Criminally underfunded and almost completely neglected, Nigeria’s health care delivery system is in a shambles. But the extent of the mess may not be so obvious to many, which is why experts have to weigh in with their opinions from time to time. This is what Babatunde Okunola, a World Health Organisation Senior Health Specialist, attempted to do recently when he gave the bitter verdict that only four per cent of Nigerians have access to quality health care without facing financial difficulty.
It can indeed be disquieting, considering the sheer number of people that make up the remaining 96 per cent that have been inexcusably excluded from the universal health coverage. In a country with a population of about 193 million people, according to National Bureau of Statistics figures, it means that about 185.3 million Nigerians are denied access to quality health care. This is mindboggling and, perhaps, the reason why Nigeria has recorded minimal success in tackling various health-related challenges, including disease control and eradication, rehabilitation, treatment, infant and maternal mortality and primary health care.
This has ended up driving people into taking up options such as embracing quacks or embarking on self-medication. As a signatory to the Alma Ata Declaration of 1978, Nigeria owes her citizens the right to quality and affordable health care, which should not in any way expose beneficiaries to poverty. However, what obtains in Nigeria is anything but equity in access to health services; in some cases, only the rich can access health care.
It is not surprising that simple ailments are sometimes poorly managed until victims develop complications before they are taken to the hospital. This is especially so among those who cannot cope with the rising cost of treatment. It is so serious that people are sometimes detained at hospitals after they must have completed their treatment and attained full recovery, because they cannot afford to pay their bills. In many cases, lives have been lost because patients are asked to deposit huge sums of money, which they cannot afford, before accessing treatment.
In some other situations, such as in the rural areas, health facilities are virtually non-existent, not even the primary health care facilities, which are supposed to be present in every local government area. As the first level of contact citizens should have with the country’s health care system, a PHC is supposed to be the fulcrum of Nigeria’s entire health system. That is what the late Olikoye Ransome-Kuti tried to promote as the Minister of Health. Unfortunately, everything he built then now lies in ruins.
That is why, for those who are in a more financially comfortable position, the preference is to fly abroad at the slightest sign of any ailment. For instance, a former state governor, who boasted that he had built a world-class medical facility in his state, did not think twice before hopping on the next available plane to seek treatment abroad after sustaining a minor injury in a road accident. President Muhammadu Buhari also spent over 100 days in London, where he received medical care when he took ill shortly after assuming office. To the chagrin of many Nigerians, it was also revealed that the State House clinic was poorly equipped, despite the millions voted for it in the yearly budgets.
Accessing medical treatment abroad, however, comes at great cost. A former President of the Nigerian Medical Association, Osahon Enabulele, once estimated that Nigeria was losing $1 billion annually to medical tourism, with India as the most preferred destination. This is money that could have been invested in the upgrade of medical facilities in the country. It is baffling to note, for instance, that, in 2015, Nigeria had only seven radiotherapy machines, out of which only two were functional, despite the fact that cancer has become one of the leading killers in the country.
Yet, for Nigeria to stand tall in the comity of nations, she cannot afford to ignore the UHC because of the relevance of the health of the citizens in nation building and development. WHO says, “Good health is essential to sustained economic and social development.” Access to good health is also vital to poverty reduction, which is why it has become a major priority objective for WHO.
It, therefore, goes without saying that reforming the Nigerian health sector is long overdue. It is already commendable that one per cent of the consolidated revenue of the Federal Government for the funding of health was incorporated in the 2018 budget. But a lot more still has to be done to change the ugly face of the Nigerian health system. For instance, coverage for the National Health Insurance Scheme should be widened to include more Nigerians.
The Minister of Health, Isaac Adewole, was quoted recently as saying that 95 per cent of Nigerians were not enrolled in any health insurance plan. This is outrageous and goes a long way to confirm Okunola’s assertion about Nigeria. The country needs to go back to the promotion of PHC as the foundation of her health care system. With a sound PHC in place, the burden on the secondary and tertiary levels will surely be reduced. Most importantly, tackling the health crisis is not an exclusive burden for the Federal Government, but involves both the states and local governments.
In the United States, for example, health is so important that it is always an election issue. It has been such that since Donald Trump became the US President, he has dissipated so much energy to roll back Obamacare, the signature health programme of his predecessor, Barack Obama, which tried to cover as many people as possible in health care provision.
This is because a country like the US understands the value of health to the development of its society. Unfortunately, no candidate in the current electioneering has told Nigerians their plan for the health sector. That is not good enough.
