The results of the World Health Organisation’s analysis of the world’s health systems among 191 member states are in, and Nigeria ranked 187 only ahead of Democratic Republic of the Congo, Central African Republic and Myanmar. Using performance indicators including overall level of health, distribution of health in populations, responsiveness and distribution of finance, France ranked 1, followed by Italy, San Marino, Andorra and Malta, respectively. Clearly, there is much to be done in Nigeria. It is about time we began to remove the financial barriers standing in the way of attaining a working health system, because, in the words of Harry S Truman, “The health of all its citizens deserves the help of all the nation.”
Although there has been enormous improvement in relation to the last decades, with current statistics claiming 33,303 general hospitals, 20,278 primary health centres and posts, and 59 teaching hospital and federal medical centres, Nigeria continues to suffer crippling shortages in the health care institution, and increase in the rate of health tourism. It is reported that Nigeria loses around $1 billion to health tourism each year. A classic example is the current case of the ‘missing President Buhari’ who is said to currently be on vacation in the United Kingdom, or receiving health care; depending on which story you want to believe. In fact, not too long ago – June 2016 – the same President Buhari travelled to London to see an ear, nose and throat specialist after contracting an ear infection, when a generous allocation is given to the state house clinic for the treatment of government officials, including the president in the country’s budget.
Unfortunately, despite Nigeria's strategic position in Africa, the country is greatly underserved in the health care sphere, with a total expenditure amounting to 4.6% of the GDP. Bogged down by a plethora of problems including: financial management competency, inadequate funding, inadequate and inefficient health facilities (health centres, personnel, and medical equipment) especially in rural areas, inadequate and non-functional surveillance systems, numerous strikes and counter strikes the health services are greatly weakened, have shown maximum disrespect for human lives, and have jettisoned the established order of humanity to care for the sick.
Furthermore, per the 2009 communiqué of the Nigerian national health conference, the health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care on top of the very deplorable quality of care. The communiqué further outlined the lack of clarity of roles and responsibilities among the different levels of government as increasingly compounding the situation.
However, irrespective of the challenges facing Nigeria’s health sector, there have been numerous achievements and impact made by several funding bodies, organisations, and the government, which we would be prudent to capitalise on.
The Partnership for Transforming Health Systems II (PATHS2) was originally a six-year (2008 - 2014) development initiative aiming to ensure that Nigeria achieves important health-related Millennium Development Goals, funded by UK aid from the Department for International Development. PATHS2 is working in partnership with the Federal Government of Nigeria and other stakeholders to improve the planning, financing and delivery of sustainable and replicable pro-poor health services for common health problems in five states in Nigeria – Enugu, Jigawa, Lagos, Kaduna, and Kano.
Also, the Private Sector Health Alliance of Nigeria (PHN) is the country’s foremost private sector collaboration dedicated to the Saving One Million Lives movement and advancing progress in meeting global health targets with a clear vision and focused strategy. In a move aimed at improving Nigeria’s health indices and reducing maternal mortality ratio by three quarters in 2015 and beyond, in line with MDG 5, PHN committed $24.2 million to drive a private sector emergency response to the Saving One Million Lives initiative, and continues to invest in critical segments of the healthcare value chain that benefits the underserved.
Reports in December 2016 reveal that Huawei Technologies, in collaboration with Access Bank Plc and PHN, has staked N50 million to support the drive for eradication of malaria in the country. The move is designed to complement Federal Government’s effort in achieving its malaria pre-elimination goals by 2020, tagged ‘Malaria-To-Zero’ initiative. The donation, according to the company, is an innovative financing platform that seeks to galvanise private sector resources and capabilities for sustained support towards averting at least 1 million malaria cases and deaths in Nigeria.
In addition, the National Agency for the Control of AIDS (NACA) is a governmental organisation with a mission to provide enabling policy environment and stable on-going facilitation of proactive multi-sectorial planning, coordinated the implementation, monitoring and evaluation of all HIV/AIDS prevention and impact mitigation activities in Nigeria. Through its work, Nigeria has recorded tremendous success in the fight against HIV\AIDS, with the country moving from a high prevalence rate of over 5.8% in 2001, to less than 3% prevalence rate in 2014.
By way of international support, USAID is the lead U.S. Government agency that works to end extreme global poverty and enable resilient, democratic societies to realise their potential. USAID supports increased access to quality family planning and reproductive health services, immunization, polio eradication, malaria prevention and maternal health service. In October 2016, USAID donated 4.5 million mosquito bed nets to the people of Oyo State, and also announced $92 million in additional humanitarian assistance for Nigeria in December 2016.
One thing is certain: the importance of partnerships in turning the health sector around cannot be overemphasised. It is only through the deliberate participation of ALL stakeholders – government, professionals, private sector and citizens alike – that any real progress can be made. The level of uncertainty that thrives in the Nigerian health care system implies that we are not all on the same side; producing additional disruption in development of the health sector. There is, therefore, a need to focus our efforts on the effective mobilisation of health care professionals, the use of sustainable care plans by government, the use of integrated medical intelligence and surveillance systems, increased accountability and commitment, and making quality health care accessible to all citizens at affordable costs – this suggests that the federal and state governments should channel their energy to the grassroots.
The health of the populace is by no means a trivial matter, especially because it impacts directly on the productivity of the nation. Based solely on the performance indicators applied by the WHO, every industry can actively play a significant role in creating a viable health care system we can all enjoy. We are, therefore, calling all stakeholders to critically examine the sector with an aim to proffer workable, inclusive and sustainable solutions to the numerous health challenges we face.