Ensuring Effective, Qualitative, Affordable and Accessible Health Care for All Nigerians Beyond 2007

by Felix-Abrahams Obi

The Nigerian National Health Conference 2006 was well attended, with over 400
participants that represented health stakeholders from within and outside Nigeria,
including The Presidency, National Assembly, State and Local Governments and their
agencies, Federal and States Ministries of Health and other line Ministries, Policy
makers, Community leaders, Traditional leaders, The United Nations System/WHO,
Development Partners, Professional organizations, Civil Society Organizations (CSOs),
Parastatals and institutions, Health care financiers, Health care providers, Facility owners,
Nigerians in the Diaspora, Pharmaceutical manufacturers/suppliers and clients/patients.
Government’s responsibility for health is shared between the three tiers of government
without any clear legal division as to who does what.

Primary Health Care is much more effective than hospital-based care in preventing and
treating 90% of health problems, and yet it has been allowed to collapse in most of
Nigeria. In 2000 the World Health Organization ranked the Nigerian health system in 187th place out of 191 countries evaluated.

According to UNDP, life expectancy in Nigeria has declined to 43 years (2006) from 47
in 1990. In contrast life expectancy in Malaysia, which attained nationhood at the same
time as Nigeria, has now reached 70 years.

Over 50,000 Nigerian women die from child birth every year (equivalent to a plane
carrying 140 people crashing every single day)

One in five Nigerian children will die before his/her 5th birthday. About a million
Nigerian children die of preventable causes every year.

Only 18% of Nigerian children are fully immunized by their first birthday.

Malaria kills more Nigerians than any other disease, and yet less than 5% of the
population uses insecticide treated nets that are proven to be effective in preventing

The Nigerian Government at all levels spends less than 5% of public expenditure on
health, despite being signatory to the 2000 Abuja Declaration to increase this to 15%.
In 2004 the current civilian regime launched an ambitious programme of “Health Sector
Reform”. This is designed to reform the national health system and thereby improve the
health status of all Nigerians.

There is a draft National Health Bill before the National Assembly, which is yet to be
passed. This defines the roles and responsibilities of tiers of government, establishes a
fund for Primary Health Care, and sets out a minimum package of health for all citizens.
The Federal Government has increased its spending on health, and in 2006 the largest
allocation of savings gained from debt relief was allocated to the health sector. A few
State Governments have increased their allocations to health. Many have not.

The conference observed that the Nigerian health system is in a deplorable stage and the
performance is very poor to the extent that some Nigerians seek for health care abroad;
The Nigerian Health System is dysfunctional and grossly under-funded with per
capita expenditure of US$9.44 on health (World Bank, 2005) as a result of which Nigeria
still has one of the worst health indices in the world and sadly accounts for 10% of the
world’s maternal deaths in child birth whereas the country represents 2% of the world
population, as at year 2000;

The national health management information system is still weak and without an integrated system for disease surveillance, prevention and management;

Nigeria trains and develops human resources for health, but loses them to other sectors
within the country and abroad due to relatively higher remuneration, welfare and
motivation packages; in addition to the negative attitude of most Health workers which
discourages access to health services and reflect their non-accountability to duties and
funds/equipment committed to their care;

There is a loud disconnect between policy making process, research activities and
ownership of research agenda by key stakeholders;

Road traffic accidents and violence are other challenges to the health system.


1. The conference commended the effort of the Federal Government in implementing
comprehensive reforms in the Nigerian Health Sector particularly on enhancing
stewardship role of government, improving access to qualitative and affordable health
services and strengthening public private partnership in health care delivery.

2. National Assembly should pass the National Health Act before end of February 2007.

3. All political parties should commit themselves to implementing the provision of the
National Health Act if voted into power.

4. Nigeria should increase her per capita spending in health from 9.44 USD to at least 34
USD as recommended by the World Health Organisation [WHO]. Towards this, all levels
of governments, Federal, State and local should increase budgetary allocation to Health to
at least 15% and publish such budget.

5. There is need to have in place a special system of social welfare focusing on providing
safety nets and free medical services for the disadvantaged or vulnerable groups in
Nigeria including pregnant women, children under 5 years of age, the aged and poor
(persons living on less than US$1.00 daily) should be instituted;

6. The National Health Insurance Scheme should expand coverage to more persons in the
rural and urban centers; while incentives should be provided to promote not-for-profit
and community-based insurance schemes; because despite the progress made, there is
still much to be done especially by states and local governments.

7. Government at all levels should address social issues affecting health; these include
poverty alleviation, women empowerment and education (particularly girl child
education), employment and elimination of corruption.

8. Government should take steps to improve the motivation, training and retention of her
health workforce.

9. Existing health facilities should be equipped and well-managed, rather than build new
ones in the same or close locations;

10. Communities should institute processes that will require elected officers to account
for their stewardship especially in the area of health care funding while communities also
participate in community health insurance scheme.

11. Institutional framework should be created to feed the products of research institutes to
the pharmaceutical companies and other potential consumers/clients, by inaugurating a
committee consisting of all research and product control agencies;

12. Appropriate policy and legislative measures should be taken to control and manage
road traffic accidents and other violence, to the barest minimum; while communities
should institute processes that will require elected officers to account for their
Ensuring Effective, Qualitative, Affordable and Accessible Health Care for All Nigerians Beyond 2007 stewardship especially in the area of health care funding while community also participate in community health insurance scheme.

In view of the above we would like to reiterate that we need to collectively take it upon
ourselves to carry out the following actions individually and collectively, so as to ensure
better health for all Nigerians beyond 2007. We have categorized here the following
envisaged actions

– Policy makers should ensure that policies are designed to respond to the
deplorable health status of Nigerian with the view of reducing the disease burden
in the country
– Members of the National Assembly follow up and ensure the passage of the
National Health Act before end of February 2007.
– All levels of government should implement the Health Act

– Should ensure continues advocacy towards increasing budgetary allocation to
health by all governments to at least 15%
– Advocate to elected officers to account for their stewardship especially in the area
of health care funding

– Individuals at community level should ensure that electoral candidates reflect
health in the manifesto of their political parties
– Individuals at community levels should demand to know what health services
should be provided to them by their leaders
– To participate in the health insurance scheme
– Individuals should live a healthy and positive live by promoting and sustaining
their health and preventing themselves from preventable diseases.

BE A NEW NIGERIAN. Go on with the health reform – www.herfon.org, info@herfon.org, 09-4618496, 08033581695

…Better Health for All Nigerians

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