Among the myriad problems that President Bola Tinubu inherits are the terribly dysfunctional health and education sectors. To describe them as a mess is an understatement. Although his inaugural speech was silent on these two critical sectors, his manifesto sets out an ambitious desire to transform the education sector, reform the health care delivery system and guarantee access to health services to all citizens. He will need to bring considerable skills, doggedness and effective policies to bear to fulfil these promises.
Tinubu advertises Nigeria’s broken health system. Like his predecessor, Muhammadu Buhari, he relies on foreign medical facilities for his own health care needs. Shamelessly, Nigeria’s leaders at every level jet abroad for theirs and their families’ health care. Buhari spent a cumulative 225 days on medical tourism in his eight years in office, according to Saturday PUNCH. Umaru Yar’Adua spent the greater part of the three years as president in German and Saudi Arabian hospitals before dying in office in 2010.
Tinubu had also been flitting in and out of the country for medical care ahead of his inauguration. Worse, also like his predecessors, he and his aides refuse to come clean with Nigerians on his health status. He should break sharply with such embarrassing behaviour by resolving to build first-rate hospitals and a national health care system that will obviate the need to seek care abroad. Findings by The PUNCH revealed that Nigerians spent $3 billion on medical tourism between 2020 and 2022.
The same applies to the education sector. Nigeria’s leaders at federal, state and local government levels have demonstrated their loss of faith in the country’s public educational system. Having ruined the public education system, they send their own children to exclusive preparatory, primary and secondary schools in the country. They thereafter send them abroad for higher education. Again, without shame, they regale Nigerians with photographs of their children matriculating or graduating in foreign institutions. Tinubu must reverse this trend. Development is accelerated by leaders determined to replicate the modernity they observed in other countries at home. But Nigeria’s public office holders simply do not care.
The disrepair in public hospitals, ill-motivated health workers and decrepit equipment have increased the appeal of overseas medical trips. Governments at all levels have refused to fix the problems.
Medical personnel are leaving in droves. The UK General Medical Council licensed at least 200 Nigerian-trained doctors between August 31 and September 30, 2022. Its data further indicated that 10,096 Nigerian-trained doctors moved to the UK 2015-2023. Nurses are not left out: 7,256 Nigerian-trained nurses relocated to the UK between March 2021 and March 2022, according to the UK Nursing and Midwifery Council.
Rather than confront the mess through adequate funding, equipping and motivation of personnel, and engagement with critical stakeholders, the government and the National Assembly chase shadows. The House of Representatives hurriedly proposed a draconian bill to amend the Medical and Dental Council of Nigeria Act to deny Nigerian-trained medical and dental medicine practitioners being fully licensed until they have worked for a minimum of five years in the country. The bill, which stakeholders say amounts to an exercise in futility, is a distraction; the sector needs radical reform to serve Nigerians and retain manpower.
Tinubu should tackle the rot headlong. His manifesto rightly acknowledges access to healthcare as a fundamental human right “and a matter of long-term national security.” It declares an intention to pursue reforms and policies “defined by the concept of Universal Health Coverage,” and through this, provide universal coverage, create jobs and reinvigorate the economy. That is the way to go.
Cuba has proved to the world that a country does not have to be rich to build an efficient healthcare delivery system. Its three-tiered structure of primary, secondary, and tertiary care is regarded as the world’s best and is recommended for developing economies by the World Health Organisation.
He should end public funding of medical tourism for public office holders. This requires building a sustainable and strong health care system through the provision of facilities and substantial funding. The administration’s mandate should focus on a patient-centred and motivated workforce. He should ensure accessible, quality and efficient health services with buy-in from state governments. Many Nigerians are dying from common diseases because they cannot afford the cost of treatment.
The state of primary health centres across states compounds the challenges with their lack of manpower, facilities, drugs, and rundown structures. They should be fully equipped in communities to reduce mortality rates and improve Nigeria’s health indices. The WHO states, “Primary health care enables health systems to support a person’s health needs–from health promotion to disease prevention, treatment, rehabilitation, palliative and more.”
Tinubu needs to end perennial strikes by health workers by engaging honestly with them. A Saturday PUNCH report found that the numerous strikes by the National Association of Resident Doctors cost about 128 working days lost between 2016 and 2023. The doctors are seeking better working conditions and improved funding of the health care system.
The brain drain in the sector is disconcerting and Tinubu must stem the tide. The Nigerian Medical Association said only 24,000 licensed physicians currently cater to the over 200 million population in the country. This negates the WHO minimum threshold that a country needs a mix of 23 doctors, nurses, and midwives per 10,000 population.
Nigeria depends heavily on foreign drug manufacturers for its medical needs. For instance, Foreign Trade Statistics by the National Bureau of Statistics revealed that the country imported anti-malarial drugs worth N65.98 billion in the third quarter of 2021, and N43.47 billion in Q4 of the same year. The Tinubu administration must implement measures to stimulate local drug manufacturing capacity.
The challenges in the education sector are also legion. From inadequate funding, brain drain, inadequate research, and infrastructure decay to incessant strikes by the Academic Staff Union of Universities and other unions, education wobbles.
A United Nations Children Emergency Fund report in 2022 said Nigeria accounts for approximately 20.2 million out-of-school children, the second highest number of unschooled children globally after India. The situation is blamed on insecurity, poverty, displacement, street hawking, and excessive childbearing, among others. These issues must be addressed with allied partners, including community and religious leaders in the North, where the problem is most commonplace.
The current administration should convene an education summit involving states since education is on the Concurrent List to engender quality and relevance in the country’s education space. States and local governments should be roused to entirely drive primary and secondary education as they have embarrassingly abdicated this responsibility. NEEDS assessments should be conducted to identify key needs and ways to address them.
The broad objectives set out in Tinubu’s manifesto promise reforms focused on quality access, funding management, effectiveness, and competitiveness. It highlights improvements across the board and investment in infrastructure in educational institutions, including improved access to ICT by learners and the reintroduction of student loans.
Hopefully, these should not be mere empty documents to be promptly dumped on assuming office as all political parties in the Fourth Republic have done.
The national curriculum should be reviewed to reflect global learning and real-world issues. Competent education ministers must be appointed. The era of putting square pegs in round holes as a political reward should cease. Garrulous, mediocre, and incompetent individuals have no place in education, the bedrock of serious nations keen on growth and development stimulation.
Nigeria has higher institutions it cannot fund; yet federal lawmakers keep approving new ones. There are 49 federal, 59 state and 111 private universities in the country according to the NUC; 40 federal, 49 state and 76 private polytechnics; 17 private, 70 federal and state-owned colleges of health with 219 colleges of education. These are in addition to specialised institutions established with ridiculously low take-off grants. In 2021, four additional universities took off with a combined grant of N18 billion.
Past governments have been unable to meet the UNESCO benchmark for funding, which recommends governments spend between four per cent and six per cent of GDP on education, and an adequate percentage of national budgets. There should be a moratorium on new federal higher institutions as the government does not have the financial or personnel wherewithal to run the existing ones
Tinubu’s campaign and initial pronouncements have been uncomfortably silent on the decades-old FG/ASUU stand-off. Yet, the unresolved agreements and the ensuing endless ASUU strikes have been the main issues in Nigeria’s tertiary education system for two decades. He should resolve to end the crisis. Cumulatively, the university system has lost several semesters, the academic calendar has been disrupted, quality compromised, and many dons have left the system, some relocating abroad.
The issues of allowances, revitalisation of public universities, transparency and accountability, among many others, should be finally addressed within the government’s financial means and capacity. Agreements must be honoured.
Decay, crises and dysfunction reign in the education and health sectors. Successive administrations came, saw and all, without exception, left them in even worse shape than they met them.
Tinubu should break the mould and breathe life into these two important areas of national life.
