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Critical Analysis of the Nigerian Health Sector
By Ayo Abelegbe
Health is one of the most critical sectors that drive the economy of any country, nay Nigerian economy. Developed countries with robust economies are known for making robust public health policies that enhance the delivery of measurable health care to their citizens. That has helped them cater for their citizens’ well-being effectively. It has also made it easy for them to monitor and control the epidemic outbreaks in their country.
Taking a closer look at the Nigerian Health Sector, it is obvious that the Sector, although a very important aspect of the country’s economy, has suffered lots of setback over time. The setbacks include inadequate funding, disease outbreaks, lack of modern equipment, inadequate health personnel and frequent strikes by health workers.
In 2001 all member countries of the African Union (AU), including Nigeria, at An Abuja Declaration, arrived at a recommendation that for the continent to be at par with other nations of the world in terms of healthcare provision, at least 15 percent of their annual budget, should be allocated to the health sector. Ironically, Nigeria’s health budget has continually fallen short of the recommended threshold: in 2015 – 5.78%; 2016 – 4.23%; 2017 – 4.16%; 2018 – 4.4%; 2019 – 4.75%; 2020 – 4.14%. The highest Nigerian budgetary allocation to the health sector since the 2001 Abuja Declaration was 5.95% in year 2012.
The lack of adequate funding has a multiplier effect of lack of enough health facilities across board and dearth of modern equipment in the existing facilities. The health workers on ground are bereft of adequate welfare packages thus leading to the flight of a substantial proportion of home grown health professionals seeking greener pastures abroad. Those staying behind embark on strikes on agitation for better welfare package thus leaving the sector worsened. The near comatose state of health facilities in Nigeria is boldly reflected in the lack of confidence in the sector by the populace. The high ranking members of the populace, including leading political figures and the bulk of the middle class (prior to the current Coronavirus pandemic) embark on medical tourism in Europe, USA, India and South Africa. A large portion of the rest of the populace who lack the capacity for foreign health treatments resort to self-medication and traditional medicine for their health needs.
The dire situation of the Nigeria Health Sector is better captivated in a 2019 rating by the World Health Organization (WHO). WHO had rated Nigeria 187 out of 191 countries in terms of health care delivery. One third of more than 700 facilities across the country were indicated as having been destroyed with more than 3.7 million people in need of critical health assistance. The global health body had placed Nigeria at 3rd highest in infant mortality rate in the world.
The National Health Insurance Scheme (NHIS) established in 2005 has not made the expected significant impact. The Scheme has been bedeviled mainly by lack of proper marketing to the bulk majority of the populace, most of whom are illiterates and resident in the rural areas. So also is the lackadaisical attitude of the Health Management Organisations (HMOs) and dearth of medical practitioners to effectively implement the scheme. Available statistics, as at 2017, indicated that Nigeria had about 80,000 registered doctors with more than 50,000 of them practicing abroad. A large percentage of those in the country were at the verge of seeking greener pastures abroad.
The state of the Nigerian Health Sector is not without some modicum of breakthroughs.
The campaign against polio has been relentlessly fostered by the government. The polio eradication initiative has been carried out door-to-door in major cities and towns across the country breaking through some initial skepticism cocooned in primordial cultural and religious beliefs. The alacrity with the outbreak of the Ebola epidemic shows that given the right atmosphere, the Nigeria health sector could tackle arising health challenges.
The ongoing approach towards the Coronavirus pandemic, currently ravaging the globe, is a wake-up call on the Nigerian health sector to be properly positioned to cater for the teeming population of the country. The reality of the ongoing pandemic is that all Nigerians, both highly and lowly placed would only survive if the Nigerian health sector is properly positioned. The high and middle level economic class and politicians who had in the past relished in foreign medical tourism could no longer have such an advantage in view of the global reality of the pandemic and the pervading lockdown.
This is the appropriate time for all tiers of government in Nigeria to invest hugely in the health sector by ensuring that adequate health infrastructures are put in place coupled with attractive welfare packages for health workers across board.
Towards a sustainable home grown health services the Federal Government of Nigeria and those of the federating units should provide an enabling environment for medical research that would include local input by enhancing a synergy between orthodox and traditional herbal medicines. The time is ripe for the Department of Traditional Complementary and Alternative Medicine, in the Federal Ministry of Health, to partner with the National Institute of Pharmaceutical Research and develop vaccines, curative medicines and relative antidotes to the diseases facing the society including Covid-19 pandemic. As the health apparatus of the advanced countries appear to be caving-in under the pandemic, it is apparent that what Nigeria needs most, at this critical moment, is a virile home-grown medical approach.
The National Health Insurance Scheme, introduced in 2005, needs to be reinvigorated and made all-encompassing to adequately cover the Nigerian populace in both the formal and informal sectors. This could be aptly attained if such is properly addressed in the National Health Insurance Commission Bill currently pending before the National Assembly with the process towards the enactment of the bill into Law sped up appropriately.
––Ayo Abelegbe is a public Affairs analyst in Ado-Ekiti, Ekiti State
