Many more Nigerians are falling victim to the systemic rot in the country’s health sector. Inexcusably, hospitals are grossly inadequate, poorly equipped and underfunded. With an acute shortage of personnel, the hope that the sick will get a relief soon is faint. In an investigative series that resonated with the grief-stricken majority, this newspaper has freshly exposed the crisis in the sector in microscopic detail. Unfortunately, for the health authorities and government at all levels, it is business as usual. It should not be so.
Like many African countries, Nigeria has a gnawing deficiency in the area of medical doctors. The Medical and Dental Council of Nigeria states that only 72,000 doctors are registered here. The catch is that because of dire work conditions, over half of them have emigrated overseas. Consequently, local hospitals are shorthanded. The Minister of Health, Isaac Adewole, estimates that one doctor attends to between 5,000 and 6,000 patients. This is disastrous. For optimal health care delivery, the World Health Organisation recommends a doctor/patient ratio of 1:600 for every country.
In this merciless environment, patients wait endlessly in queues to see a doctor, no matter how critical their illness might be. Bed spaces are so insufficient that the sick are made to sleep on the bare floor in hospitals. A concerned father, whose son was admitted at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, said, “Mosquitoes bit my son to the extent that parts of his body were swollen. The electric fans there are not working. In that hospital, if you go there, you may end up dying…” This is double jeopardy.
The crisis is accentuated by the near-collapse of the primary health care system. In the 1960s and 1970s, the primary and secondary healthcare centres catered for many categories of illnesses. These facilities are currently in a shabby state, with many of them having been abandoned altogether. The few health personnel attached to them prefer to work in the urban centres, leaving the rural areas bereft of attention. In contrast, Cuba built its thriving system on primary healthcare.
But the failure of the primary healthcare system in Nigeria is principally why there is a rush to get treatment at the tertiary health institutions. With a population estimated at 201 million by the UN, it is obvious that the country’s 21 federal teaching hospitals cannot cope with the surge. They lack basic amenities like potable water and electricity. In the three years to 2019, the total combined budgetary allocation by the Federal Government to its teaching hospitals was N475.3 billion — N140.68 billion in 2017; N158.24 billion in 2018 and N176.45 billion in 2019.
This is depressing. The Obafemi Awolowo University Teaching Hospital, Ile-Ife, receives a statutory monthly allocation of N8 million, but it pays N13 million monthly for electricity to the Ibadan Electricity Distribution Company. It also spends N5 million monthly to buy diesel for its generators. The OAUTHC cannot open two children’s wards because of staff shortage. Likewise, the University of Nigeria Teaching Hospital, Enugu, which is plagued by water scarcity and insecurity, spends N18 million monthly on electricity, but receives just N5.5 million; the Jos University Teaching Hospital cannot afford an electro-convulsive therapy machine and the University of Benin Teaching Hospital is sorely overcrowded. According to these institutions, they are surviving at the mercy of local and international donors, alumni and philanthropists.
Consequently, Nigerians escape overseas for medical tourism. President Muhammadu Buhari, whose vantage position saddles him with the task of providing a radical solution, jets overseas for medical treatment. As of May 2018, he had spent a combination of 170 days for medical tourism in the United Kingdom, despite his initial vow that government resources would not be available to public officials for such indiscretions.
It is a reflection of the sordid state of Nigeria’s health indices. As President, Umaru Yar’Adua was brought home nearly dead from a Saudi Arabia hospital in 2010, having also received treatment in German hospitals. Former Vice-President, Namadi Sambo, and former and sitting governors had many times embarked on medical tourism. The Nigerian treasury is the poorer for it.
According to the Nigerian Medical Association, Nigerians shell out as much as $1 billion annually for medical tourism, particularly to India, the United States and the Middle East. In April, Buhari put the loss to medical tourism at N400 billion annually. Comparatively, the Federal Government budgeted N340.45 billion or 3.9 percent for the Health Ministry in 2018. At that rate, it translated to N1,888 per citizen annually.
So, what is the way forward? First, the primary health care system has to be resuscitated. All the dispensaries and health centres should be rehabilitated to treat cases of fever, inoculation, wounds, ante- and post-natal care and other ailments. The state and local governments should revive and add more secondary hospitals. This will save the tertiary hospitals from their current troubles. Through its Health for All programme launched in conjunction with WHO, China radically targeted 900 million of its rural population, the Chinese Communist Party said. Since 1949, the Chinese health system has grown to 209,000 medical and health institutions, 2.6 million hospital beds, 4.9 million medical and health workers. This way, diseases such as cholera and smallpox have been eliminated. Cuba, which the WHO regards highly, is reputed for its efficient primary healthcare system.
Nigeria has to train more doctors and other health professionals. Governments should devote more resources to the training of doctors and provide equipment for them to work with. By motivating them in a work environment that is conducive, they are less likely to emigrate overseas. Eventually, government officials should be barred from using public resources for overseas medical trips.
