Drawbacks of Nigeria’s Health Sector

Incessant strikes by doctors and health workers, medical tourism, low budgetary allocations, brain drain, poor research culture and a host of other issues have been identified by experts as major drawbacks for Nigeria’s healthcare sector. Martins Ifijeh writes

When nearly two decades ago, Estonian, a tiny country, was battling with low gross domestic product and a crippling economic strength, not many nations thought they would experience turnaround since their government had made several efforts without achieving much success.

But the Estonian story tellers say the determination, not only by the stakeholders, but by the citizens changed the narrative, as they have become the most technology savvy nation on earth, resulting in economic boom for the country.

But same cannot be said of Nigeria’s healthcare system, as actions and inactions by especially some major players in the industry, the government and the citizens in general, have continued to hamper the desired growth needed for the sector to impact lives positively.

While Nigerians continue to trade blames for the slow pace of progress in the sector since inception of democracy, others believed the blame game must be shared by the government, doctors and health workers, privileged Nigerians and health bodies across board.

Incessant strike actions has not helped the system
For instance, a Clinical Psychologist with Gray Havens Medical Centre, Port Harcourt, Dr. Alphosus Kalu, believed not few Nigerians have died because they were unable to access treatments due to strike actions by either medical doctors or other health workers, adding that for every strike action in hospitals, patients, whose tax payers money are used in running healthcare suffer the most, and in most cases this has resulted in deaths or irreversible health damages.

“While it is every worker’s right to use strike action to press home their demands, the critical position of importance of doctors and health workers makes it almost never an option, as other rules of engagement with administrations and the government are often advised to be used,” he said.

Records show that in 2016 alone, resident doctors of 25 teaching hospitals across the country went on strike to press home their demands. Joint Health Sector Unions (JOHESU) embarked on a nationwide strike to also press home their demands, and other associations as well went on strike at one point or the other.

For example, medical doctors in Irrua Specialist Teaching Hospitals embarked on strike action for almost four months in the year alone, making patients who were meant to access treatments in the hospital to live at the mercy of other health workers for treatments.

“A situation where citizens are unable to access healthcare because the hospital personnel are on strike will in no small measure hamper healthcare provision,” he stated.

He advised that private investors should consider investing in the health sector of the country the way they have invested in the power and oil sector,” he said.

While Kalu argues that though it remains the right of doctors and other health workers to embark on strike actions, it was important that government and the various associations settle their differences once and for all as this will continue to negatively affect the progress of the sector year in year out if nothing is done.

Desiring a world class health system but providing low budgetary allocation
The WHO has continued to clamour for member countries to give at least 13 per cent of its minimum allocation to the health sector if they must adequately meet the healthcare needs of their citizens. The Nigerian government even went further to sign the African Union’s Abuja Declaration of 2001 where all member countries promised to allocate 15 per cent of its annual budget to the health sector.

Sadly, since the mandate from the WHO and the Abuja Declaration, Nigeria’s budget allocation for health keep dwindling between 2.0 and 6.0 per cent, and in some instances, education and power sector take more budgetary allocations than the health sector, which is arguably the most important sector in a country, as other areas of the economy depends on how healthy the people and the nation are.

With the coming of a new government in power, one would think the priority given to the health sector would finally be restored. However, this year’s allocated amount fell short of what was envisaged, especially in the face of more health challenges affecting the country.

From 5.7 per cent allocated to the sector in 2015, the allocation dropped to 4.3 per cent for 2016, which translates into N221.7 billion from the total budget of N6.08 trillion, a figure far below the N1trillion mark that was envisaged by stakeholders in the industry in view of the increased health issues.

The Chairman, National Immunisation Financing Task Team, Dr. Ben Anyene, described the allocation of 4.3 per cent of annual national budget to health sector in 2016 as grossly inadequate to cater for the health needs of the populace, and has insisted that 15 per cent of the budget for the sector be used in 2017 if the country must make gains in the sector.

The doctor, who described making policy without its implementation as baseless, said giving full health to Nigerians would prevent health challenges. “The masses who were faced with diverse health challenge could not survive with such meagre allocation, neither could the health of Nigerians,” he added.

Experts want the 2017 budget allocation for health to significantly increase.

The WHO believes if all health intervention areas in Nigeria were put into consideration and adequately captured in the budget, it would mean the government will spend a minimum of N6,908 per Nigerian in a year. But, as it is, the country still spends just a little above N1,500 per Nigerian on healthcare, which means about 80 per cent of healthcare services is being funded from out-of-pocket expenses of Nigerians.

Brain drain as a drawback
Of the over 80,000 Nigerian medical doctors registered with the Medical and Dental Council, available information suggests not more than 21,000 are currently working in the country due to quest for better working environment and greener pastures.

In an earlier interview with the media, the former President, Nigeria Medical Association, Dr. Osahon Enabulele, said over 7,000 Nigerian medical doctors work in public health in the United Kingdom, while others have left the profession altogether.

For a medical doctor, Adebayo Tunde-Vincent, Nigeria may not boast of 10,000 doctors in the next 10 years with the level of exodus of doctors out of the country due to “poor renumeration and conditions of service,” adding that Nigeria presently has less than 21,000 doctors practising in the country while over 22,000 were currently practicing in the United Kingdom and several thousands in the United States. “This statistics show that we have more Nigerian doctors in the UK than even in our own country,” he added.

He added that majority of those he graduated with several years ago have travelled to other developed countries where they are better appreciated. He believed an average Nigerian doctor wants to be practising in countries like, United States, United Kingdom, Saudi Arabia, Canada, among others, as they have better conditions of service.

Agreeing that the brain drain was part of reasons for the slow growth of the sector, Tunde-Vincent said if the country wants the best out of doctors and other health workers, who often work round the clock for the provision of good health for the people, remuneration and other conditions of service must be upgraded considering the importance of their responsibilities.

He also called on President Muhammadu Buhari to decisively step into the unending crisis in the sector so that everyone can speak with same voice. “Are you aware that an average Nigerian doctor working for the government earns about N170,000 per month, while their counterparts in South Africa earn about N300,000 per month? So you can see there are many reasons for the brain drain, which at the long run also affects how our healthcare is positioned,” he explained.

Earlier this month, Nigeria’s House of Representatives Committee on the Diaspora raised alarm that about 77 per cent of black doctors practising in the United States of America were Nigerians.

According to WHO, for a country to optimally provide healthcare for its citizens, there must be at least one medical doctor to six patients. For Nigeria to achieve this, experts say the country needs at least 280,000 medical doctors, as against the less than 30,000 currently practising.

This, has in no doubt therefore contributed to the drawbacks of the country’s healthcare system.

Discourage medical tourism
India’s medical association’s annual reports for 2014 show that in 2012 alone, 18,000 Nigerians obtained medical visa and about 47 per cent of outbound medical tourism from the country goes to India, totaling about $260 million.

According to the former director of Planning Research and Statistics, Federal Ministry of Health, Dr. Ngozi Azodoh, public officials who travelled abroad for medical care in 2014 alone expended N198.95 billion ($1 billion) of tax payers money while available estimates show that up to 40 medical trips to India alone were embarked on mostly by public officials at government expense.

Experts argue that if such moneys are expended in the country and re invested into healthcare for the year, it would go a long way to shaping the system positively.

Poor research culture
A Professor of Virology, University of Massachusetts, Prof. Kelvin Dimeji, wants Nigeria to opt its game in medical research development, as this would help in providing better information in tackling some diseases affecting the citizens and Africa.

“Malaria and some other health burdens are part of the challenges we must solve through research and developments. A lot of Nigerians are dying from diseases that if adequately funded, vaccines may be available for,” he said.

He called on the government to give priority to research funding in the country.