Nigeria: The Time for Our 21st Century Health Care System is Now!

Nigeria’s health care system has been a perennial cause for concern as it has been in an abysmal state for so many years now, in comparison with other African countries. For just one example in 2005, whilst Uganda allocated 11% of its total budget to health care, Nigeria budgeted just 5.6% and whereas Uganda was ranked 149th out of 191 countries, Nigeria came in at a desperate 187th out of 191 in the World Health Organisation’s Report 2000.With our countries low level of expenditure on health care per capita, there is no doubt we will fall well short of meeting Millennium Development Goal 4 on Reduced Child Mortality and 5 on Improved Maternal Health. There is a limit to what international agencies can do such as the United Nations Population Fund (UNPF) which provides technical and financial assistance to the Nigerian government towards strengthening the national health system; Save the Children, who work to strengthen health systems and support maternal and child health in four northern states in Nigeria and international service organisations such as Rotary in Nigeria who fund pilot health programmes and a host of other international and local agencies all working towards an improved health system. Even then more has to be done by the government both at federal and state level.

It all started with the 1999 Constitution which does not provide for basic health care. Neither is there a clear definition of roles or responsibilities of different tiers of government, therefore no one can be easily held responsible for the poor state of our health care system.  Transfers from the federation account to state and local governments are not ‘earmarked’ that is, each state and local government decides how they spend the funds that are allocated to them. As they are not required to provide budget expenditure reports to the federal government, this means that the latter does not have any significant influence on funds allocated for primary and secondary health services (except those funded through special agencies and programmes)

Not surprisingly our health care system has been described as one of the weakest in the world, as it operates under no clear guidelines. This phenomenal decay in the health sector has paved the way for medical experts from other parts of the world to set up businesses here and millions of dollars are spent annually by Nigerians on foreign medical trips. I know of a laboratory that carries out scans that are immediately relayed to India and a full report on them is made available within 24hrs.Another area of great concern is the lack of funding for medical research. I was at a Nigeria/British Association’s event earlier in the year and a presentation was made by an eloquent professor of medicine on the disheartening lack of funding for cancer research in Nigeria.

There are reforms going on in all sectors of the government and mercifully, the health sector has not been left out. However, it is the outcome of these reforms that is frustrating the good people of this country. The government has put in place a comprehensive reform structure namely: (i) improving the stewardship role of government; (ii) strengthening the national health system and its management; (iii) reduction of disease burden;(iv) improving availability of health resources and their management; (v) improving access to quality health service; (vi) improving consumer awareness and community involvement; and (vii) promoting effective partnership, collaboration and coordination.

In 2004 stakeholders put together a National Health Bill (NHB) which in addition to defining clear roles and responsibilities for the three tiers of government, provides for the creation of a Primary Health Care Development Fund, 50 % of which shall be used for the provision of basic package of health services to all citizens in primary health care facilities through the National Health Insurance Scheme (NHIS). Section 45 further mandates that no industrial action or disruption in the health system shall last more than 14 days – that the ‘health services shall be classified as essential services’ whilst section 46 prohibits medical tourism for public officials, among many other measures. The bill was set for Presidential assent in May 2011 but a disagreement among stakeholders over some of its sections forced President Goodluck Johnathan to return it to the National Assembly for amendment. On February 19th 2014 the bill was passed at a plenary of the Senate.

As with so much else, the bill is shrouded in controversy. Some non-governmental organisations are against certain sections as they are considered to be full of contradictions, conflicting legal clauses and sections capable of worsening the declining conditions of the health sector.10 years after the process started, here we are with yet another bill lying fallow. When indeed will the well intended reforms take place and move this country forward?

On July 1st this year the Nigerian Medical Association (NMA) went on strike because the government had not met their 24 demands which included discontinuation of recognition of non-medical doctors as directors and the consultant title to any other health worker other than medical doctors as well as the appointment of a surgeon –general of the federation, among many issues of contention. The NMA as with any other professional association necessarily interacting with government, has a right to champion their cause. The huge dilemma here for citizens is the untold suffering of the millions, literally, who have no means of private health care whilst the strike continues. Is it not possible that the NMA set up a small group of negotiators to fight their cause with the government instead of going on a full blown strike? The work doctors do and the dedication shown, I must say, often goes above and beyond their professional calling.

As the turmoil regarding the NMA strike appears to be gaining strength the dreaded Ebola virus claims its first victim in Nigeria, sending shock waves across the world. The Ebola virus broke out in Guinea, Liberia and Sierra Leone in March and yet nothing appears to have been put in place in the event that it would find its way to Nigeria (which it assuredly did) e.g. alerting the public, health workers, customs, immigration etc. A general and timely public enlightenment would have done a world of good. Undoubtedly foreign aid will come, as I was recently contacted through a mutual friend by an American doctor who is on her way Nigeria and Sierra Leone to help contain the Ebola virus, though painfully, considering the ‘life or death’ nature of her assignment, her first question was about the safety and security of our beloved country (surely the subject of a future editorial…)

This is a wakeup call for our health care system to be revamped without further ado and to be finally dragged, kicking and screaming, into the 21st century.

Courtesy of ‘The Day NG’
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FROM Da SOURCE by lnvisiblε NεtωorK™

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