Nigeria’s appalling health indices seem to be attracting interest from the appropriate quarters. After decades of limiting itself to mere activism, the Nigerian Medical Association has formulated a plan to rescue the sector. The idea is a joint venture of government, donors and international aid organisations. Nigerians are dying daily from preventable diseases because the structure has collapsed. Therefore, the NMA plan is worth being given a try.
The umbrella body of medical doctors showed that it means business when it unveiled the five-year strategic plan in April. With the implementation cycle set for between 2017 and 2022, the NMA will collaborate with development partners to catalyse the plan, which will be inclusive of all professional medical associations. In the past, different professional associations had been at loggerheads, leading to unnecessary rancour in the sector.
The scheme is anchored on the National Strategic Health Development Plan designed by the Federal Ministry of Health in 2009. With eight priority areas, 33 strategic objectives/programmes and 70 strategic interventions, the overarching goal is “to strengthen the national health system and to vastly improve the health status of Nigerians.” Some of the priority areas include revitalising integrated service delivery and ensuring that adequate and sustainable funds are available and allocated for accessible, affordable, efficient and equitable health care provision and consumption at local government, state and federal levels. Although the document was well received, its Achilles’ heel – just like other comprehensive proposals in the past – has been poor implementation. Excellent policies die in Nigeria because non-implementation is a national pastime.
Yet, Nigeria’s deteriorating health indices require urgent reforms. The World Health Organisation says Nigeria is one of the “57 human resources for health crisis countries” in the world. WHO attributes this to “densities of nurses, midwives and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000).” Disillusioned medical professionals migrate to lucrative overseas destinations, worsening the personnel deficit in the country.
This dire structure shows clearly in the high lilt of morbidity and mortality. As of April 26, a deadly outbreak of meningitis had killed 813 people, the Minister of Health, Isaac Adewole, said. Eight more died in Katsina State last Wednesday. Apart from a growing crisis of non-communicable diseases, Lassa fever and cholera kill in hundreds. Polio has yet to be eliminated. HIV/AIDS is a national epidemic. The UNAIDS says that 3.5 million Nigerians are infected with the disease. This is the second largest global burden.
Daily, 2,300 under-five Nigerian children die of malaria, cholera and other diseases and 145 women of child-bearing age die daily, making Nigeria the second largest contributor to the under-five and maternal mortality rate in the world, according to UNICEF. This is a human tragedy. Hospitals have no drugs to treat common ailments. Where health services are available, they are expensive.
The rich escape abroad to treat themselves. Medical tourism, especially to India, costs Nigeria $1 billion annually, says Osagie Ehanire, the Minister of State (Health). This is absurd. But the NMA itself is an integral part of the crisis. It embarks on frequent strikes and squabbles repeatedly with other health professionals over positions in public health institutions. State and local governments are as cavalierly as the Federal Government. They have abandoned primary health care, an area that constitutes a viable peg in Cuba’s globally-acclaimed health care system.
Nigeria, blessed with world-class medical professionals, needs to put pedal to the metal so as to fully capitalise on the potential of its citizens, who are performing medical feats overseas. One of them is Oluyinka Olutoye, a professor of paediatrics based in the United States. In 2016, Olutoye performed a groundbreaking surgery on a 23-week old foetus to remove a tumour and returned the foetus to the mother’s womb for full gestation.
To reverse the negative indices, the five-year strategic plan has to focus on the key areas, especially the shortage of personnel. According to the NMA, Nigeria, with a population of 170 million, has just 40,000 doctors, though 19,000 of them have migrated overseas. The Nursing and Midwifery Council of Nigeria says the country has 120,000 nurses. In comparison, Cuba (11 million pop.), had 70,594 doctors in 2005, says WHO. At 155:1, it has the lowest patient per doctor ratio in the world. According to the General Medical Council in the United Kingdom, there are 236,976 licensed doctors in that country, while the United States has 1,045,910 doctors.
Cuba rapidly multiplied its ranks of doctors from 6,000 after the 1959 revolution by empowering a system that graduated over 1,000 doctors annually. Conversely, the American health system depends on foreign doctors to augment its needs. In the 15 years to 2017, its Conrad 30J-1 waiver has channelled 15,000 foreign doctors to America.
Nigeria needs to prioritise the development of young quality medical doctors through a medley of right policies and sustained investment in their training. Along with the provision of infrastructure, medical professionals have to be incentivised to work in all parts of Nigeria. Like the UK, which funds its free health system through taxes, Nigeria should devise constructive ways of funding its health programmes. States and LGs should revive their abandoned primary health care system to reduce mortality in women and children.
