrimental to health and wellbeing of those involved in it. A Nigerian singer, Joshua Iniyezo aka Solidstar, recently disclosed how substance abused nearly ruined him. According to him, he was introduced to a banned substance called Ice in 2021. He said the substance made him see himself as “a king’’ who didn’t have to pay for any item. One day he walked from Awoyaya in Lagos Mainland to the Oriental Hotel a distance of about 32 kilometres.  Another singer, Inetimi Alfred, popularly known as Timaya, said he was introduced to Molly, a synthetic drug with psychedelic effects. The drug initially brought him happiness but eventually led to detrimental effects on his health, including weight loss and financial struggles. His words: “When I took it, I did not understand myself. I was so happy that I dashed all the money in my pocket. So I wanted to just keep feeling like that. That was how I lost a lot of weight. I was not eating, I was just happy. When I said I was taking Molly, I was taking like three pills every day and it felt like medication. I got kicked out of jobs and contracts… people I was doing business with did not want to work with me again.”
So, substance abuse makes the youth to get ‘high’ but it does more than that. It can make them paranoid, it can precipitate heart attack or failure, stroke, seizures, sleep disorders, drowsiness, nausea, respiratory depression, fatigue, disorientation, impairment in memory, learning, concentration, and problem-solving, hallucinations, decline in academic performance, etc.  As seen in the case of Timaya, it can result in job loss and can pose a threat to relationships. There is also the tendency to engage in criminal activities when ‘high’. Substance abuse among Nigerian youth is nearing the status of a pandemic. According to the National Drug Law Enforcement Agency (NDLEA’s) statistics, about 40 per cent of Nigerian youths between 18 and 35 years are deeply involved in the abuse of drugs. What does the future hold for the country if 4 out of every 10 young people are engaged in substance abuse?
The media is central to our lives. The media shapes our perception of the world. The media is actually the gateway to the mind. The media accesses the mind through the eyes and the ears. So, media contents are food for the mind. The mind is where decisions are made and where opinions are formed. Since the media has access to the mind, the media subtly controls the mind and plays a major role in the decision-making process. So, when the media projects something as good many people in the society take a cue from the media and believe that it is good. In the same vein, when the media projects an act as evil, the society largely avoids it. The media never leaves anything it comes in contact with the same way; it always affects them one way or the other. The media affects individuals in six various ways.  The media can affect cognition, which is the mental process. By affecting an individual’s cognition, the media affects his perception to the extent that he begins to see a particular phenomenon in a new light. The media also affects beliefs. The Western media has consistently showcased the Western culture as being superior to the African culture and this, to a degree, has been absorbed by some Africans who try all they can to travel abroad for ‘greener pastures’ only to get there and find out that the grass is always greener on the other side.
The media also affects attitude. If a child is exposed to violence, he begins to see violence as an option and will be tempted to try same every now and then. Another media effect is affect. This has to do with feelings, emotions and moods. Seeing a scene on television or reading about an event can affect the mood of an individual throughout the day. Media also has psychological effect on its audience. This means the media can affectthe orientation of people. The media also affects the behaviour of its users. Behaviour is the culmination of all the effects of media exposure that have been listed. By the time cognition, belief and attitude are affected, behaviour will change. Ladies and gentlemen, in light of the above, I will like to submit that advertently or not, the media has been encouraging substance abuse. This is a global phenomenon and not a Nigerian thing. When a television ad presents a successful musician with a bottle of an alcoholic drink at the background, though the focus of the advertiser from all intents and purposes will be to draw the attention of the society to its alcoholic drink, but the loud message is that “To be as successful as the musician in the ad, take alcohol”. Or, “Successful people take this alcohol; don’t you want to be like them?”
When a musical video glamourises boozing and smoking, what is the message to the society? A song like ‘FotiFoyin’ (brush your teeth with alcohol) encourages the youth to consume alcohol, while a musical video like ‘Asake Loaded’ celebrates smoking. The producers of these musical contents are role models in the society. Some of them are even brand ambassadors. If, as we said, the media is the gateway to the mind, what is the message of these media contents to the society?   The media has to be alive to its social responsibility if Nigeria will win the war against substance abuse by the youth.  The social responsibility theory of the media mandates the media to put the societal wellbeing at the centre of its activities.
This theory says that the media has a responsibility to the society and should always work in the interest of the society. While a media outfit may be a business organization that must make returns to its shareholders, the operators of the business must realize that they will only continue in business if the society survives. If the society is destroyed, the business outfits operating in it will also go down. The easiest way to destroy a society is to destroy its youths.
If the media understands this responsibility and upholds it, it will be clear that the future of the youth who are being exposed to substance abuse is of more importance than the immediate pecuniary gain they will make by pushing out deleterious contents that will push the youth into seeking substances that would make them high.
The media is a major factor in the wellbeing of the society because it plays a major role in what is permissible or prohibited. This is done through what it promotes or refrains from promoting.
As part of its social responsibility, the media should embark on sensitisation of the public on the dangers inherent in substance abuse. This should be continuous and sustained as the media’s contribution to the wellbeing of society.
The government is the most important factor in curbing substance abuse because government is a change agent. Whatever the government permits gains prominence and whatever it prohibits is frowned at.
Government can curb substance abuse through orientation and reorientation. By deploying its massive resources, the government can get across to all strata of the society on the ills of substance abuse and why it is pertinent for it to be spurned by the youth. By making use of all channels of communication and all media outlets, the government can drive home the point on why substance abuse should not be embraced by the youth.
Another means the government deploys to curb the spread of substance abuse is regulation. The Federal Government has, over the years, come up with various regulations to reduce substance abuse in the country. These include:
The Indian Hemp Decree No. 19 of 1966.
The Indian Hemp (Amendment) Decree No. 34 of 1979.
The Indian Hemp (Amendment) Decree, and the Special Tribunal (Miscellaneous Offences) Decree No. 20 of 1984.
The Special Tribunal (Miscellaneous Offences) (Amendment) Decree of 1986 and the National Drug Law Enforcement Agency Decree No. 48 of 1989 (as amended by Decree No.33 of 1990, Decree No 15 of 1992 and Decree No. 62 of 1999). These laws were harmonized as an Act of the parliament, CAP N30 Laws of the Federation of Nigeria (LFN) 2004. This Act established the NDLEA.
The government also fights substance abuse through Enforcement.
The National Drug Law Enforcement Agency (NDLEA) is the agency of government primarily saddled with the enforcement of substance abuse laws. The agency, which is under the Federal Ministry of Justice, is charged with eliminating the growing, processing, manufacturing, selling, exporting, and trafficking of hard drugs. The agency was established by Decree Number 48 of 1989. (1) The NDLEA is present in international airports, seaports, and border crossings.
The last leg is prosecution.
Section 11 (a) of NDLEA Act makes it an offence for a person, who having no lawful authority to do so, to engage in the importation, production, manufacturing, processing, growing and planting of cocaine, heroin, LSD or any other drugs of similar nature. The offence is punishable on conviction with life imprisonment. Section 11(b) and (c) also spell out punishments for those who contravene NDLEA laws. The import is that NDLEA is the primary agency with prosecutorial powers on substance abuse. The Nigeria Police Force can also prosecute.
Of the four legs to combating substance abuse, it is only orientation and reorientation that involve the three tiers of government. The remaining three, regulation, enforcement and prosecution are within the ambits of the federal government. How can NDLEA be on top of the situation of those smoking igbo at Igbo Ora or those sniffing Kushy at Kishi?
The point here is that substance abuse among Nigerian youths is on the rise because the strategy is wrong. Every criminality is local. Therefore, criminality is best fought or combated at the local level. Nigeria cannot successfully overcome the challenge of substance abuse among the youth unless the states and local government authorities are fully involved in it. That brings us again to the issue of the elephant in the room: restructuring.
We need to restructure the policing system as well as the substance abuse regulation and enforcement systems to defeat substance abuse among the nation’s youth.
The media and the government have critical roles to play in reducing substance abuse among the youth. The media needs to take its social responsibilities seriously and ensures that it projects values that would make the society better and stronger.
The government needs to take its sensitization and orientation responsibilities very seriously. Then, the system of government that makes the fight against substance abuse more of a matter of the federal government needs to be tinkered with so that all tiers of government can own the battle and deliver our youths from the jaws of substance.
Olanrewaju is Special Adviser (Media)/Chief Press Secretary to Oyo State Governor.

By: Sulaimon Olanrewaju

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Curbing Substance Abuse Among Nigerian Youths

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In September 2023, a 24-year old lady had a birthday party in a South-West state where one of the guests offered to sell sachets of ‘Milo’ for N1,500 each. The guest, a young lady, had mixed marijuana with Milo and put same in Milo sachets, which had been so expertly sealed that no one would have suspected what the content of the sachets was. The guests at the party rushed the ‘Milo sachet’ and went on a binge, drinking and smoking themselves to get ‘high’. After getting high, fight eventually broke out among them and security operatives had to be brought in to maintain the peace. It was at that point that unsuspecting members of the public got to know that the party guests had gone on a marijuana trip. According to the World Health Organization (WHO), substance abuse, or misuse, is the harmful use of psychoactive substances, including alcohol and illicit drugs. A psychoactive substance is a drug that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behaviour. Examples of psychoactive substances include alcohol, caffeine, nicotine, marijuana and some pain relievers. Other substances abused by Nigerian youths include, ice, molly, cannabis, tobacco, cigarettes, cocaine, sedatives, kolanuts, analgesics, glue, heroine, energy drinks, miraa, tramadol, tranquillizers, cough drops,antimalarial and antibiotics.

Substance abuse is detrimental to health and wellbeing of those involved in it. A Nigerian singer, Joshua Iniyezo aka Solidstar, recently disclosed how substance abused nearly ruined him. According to him, he was introduced to a banned substance called Ice in 2021. He said the substance made him see himself as ‘’a king’’ who didn’t have to pay for any item. One day he walked from Awoyaya in Lagos Mainland to the Oriental Hotel a distance of about 32 kilometres.  Another singer, Inetimi Alfred, popularly known as Timaya, said he was introduced to Molly, a synthetic drug with psychedelic effects. The drug initially brought him happiness but eventually led to detrimental effects on his health, including weight loss and financial struggles. His words: “When I took it, I did not understand myself. I was so happy that I dashed all the money in my pocket. So I wanted to just keep feeling like that. That was how I lost a lot of weight. I was not eating, I was just happy. When I said I was taking Molly, I was taking like three pills every day and it felt like medication. I got kicked out of jobs and contracts… people I was doing business with did not want to work with me again.”

So, substance abuse makes the youth to get ‘high’ but it does more than that. It can make them paranoid, it can precipitate heart attack or failure, stroke, seizures, sleep disorders, drowsiness, nausea, respiratory depression, fatigue, disorientation, impairment in memory, learning, concentration, and problem-solving, hallucinations, decline in academic performance, etc.  As seen in the case of Timaya, it can result in job loss and can pose a threat to relationships. There is also the tendency to engage in criminal activities when ‘high’. Substance abuse among Nigerian youth is nearing the status of a pandemic. According to the National Drug Law Enforcement Agency (NDLEA’s) statistics, about 40 per cent of Nigerian youths between 18 and 35 years are deeply involved in the abuse of drugs. What does the future hold for the country if 4 out of every 10 young people are engaged in substance abuse?

The media is central to our lives. The media shapes our perception of the world. The media is actually the gateway to the mind. The media accesses the mind through the eyes and the ears. So, media contents are food for the mind. The mind is where decisions are made and where opinions are formed. Since the media has access to the mind, the media subtly controls the mind and plays a major role in the decision-making process. So, when the media projects something as good many people in the society take a cue from the media and believe that it is good. In the same vein, when the media projects an act as evil, the society largely avoids it. The media never leaves anything it comes in contact with the same way; it always affects them one way or the other. The media affects individuals in six various ways.  The media can affect cognition, which is the mental process. By affecting an individual’s cognition, the media affects his perception to the extent that he begins to see a particular phenomenon in a new light. The media also affects beliefs. The Western media has consistently showcased the Western culture as being superior to the African culture and this, to a degree, has been absorbed by some Africans who try all they can to travel abroad for ‘greener pastures’ only to get there and find out that the grass is always greener on the other side.

The media also affects attitude. If a child is exposed to violence, he begins to see violence as an option and will be tempted to try same every now and then. Another media effect is affect. This has to do with feelings, emotions and moods. Seeing a scene on television or reading about an event can affect the mood of an individual throughout the day. Media also has psychological effect on its audience. This means the media can affect the orientation of people. The media also affects the behaviour of its users. Behaviour is the culmination of all the effects of media exposure that have been listed. By the time cognition, belief and attitude are affected, behaviour will change. Ladies and gentlemen, in light of the above, I will like to submit that advertently or not, the media has been encouraging substance abuse. This is a global phenomenon and not a Nigerian thing. When a television ad presents a successful musician with a bottle of an alcoholic drink at the background, though the focus of the advertiser from all intents and purposes will be to draw the attention of the society to its alcoholic drink, but the loud message is that “To be as successful as the musician in the ad, take alcohol”. Or, “Successful people take this alcohol; don’t you want to be like them?”

When a musical video glamourises boozing and smoking, what is the message to the society? A song like ‘FotiFoyin’ (brush your teeth with alcohol) encourages the youth to consume alcohol, while a musical video like ‘Asake Loaded’ celebrates smoking. The producers of these musical contents are role models in the society. Some of them are even brand ambassadors. If, as we said, the media is the gateway to the mind, what is the message of these media contents to the society?   The media has to be alive to its social responsibility if Nigeria will win the war against substance abuse by the youth.  The social responsibility theory of the media mandates the media to put the societal wellbeing at the centre of its activities.

This theory says that the media has a responsibility to the society and should always work in the interest of the society. While a media outfit may be a business organization that must make returns to its shareholders, the operators of the business must realize that they will only continue in business if the society survives. If the society is destroyed, the business outfits operating in it will also go down. The easiest way to destroy a society is to destroy its youths.

If the media understands this responsibility and upholds it, it will be clear that the future of the youth who are being exposed to substance abuse is of more importance than the immediate pecuniary gain they will make by pushing out deleterious contents that will push the youth into seeking substances that would make them high.

The media is a major factor in the wellbeing of the society because it plays a major role in what is permissible or prohibited. This is done through what it promotes or refrains from promoting.
As part of its social responsibility, the media should embark on sensitization of the public on the dangers inherent in substance abuse. This should be continuous and sustained as the media’s contribution to the wellbeing of society.

**The government is the most important factor in curbing substance abuse because government is a change agent. Whatever the government permits gains prominence and whatever it prohibits is frowned at.

Government can curb substance abuse through orientation and reorientation. By deploying its massive resources, the government can get across to all strata of the society on the ills of substance abuse and why it is pertinent for it to be spurned by the youth. By making use of all channels of communication and all media outlets, the government can drive home the point on why substance abuse should not be embraced by the youth.
Another means the government deploys to curb the spread of substance abuse is regulation. The Federal Government has, over the years, come up with various regulations to reduce substance abuse in the country. These include:
The Indian Hemp Decree No. 19 of 1966.
The Indian Hemp (Amendment) Decree No. 34 of 1979.
The Indian Hemp (Amendment) Decree, and the Special Tribunal (Miscellaneous Offences) Decree No. 20 of 1984.
The Special Tribunal (Miscellaneous Offences) (Amendment) Decree of 1986 and the National Drug Law Enforcement Agency Decree No. 48 of 1989 (as amended by Decree No.33 of 1990, Decree No 15 of 1992 and Decree No. 62 of 1999). These laws were harmonized as an Act of the parliament, CAP N30 Laws of the Federation of Nigeria (LFN) 2004. This Act established the NDLEA.
The government also fights substance abuse through Enforcement.
The National Drug Law Enforcement Agency (NDLEA) is the agency of government primarily saddled with the enforcement of substance abuse laws. The agency, which is under the Federal Ministry of Justice, is charged with eliminating the growing, processing, manufacturing, selling, exporting, and trafficking of hard drugs. The agency was established by Decree Number 48 of 1989.[1] The NDLEA is present in international airports, seaports, and border crossings.

The last leg is prosecution.
Section 11 (a) of NDLEA Act makes it an offence for a person, who having no lawful authority to do so, to engage in the importation, production, manufacturing, processing, growing and planting of cocaine, heroin, LSD or any other drugs of similar nature. The offence is punishable on conviction with life imprisonment. Section 11(b) and (c) also spell out punishments for those who contravene NDLEA laws. The import is that NDLEA is the primary agency with prosecutorial powers on substance abuse. The Nigeria Police Force can also prosecute.

Of the four legs to combating substance abuse, it is only orientation and reorientation that involve the three tiers of government. The remaining three, regulation, enforcement and prosecution are within the ambits of the federal government. How can NDLEA be on top of the situation of those smoking igbo at Igbo Ora or those sniffing Kushy at Kishi?

The point here is that substance abuse among Nigerian youths is on the rise because the strategy is wrong. Every criminality is local. Therefore, criminality is best fought or combated at the local level. Nigeria cannot successfully overcome the challenge of substance abuse among the youth unless the states and local government authorities are fully involved in it. That brings us again to the issue of the elephant in the room: restructuring.

**We need to restructure the policing system as well as the substance abuse regulation and enforcement systems to defeat substance abuse among the nation’s youth.

The media and the government have critical roles to play in reducing substance abuse among the youth. The media needs to take its social responsibilities seriously and ensures that it projects values that would make the society better and stronger.

The government needs to take its sensitization and orientation responsibilities very seriously. Then, the system of government that makes the fight against substance abuse more of a matter of the federal government needs to be tinkered with so that all tiers of government can own the battle and deliver our youths from the jaws of substance.

Sulaimon Olanrewaju
Olanrewaju is Special Adviser (Media)/Chief Press Secretary to Oyo State Governor,

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