It is a bit of good news that Nigeria’s health sector is finally getting some plausible attention. For pregnant women, under-five children and the elderly in the country that often die as a result of lack of basic health care, the new National Health Bill signed into law on December 9, 2014 by President Goodluck Jonathan offers a huge relief. These categories of people, the most vulnerable in the society, are to receive free basic health services under the scheme. That, at least, is the plan. The initiative is to be funded with one per cent deduction from the Consolidated Revenue Fund of the Federation.
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The National Primary Health Care Development Agency is correct when it says the law is a milestone towards achieving the Universal Health Coverage for all Nigerians. Other beneficiaries are people with disabilities, just as the law will guarantee the universal acceptance of accident victims in both public and private health institutions. There are 772 primary health care centres in the country that are badly funded, but would now be reactivated with improved funding and equipment under the policy. The NPHDA will hold 45 per cent of the fund, which it will disburse to states and the Federal Capital Territory, Abuja. The Act is a high-water mark for government involvement in primary health care system.
But the task is quite arduous. Infant mortality is very high in Nigeria, an awful national profile underscored by the 2,300 under-five children deaths that are recorded daily, according to UNICEF. These children are killed by preventable diseases like malaria, diarrhoea, measles and HIV/AIDS. Added to this is the high rate of maternal mortality. A Demographic Health Survey in 2013 found that Nigeria contributes about 13 per cent of global maternal mortality, with estimated 36,000 deaths annually. Included in the figure are 5,500 teenage mothers’ deaths in Jigawa, Katsina, Zamfara, Sokoto and Bauchi states. Unlike in Western societies, Nigeria does not run any social welfare programme for its senior citizens.
The absence of life-enhancing social mechanisms such as this resulted in the death of Olusa Ayodele, an 80-year old pensioner who died in 2011 in a pension verification queue in Ondo State. His son, Deji, who carried him on his back to a pensioners’ verification centre, where he collapsed, lamented, “My father was sick and this made it difficult for him to walk…When he started vomiting, I shouted for help, but there were no medical personnel on the ground to offer first aid treatment.”
Avoidable deaths like Ayodele’s define our primary health care system. Basic health care services, which fall under the duty schedule of local government councils, are no longer available as that third tier of government has collapsed completely. As a result, most Nigerians, especially those in the rural areas, have undiagnosed hypertension, diabetes, tuberculosis, malaria and other diseases, leading to complications, and eventual preventable deaths.
It is cheering that a positive change is in the offing if the NHA is properly implemented. Assessing the new policy against the backdrop of the prevailing condition, a former President, Nigerian Medical Association, Osahon Enabulele, said, “There will be improved funding of health care services at the grass roots so that people do not have to travel far to access medical services…The Act will reduce mortality among Nigerians who die because they don’t go to hospital when they are sick as they cannot afford to pay their bills.”
That is not all. Apart from those who would receive free treatment, the Act also curbs senior public officers’ use of public funds for treatment abroad, especially for ailments that can be treated locally. India is said to be making $260 million annually from Nigerian patients, while an estimated 5,000 persons travel out monthly for medical treatment, many of them public officers who do so at taxpayers’ expense. The Nigerian High Commissioner to India, Oyebola Kuku, while decrying this development, stated that 20,000 out of 25,000 Nigerians given visas in 2011 went there for medical care.
This, indeed, seems to be a giant stride in health care reforms. However, over the years, we have seen disjunctions between policy formulation and implementation, the bane of many good initiatives in the country. For instance, while some oil companies have not been paying the 3 per cent of their budget as required by law for the operations of the Niger Delta Development Commission, the Federal Government also owes about N500 billion to the agency, thereby subverting the objectives for which it was set up. Similar infidelity to the Acts that established Ecological Fund, Natural Resource Fund and National Stabilisation accounts has made a nonsense of the goals that informed their creation.
Children are the future; but if Nigeria is the ninth out of the worst 10 in under-five mortality rankings of 194 countries in 2014 by UNICEF, then our future is behind us. Only Sierra Leone, Angola, Chad, Somalia Democratic Republic of Congo, Central African Republic, Guinea-Bissau, Mali – all from Africa – are worse off. Daunting as the challenge is, it should not cause health authorities to lose too much sleep. All that it takes is total commitment to the execution of the Act by all and sundry. For the NHA to be different, therefore, all tiers of government involved in executing it must see it as a serious national challenge.
