The coronavirus pandemic has exposed the country’s dilapidated healthcare delivery system to harsh scrutiny and its leaders to well-deserved odium. From the glaring scarcity of basic medicines and supplies to inadequate hospitals and facilities and a broken bureaucracy, the incapacity of the system to cope with a challenge that has so far, mercifully spared Nigeria the grim levy it is exacting elsewhere, is foreboding.
In the short-term, federal and state government officials will need to demonstrate uncommon leadership to fend off the virus and post-COVID-19, implement a radical overhaul of the healthcare delivery system.
Though the infection rate and fatalities have been low, compared to its apocalyptic dimensions outside of Africa, experts, including the World Health Organisation, have voiced strong fears that if the infection rate should spike, the country’s fragile healthcare structure could collapse and result in thousands of deaths. This is no idle warning. Worldwide, COVID-19 is making short work of the most advanced national healthcare systems. The speed and casualty rate have humbled the rich and most powerful nations, especially the United States, Italy, Spain, the United Kingdom and Japan.
Nigeria’s infections and deaths by comparison appear low for a population of over 200 million. Even at that, our response to the pandemic has been feeble. For instance, only about 5,000 persons have been tested here, compared to over 60,000 in South Africa with a population of 57.78 million, reflecting the wide gap in capability.
The WHO ranks Nigeria as having the world’s fifth worst health care delivery system, after fragile states like Sierra Leone, Myanmar, Central African Republic and the Democratic Republic of Congo. It has a life expectancy of 55 years, the globe’s fourth lowest, said the United Nations Population Fund. For perspective, war-ravaged Afghanistan, Somalia and Syria post 65, 58 and 73 years respectively.
The country had the eighth highest infant mortality rate and a maternal mortality of 814 deaths per 100,000 live births, with one woman dying in childbirth every 10 minutes, said World Health Statistics 2016. Malaria kills over 300,000 persons each year; cerebrospinal meningitis, polio, tuberculosis, Lassa fever, HIV/AIDS and cholera are endemic. By midweek, Lassa fever had so far killed 188 persons this year from 963 confirmed infections. About 90 per cent of the population lack health insurance, 15 years after the National Health Insurance Scheme was inaugurated.
Such outcomes are the inevitable results of public corruption, utter neglect, underfunding and under-investment in health infrastructure. Though the African Union countries agreed in 2001 to allocate 15 per cent of their annual budgets to health, it received an average 4.1 per cent in 2019 and 2020.
Health Infrastructure is grossly inadequate, but instead of addressing this, the elite junket abroad for minor and major ailments and many, including those who can ill-afford it have to raise funds to seek treatment for serious afflictions.
But COVID-19 teaches the hard lessons that every country must have a competent healthcare sector. The President, Major General Muhammadu Buhari (retd.), who travels regularly to London for medical care and other elite, including state governors, should fund and equip health facilities and build efficient healthcare delivery system. Experience elsewhere proves that you don’t have to be rich to succeed. The WHO recommends the Cuban model to developing nations whose success is underscored by its more than 29,000 medical professionals practising in 59 countries. Now, the island nation is sending medical teams around the globe to help with the coronavirus response.
Its reputation as a medical power was demonstrated by the arrival of 57 medical personnel from the Third World country to assist Italy in combating the pandemic. Anchored on preventive and primary healthcare, the tiny Caribbean nation’s system is rated better than that of the US. Margaret Chan, former director-general of the WHO said, “Cuba is the only country that has a healthcare system closely linked to research and development. This is the way to go, because human health can only improve through innovation.”
But Cuba is not alone in the healthcare Hall of Fame. Rwanda, emerging from a gruesome civil war and a horrific genocide, has been rebuilding its health sector by devolving management and funding to provincial and local levels. It adopted universal health insurance and is described as having one of the best healthcare systems in Africa.
Nigeria’s predicament is neither for lack of policies nor personnel. From the revised National Health Policy to the NHIS, programmes on immunisation, polio and malaria eradication, fashioned by local and international experts, policies abound, but are poorly, corruptly and incompetently pursued. The Association of Nigerian Physicians in the Americas said over 5,000 doctors, some highly renowned, practise in the US, while the United Kingdom’s register of doctors reveals that Nigerians constitute its fourth largest bloc.
Nigeria needs a public health system for all, a dedicated scientific community, an effective civil service system and a government that puts the people at the centre of its attention. Nigeria’s systemic corruption is the first dragon that must be slain. It is argued that corruption is the single greatest obstacle preventing the country from achieving its enormous potential. In 2012, it was estimated that Nigeria had lost more than $400 billion to corruption since 1960. This venal culture has not been curbed.
In 2016, Africans spent over $6 billion on outbound treatment, according to The Conversation, an online media agency. It says Nigeria is a major contributor with its citizens spending over $1 billion annually on the medical tourism fad. The August 2017 report reveals that “the cost of parking Buhari’s plane during his three-month spell in London is estimated at £360,000. That’s equivalent to about 0.07 per cent of Nigeria’s N304 billion budget allocation for health this year.” The people, through civil society groups, labour unions, professional bodies and the media, should insist that public officials, especially the President and the governors, must stop spending public funds for medical treatment abroad.
Only by doing so will the federal and state governments be compelled to invest heavily in the health sector.
There should be a dogged commitment to site, fund and equip the PHCs and a graduated scheme of effective secondary and tertiary health institutions. The three tiers should urgently commence a phased programme of upgrading their tertiary institutions to world standards. States should drive the LGs to revive, build more, equip, fund and efficiently run the PHCs in all wards.
