Tarred with the brush of underdevelopment, misfortunes are increasingly striking at the heart of Nigeria’s existence. In 2018, it expropriated the ignominious title of the global capital of extreme poverty. Rather than subside, worse misery has overtaken the country. A new report by UNICEF has just designated Nigeria as the new world capital of under-five deaths. This is damning. Humankind knows no greater tragedy than the death of a small child.
Our children are dying in their thousands, many of them to preventable deaths. This ill wind should not be underplayed or politicised by our shambling federal and state governments. They should revitalise their strategies and map out fresh ones to restore health to our vanishing children.
Around Nigeria, the statistics of children succumbing to death so early in life are grim. The situation is far worse in the North, where health services are almost nil in rural communities. The UNICEF report, entitled, ‘Levels and Trends in Child Mortality 2020’ heavily indicts government at levels, particularly because, in 2018, the World Bank had predicted that Nigeria would overtake India as the world capital of under-five deaths by 2021. Unfortunately, the acceleration to the nadir has been achieved two years earlier than projected.
That Nigeria keeps on emerging with the worst global indices is a poignant indicator of a failed state. Expressly, the report states that 2017 was the last year India had more under-five deaths than Nigeria. That year, India recorded an estimated 989,000 under-five deaths, and Nigeria 714,000 deaths.
Although India’s population is at least six times Nigeria’s, things turned dramatically after Nigeria hit 858,000 under-five deaths in 2019 while India ranked second with 824,000 deaths. Just five countries — Nigeria, India, Pakistan, the Democratic Republic of Congo and Ethiopia – account for 49 percent of the global figures, but Nigeria and India “alone account for almost a third,” the report states.
Ironically, as Nigeria’s oil wealth multiplied, the deaths are increasing. According to the report, Nigeria witnessed 209,000 neonatal deaths in 1990, but suffered an increase of 61,000 to 270,000 deaths in 2019. Child mortality is linked to multiple factors. Chiefly, poverty and absence of health facilities in rural communities impose home births on pregnant women. Up to 2003, two-thirds of births occurred at home, UNICEF said. Health professionals are few, antenatal drugs are expensive and hard to come by.
Other major causes of Nigeria’s high child mortality are neonatal tetanus, diarrhoea, malnutrition, malaria, and maternal anaemia. Malaria is virulent in the country, and it is very pricey for poor families to obtain treatment. All this has been aggravated by the onset of the coronavirus pandemic. The disease is tormenting the world with uncertainty when it would recede. It has thrown Nigeria’s shabby health system into a deep emergency. Therefore, the child mortality rate might spike significantly in the years ahead.
In an indication that Nigeria is being left behind, UNICEF says that the global under-five mortality rate reduced by almost 60 percent from 93 deaths per 1,000 live births in 1990 to 38 deaths in 2019. This is in stark contrast to Nigeria’s woeful figures. It portends great danger to the future of children in Nigeria, and it suggests that the country has yet to focus its energy on child development. UNICEF projects that if the trend continues, 53 countries, including Nigeria, will not meet the Sustainable Development Goal III target, part of which is the eradication of under-five mortality by 2030.
A bleak augury, Nigeria is now home to 105 million extremely poor citizens, the largest congregation of such people in the world, the World Poverty Clock latest data indicates. Before 2018, India owned that crown. The country was declared as the fourth most dangerous place on earth to give birth behind Sierra Leone, Central African Republic and Chad in 2018. It has just been certified free of wild poliovirus, an unwanted luggage it carried for years along with Afghanistan and Pakistan. In education, it is adjudged as having the highest number of out-of-school children in the world with a figure of 14 million.
Economic growth accounts for the falling rates of under-five death globally. With the economy in a spin arising primarily from weak policy choices and fading oil prices, these are difficult times, but the situation is not completely hopeless. In a landmark intervention, the World Health Organisation initiated the Alma-Ata 1978 Declaration to reverse the woeful health conditions around the world. Assented to by 134 countries and 67 NGOs, the declaration centred on building efficient health systems using “essential health care based on practical, scientifically sound and socially acceptable methods and technology.” To their credit, Cuba, Thailand, China and Mexico have excelled in the area of primary health care, using the Alma-Ata model.
Cuba’s PHC, the Rural Medical Service, is a global pride. It provides “disease prevention and to revitalise health services for those most in need, whether because they are poor, in precarious health or live far from urban centres,” the Cuban authorities said. The result is phenomenal: in 2004, there were seven deaths for every 1,000 under-five children – a decrease from 46 such deaths 40 years earlier, according to WHO. At 79 years, Cubans have one of the world’s highest life expectancies. The polyclinics serve between 30,000 and 60,000 people, offering services like rehabilitation, X-ray, ultrasound, emergency services, clinical laboratory, family planning, emergency dentistry, maternal–child care, immunisation, and diabetic and elderly care.
To reverse its own ugly trend, Nigeria should build on this. Nigeria was on this path when the late Olikoye Ransome-Kuti was the Minister of Health in the 1980s. The national PHC programme based on the Alma-Ata model he initiated was credited with achieving a high percentage of child immunisation. The state governments should quickly return to the PHC programme. There should be a pragmatic programme to train medical and auxiliary personnel who can man these PHCs, or at least offer first aid services to women in labour and sick children before they are transferred to secondary health institutions if need be.
In the absence of electricity in the rural communities, state governments should adopt reliable solar systems to power PHC centres to prevent essential drugs from damage and contamination.
Really, Nigeria’s problem is not a lack of policy frameworks. It is a signatory to the Abuja Declaration 2001, which emphasised the allocation of 15 percent of budgets to health. Here, implementation is the main drawback. The Federal Government should play its own part by giving grants to states to revitalise their PHCs, elevating the country’s precarious health indices. This could be like the Universal Basic Education system in which states access their grants by paying their counterpart funds and rendering financial accounts