The Nigerian healthcare system is currently struggling on many fronts – from inadequate infrastructure to gaps in key health policy implementation, shortage of personnel, persistent strikes, inadequate training, and absence of efficient multi-sectoral (public-private) partnerships.
Provision of healthcare is one of the primary objectives of all nations. A healthy nation is a productive nation. In Nigeria, accessing timely quality healthcare services in public health facilities has become a nightmare and therefore a disincentive to many people who look elsewhere for alternative solutions to their health needs. Thus, governments and all citizens have common interest in provision of quality healthcare.
In Nigeria, seven out of 10 people live on less than $1.25 (N500) a day and they also live in a country where 70% of health expenditures are out-of-pocket payments. Nineteen years after the Abuja Declaration where African Union states pledged to allocate at least 15% of their annual budget to health, Nigeria continues to default. With over 23,584 public primary health care facilities, 8,290 private primary health care facilities and 200,000 patent and proprietary medicine vendors (PPMVs), the country’s health indices and other health indicators are still abysmal: there are no significant improvements compared to other countries in sub-Saharan Africa.
This got me thinking: How long do Nigerians have to depend on out- of- pocket payments for healthcare? How long must I wait and how long must I suffer? How many Nigerians have health insurance to cater for their health needs, especially during emergencies? Do we visit the hospital to recover or to die? I believe most of us have asked these questions over and over again each time we visited a healthcare centres within the country, especially the public ones.
Strangely, our approach to our Primary Health Care has tended to be as a corpse in a decorated coffin. This is our grassroot healthcare system with festering sources of poor quality system, inadequate staff, epileptic electric supply, inadequate medicines and conundrum of slums. Most patients on admission are usually at the mercy of some heartless attendants who ignore or compound their medical conditions. People go to the hospital in the event of an illness to seek relief and not dejection.
It is a very depressing fact every day to hear that the standing mortality rate especially in childbirth and pregnant women is very high. From the number of people that die from road traffic accidents to the number of mothers that die during child births to malaria deaths to malnutrition; the statistics paint an abysmal picture of our healthcare system.
The increasing brain drain and deficiency in the
workforce are perhaps one of the biggest causes of the deplorable health indices in major parts of the country. These inadequacies in the public healthcare system have created a room for new crop of self-acclaimed traditional herbal practitioners (herbalists) and nonprofessionals who are blowing their own trumpets.
In line with the Patients’ Bill of Rights (PBOR) developed by the Consumer Protection Council and launched by the Vice President Prof. Yemi Osibanjo on Tuesday, July 31, 2018, healthcare providers must ensure that a patient’s right to seeking and obtaining quality healthcare is respected and protected. This includes the right to patient’s bill which is a “list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration”.
Sadly for us in Nigeria, poor budgetary allocation has been consistent while the country majorly depends on donors and NGOs to finance its health projects. Response and management of diseases are left in the hands of foreign partners. Governments must reduce out- of- pocket payments for health care services by households through the adoption of a tax-financed non-contributory UHC scheme while mandating states to provide health insurance coverage to all residents, prioritising children and vulnerable populations.
A comprehensive preventive health programme needs to be adopted such as vaccination programmes, health education, massive sensitisation campaign, sanitation and environmental inspection, institution of basic sanitation and water-provision infrastructure. These have been employed with great success in other developing countries. Most of our burdens are infectious and non-communicable chronic diseases. Routine medical check-ups should be advised and not seen as an elitist practice. Many of us do not know that mere hand washing is a lifesaver; diabetic and hypertensive patients today could have avoided the diseases if only they were disciplined to adopt a lifestyle change early enough.
Although death is inevitable, a lot can still be done to drastically reduce the unnecessary deaths that are registered particularly in our public hospitals day- in and day- out. We just need to build and implement a solid framework, policy and laws that have teeth and not just empty declarations.
Yusuf Hassan Wada, Usmanu Danfodiyo University Sokoto, is a winner of the PharmaNews PANSite of the Year Award (2019)