2019 INDEPENDENCE DAY EDITION
On October 1, Nigeria commemorated 59 years of independence and it was received with mixed emotions. Martins Ifijeh x-rays the country’s health sector since inception, as well as sampled opinions of healthcare professionals on what must be done to improve the sector
Prior to the introduction of colonisation by the British into what is now known as Nigeria, traditional medicine and healing was part of the culture of the people. It was the only way to deliver a child, cure diseases, restore mental illnesses, as well as fix broken bones. There were specialised healthcare practices at the time which included herbalists, divine healers, soothsayers, midwives, spiritualists, bone-setters, mental health therapists and surgeons. Solutions to healthcare issues were not just a standalone, but a mix of the culture, tradition, and a spiritual connection with ancestors.
It was the only way the people knew. Science, at the time was millions of miles afar. Women who could not give birth normally only wished they never existed. Same with those who had severe malaria, sickle cell or certain forms of challenges. For those lucky enough to get successful treatments, they considered their herbalists and spiritualists as powerful or close to the deities.
Historians said when the British, Portuguese and other western explorers at the time began to find home in the region, the mode of healthcare provision started to diversify. Missionary clinics were being established. There was the introduction of quinine in 1854 which greatly reduced high mortality from malaria and other diseases. The introduction of several other treatment regimen, as well as establishment of hospitals continued until the healthcare system of the protectorate began to take shape.
By 1954, the leaders of the protectorate proposed Health-for-All; named the Medical and Health Service Policy, which in today’s global health language could be termed Universal Health Coverage (UHC), a target the World Health Organisation (WHO) believed all member countries can achieve by the year 2030.
The leaders at the time, perhaps saw the future; that without UHC there is no future for health whether in developed or underdeveloped ones. UHC is the single most talked about healthcare intervention being pushed by the WHO to all member countries globally, and Nigeria as at today is still miles away from achieving it.
Historians said the implementation for the ‘Health-for-All’ policy was being pushed for over two decades in a bid to ensuring Nigerians in rural and hard to reach areas get access to quality and affordable healthcare. They believed even though the policy was not achieved in full, other policies by the then federal government not only made a positive impact on the healthcare system, but attracted patients from across the world to access healthcare in Nigeria.
The Medical Director, Joekem Clinic, Lagos, Dr. Emmanuel Enabulele told THISDAY that around 1960 or so, dignitaries from other countries were coming to government established hospitals in Nigeria for treatment, and that the sector had the right tools and resources to accept foreign patients.
Nigeria was one of the healthcare destinations of the world. Dignitaries from the United Kingdom, United States and other developed countries came to the country to access treatment.
But as the country began to edge closer to democracy, its healthcare system continued to deteriorate. Healthcare establishments began to have obsolete equipment, and by extension, the country’s health indices started to wane.
A Radiologist with Graceville Hospital, Lagos, Mr. Kingsley Oragwa told THISDAY that the return to democratic rule in 1999 has not addressed the deterioration of the country’s health sector, adding that various national policies on health put in place since 1954 till date has not yielded results.
Poor Funding since Democratic Rule
He said: “Right from the time of Eyitayo Lambo, to late Prof. Babatunde Osotimehin, Onyebuchi Chukwu, to the immediate past Minister of Health, Prof. Isaac Adewole, the country has still not gotten it right on health. We have so far not been able to attract adequate government funding to this sector. Until that is done, it will be difficult for us to address the myriads of healthcare issues bedeviling our country. No matter what our ministers do, if funding is not available, there will be little they can do.
“An Abuja Declaration, signed in 2001 by all member countries of the African Union, including Nigeria, who in fact was the host of the high powered meeting, recommended that for the continent to be at par with other nations of the world in terms of healthcare, 15 per cent of their annual budget, at the least, should be allocated to the health sector. But till date the Nigerian government’s allocation to health has continued to fall short of the recommended percentage.”
Maternal, Child Mortality
On how the nation has fared on maternal and child mortality, Oragwa said this remains an anomaly. Adding that Nigeria cannot confidently say it was celebrating 59 years when the lifespan of the average Nigerian male is 50 years, while that of the female is 53 years. This, according to him means any Nigerian male living above 50 years of age was living on a borrowed time; same with the women.
He said: “Comparing these indices with that of other countries, especially many African countries poorer and weaker than ours show that we shouldn’t be happy with the state we are. These are indices we should be ashamed of because it depicts how much our healthcare system has fared.”
Oragwa said most countries that got independence alongside Nigeria met the last Millennium Development Goal on maternal and child mortality. “Our women are still dying in high number daily due to pregnancy and childbearing related complications. We must reduce all these indices to the barest minimum before we can say our healthcare system has grown”, he lamented.
According to him, most Nigerians living in rural and hard to reach areas of the country are still grappling with having to survive without basic healthcare, which are the rights every country must provide for its citizens, adding that, until the country give priority to primary healthcare, the issues would continue to halt the country’s progress.
Also, a food security expert in Lagos, Mr. Azeke Usigozu, told THISDAY that the health sector needs to do more in the area of child mortality. “A country’s infant mortality rate is a reflection of the quality of health delivery available to its citizens, and to a large extent, a reflection of the quality of life enjoyed by the citizens of that country. The government should pay more attention to our local clinics where the low class go to anytime they have health challenges – this is where majority of our women go to during pregnancy as well as child birth.
“If Nigeria at 59 is channeled to improving the healthcare system, I can assure you that it will be noticed by all and sundry, from the tiniest treatments like relieving headache, up to the big treatments like bone marrow transplants and the cure of other diseases”, he said.
Medical Tourism, Brain Drain
A Public Health expert, Dr. Jude Areogbu said the high rate of medical tourism abroad was a pointer to how the country’s health sector was doing, adding that yearly, over $1 billion is lost to medical tourism abroad.
“What this means is that our health system is failing. We need to fix our it. About 20 years ago, Turkey’s health sector was as bad as ours, but money was injected, and today, they can compete with the likes of the United States and Germany. We should do same; inject money into the system. We need a strong primary, secondary and tertiary healthcare,” he added.
Another medical doctor, Adebayo Tunde-Vincent, the exodus of doctors and other health workers to other countries where they are appreciated was an evidence of how degraded the country’s health sector has reached.
He explained: “If we continue to undermine medical doctors in this country, I can tell you authoritatively that in the next 10 years, we won’t have up to 10,000 doctors around because there will be brain drain, while the younger ones who intend to study medicine would rather not bother themselves over it.
“Do you know that Nigeria presently has less than 40,000 doctors practicing in the country, while over 31,000 are currently practicing in the United Kingdom, with 12 doctors getting employment in the UK weekly. This statistic shows that we have more Nigerian doctors abroad than in our own country,” he stressed.
With the deteriorating level of the health sector till date, should the country go back to the precolonial era where the people banked only on traditional medicine and spiritual healers for health interventions?