Nigerian Healthcare System: A Ticking Time Bomb

At the International Health Conference, New York, (19 June – 22 July 1946); an harmonized all-encompassing definition of ‘health’ was postulated, accepted and signed on 22 July 1946 by the representatives of the 61- member states of the World Health Organization (Official Records of the World Health Organization, no. 2, p. 100) and enforced on 7 April 1948. The pact defined health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity as widely assumed. And till date, this definition holds sway as the hallmark and foundational basis of all health systems in most regions of the world.

Apart from the WHO whose major role as an offshoot of the United Nations is to ensure that member countries have closely monitored health sectors, and that health episodes of intra and international epidemiologic interests are well documented, individual countries also have central roles to play in ensuring that their citizens are healthy. According to protagonists of medical history, the most viable and far-reaching effective National Health Programme is the one that encompasses the primary, secondary and tertiary tiers of government, and health infrastructures. This is the type we have in Nigeria.

Rais Akhtar in one of his numerous publications reiterated the fact that the Nigerian federal government’s role in health in recent years has been limited (restricted) to coordinating the affairs of the federal university teaching hospitals and medical centers, NAFDAC and other health- related agencies, while individual state government, through respective hospital management boards, manages the various general hospitals. The local governments in Nigeria on the other hand regulate the activities of dispensaries, pharmacies, community health centers, local maternity clinics and more recently, traditional healing homes.

In Ronald J. Vogel’s book—Financing Healthcare in Sub-Saharan Africa—Nigeria’s total expenditure on healthcare as a percentage of GDP was put at 4.6, while the percentage of federal government’s total expenditure on healthcare was (and still) a miserly paltry 1.5% when juxtaposed with the nation’s official (and muted) population size, enormous health challenges like the incessant ethnic uproars and disease-predisposing religious crisis up north. The nation is also groping with illiteracy, endemic malaria, ravaging HIV, astronomic population upsurge indicating the imminent need for improved birth control, poliomyelitis, drug adulterations (fake drugs) and several other Proudly Nigeria health-related debacles which point to the fact that very soon, if something urgent is not swiftly done, danger looms at all levels.

At the state level, the dividend of democracy—politicization of the administration and running of state-owned health institutions—spells great doom. Unlike past years when duly and ably qualified health professionals were at the helm of affairs at the General Hospitals, it is gradually becoming a familiar scenario, especially in South Western Nigeria, for opulent potbellied politicians to parade themselves as heads of the Hospital Management Board (HMB). Apart from the possibility of funds meant for the development of the state’s health sector growing wings or being used for a wrong cause, the yardstick with which the success or otherwise of the health sector is measured is gradually transmogrifying from the reputed overall assessment of the health of the citizens and residents, to the number of contracts awarded by the government. Oyo state is a good case study.

On its official website (www.oyostate.gov.ng), the state government’s webmaster highlighted the following state government pioneered projects as a sign that its health sector is vibrant.

• Hospital Equipment worth 70million naira was procured by the Ministry of Health to Government hospitals in the year 2007.

• Essential drugs and consumables worth N52million were procured during the period. Contracts for the supply of Essential Drugs and consumables worth 298 million naira were also awarded to contractors in December, 2008.

• Commissioning of Health facilities, namely Cold Chain Laboratory, Eleyele, Primary Health Center, Odo-Oba, Ogo Oluwa Local Government, Butubutu, Ona-Ara Local Government and Primary Health Center, Ogbooro, Saki East Local Government.

• Construction of General Hospital, Iwere-Ile, Iwajowa Local Government is almost completed and will be ready for commissioning soon.

• Three buses were procured by Health System Development Project II [HSDP-II] for Health Institutions, namely schools of Midwifery, Nursing and Hygiene.

• Two other vehicles were procured by HSDP-II for Projects Monitoring.

• Several others

While these projects and undertakings are quite laudable, they are however inconsequential and of little significance in proving that every resident of Oyo state is healthy— physically, mentally and socially. Recent health indices give a clearer picture of the current status of the state’s health sector.

According to a recent edition of WHO Bulletin, the state still has a high incidence of poliomyelitis (a viral disease that has been declared extinct in most countries of the world). Furthermore, mental illness in Oyo state has escalated to the level that if INEC does a thorough job and fairness is ensured, mad men and women can now contest and win elections in the state. And socially, the health status of Oyo state indigenes and residents couldn’t be worse.

Social welfare services provided by the state are literally non existent, yet the state, like most Nigerian state governments, spends hundreds of millions of Naira absurdly publicizing procured equipment, renovated hospital infrastructures, free condoms, and prompt payment of health workers’ salaries as indications that the state’s Ministry of Health is healthy. The ravaging misplaced priority has also been extended to the grassroots—the primary healthcare—where the local governments had lost the confidence of the local communities.

Sometimes ago, I was at Alade Orthopeadic Hospital in Oke Adu Area of Agodi Gate, Ibadan where the owner—Dr. Moruf Alade—was happily having a busy day seeing to the health needs of his patients who religiously and astutely followed the expensive esoteric treatment regimens. While at the clinic, I coincidentally saw Egbeda Local Government’s Mobile Clinic drive by. Unlike what is expected of an ambulance, the automobile was packed full with bananas, plantains and other perishable edibles.

Nowadays, sick citizens that can afford private services are gradually not seeing government-owned primary health centers as reliable clinics to get treatment when sick. In the same vein, privately owned motherless babies homes like the one in Total Garden, Ibadan, and Red Cross Home for the Motherless situated at Warehouse, Hospital Road Owerri, now enjoy more patronage than respective State Child Welfare Units which are fast becoming CICS offices where social workers lend and borrow money at will.

Local government chairmen nowadays are enthralled by the pictures of established health centers which would be used for canvassing for votes at the polls, and not actually meeting the health needs of the host communities. Little wonder that few months after the glamorous opening ceremony, thorns and bushes encroach on the new clinic while rats and termites become the attending patients of the drug-deprived, poorly lit and deserted Local Government Health Center. Good examples are some health centers found in Ibadan North East, Ogun Waterside and Isiala Mbano L

ocal Government Areas of Oyo, Ogun and Imo states respectively. The National Primary Healthcare Development Agency (NPHCDA)—the agency responsible for the regulation and establishment of primary healthcare centers—is also haplessly helpless in the discharge of its saddled responsibilities of ensuring that our primary healthcare centers cater for our primary health needs.

According to the Organogram for the New NPHCDA Agency (NPHCDA & NPI Merged) V 2.1 – Post Lokoja Workshop, the purpose of the agency that has now been merged with the National Programme on Immunization (NPI) is to ensure the development of primary healthcare system through advocacy, social mobilization, resource mobilization, community ownership, capacity building and development of effective managerial processes. However, apart from hefty monthly salaries, a visit to the agency’s South West office in Agodi GRA in Ibadan would attest to the fact that the agency’s workers still have a lot to learn about their work mandate, and are working at a sickening slow snail speed. While they are learning, the pressure of the failure of the Nigerian primary healthcare has shifted to other tiers- the secondary and tertiary health sectors.

Presently, the only evident difference in the services rendered by these two tiers are the medical trainings—undergraduate and postgraduate—offered by the tertiary health institutions, and what remains of our extensively eroded health referral system. In Ibadan for instance, both UCH (a tertiary health institution) and Adeoyo General Hospital (a secondary health facility) treat secondary wounds, deliver babies, give immunizations and vaccinations (duties of primary health centers), operate HIV clinics, carry out minor and major surgeries, and train medical and paramedical staffs. Nigeria’s emergency medical practices and wards also point to the fact that our health system is in disarray.

The entropy (degree of disturbance and disorderliness) is highest in our tertiary health facilities where patients with minor cases that are treatable with a salt-sugar solution mixture compete for medical attention with those presenting with medical conditions that could only be treated at the prestigious King Fasai Medical Center in Saudi Arabia.

It’s only in Nigeria that a 911 dial gives a number-not-in-use response. Our various governments claim to have procured ambulances, yet no citizen knows how to contact them when in dire need. It’s therefore an expected aftermath that Nigeria, despite its enormous oil wealth, has one of the highest emergency mortality rates in world history. Even Mozambique and Tanzania fair better than the self acclaimed giant of Africa!

No thanks to the lackadaisical attitudes of those at the top, these shortcomings, as bad as they are, are nothing when compared with associated dangers of the numerous accesses that are now available to terrorists, and anyone with harmful intentions.

According to the Atlanta based US’ Centers for Disease Control and Prevention (CDC), a bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. The agents used are ubiquitous and are widely found in nature, but could be transformed to increase their viability and ability to cause disease (e.g. botulinum toxin), drug resistant (e.g. XDR-TB), or to increase their ability to be spread into the environment (e.g. anthrax). Air, water and food are common routes of spread.
Any terrorist with scores to settle with the Nigerian government or a desperate politician who can pay a medical scientist may produce biological agents that are extremely difficult to detect.

Globally, bioterrorism is fast becoming an attractive weapon because biological agents are relatively easy and inexpensive to obtain or produce. They can be easily disseminated, and can cause widespread fear and panic beyond the actual physical damage they can cause. Politicians too are gradually seeing bioterrorism as a potential tool in ensuring victory at the polls. This has been used in God’s own country—the USA.

According to a Wikipedia article, in 1984, followers of the Bhagwan Shree Rajneesh attempted to control a local election by incapacitating the local population. This was done by infecting salad bars in eleven restaurants, produce in grocery stores, doorknobs, and other public domains with Salmonella typhimurium bacteria in the city of The Dalles, Oregon. The attack infected 751 people with severe food poisoning.

In Nigeria where dangerous arms proliferation goes unabated, weaponization and dissemination of agents like small pox, anthrax, botulinum toxin, bubonic plague, and several others are but a piece of cake. The fatality of such would be as a result of our popular synonyms- executive nonchalance, cantankerous corruption, poor planning and very late response.

Biosurveillance, early detection and rapid response are the keys to combating bioterrorism. These involve a close cooperation among doctors, medical laboratory scientists, epidemiologists, security agencies, and a working healthcare system. With political agitations and confrontations coming from all fronts, it is not a white elephant project for Nigerian government to start putting its health house in order to prevent sacrificing the lives of innocent Nigerians on the altar of peculiar ignorance, professional inertia and political insanity.

As a matter of urgency, governments at all levels should remove the health sector from their political reach and allow the health system to be run by the experts. The experts should also collaborate with the brilliant minds at the ivory tower to fortify our health boundaries against adverse medical invasions and importation of foreign diseases as experienced with the report, few years ago, of Asian avian influenza in Lagos and other states of the federation.

A complete overhaul of the Nigerian healthcare workforce is long overdue as the system is presently footing the bills of numerous ghost workers and wrong workers. The government needs to sort this out to ensure that our medical facilities are manned by qualified and experienced professionals that would ensure the good health of the sick patients and patient healthy citizens.

Since our traditional health practitioners are quite numerous and currently enjoy the patronage and trust of a large proportion of the sick population, the Nigerian Ministry of Health needs to incorporate the alternative health practitioners as primary healthcare providers, and closely monitor their activities and not act, like NAFDAC numbers, as an official rubber stamp for all shady activities and esoteric procedures.

There is also the need for the National Primary Healthcare Development Agency (NPHCDA) to go back to its situation rooms and drawing boards after awakening from its perpetual slumber. The nation is in dire need of a rejuvenating and reinvigorating programme that would revitalize our sick primary healthcare and equip our local clinics with required facilities and resources (human and otherwise) to regain the long lost confidence of grassroots’ healthcare seekers.

The age long professional bias in the Nigerian health system is another clog in the wheel of the progress of the sector. The administration at all levels should be unfaltering, just and fair in ensuring that this is permanently removed, and compel health professionals to see contemporaries as colleagues, and not competitors or enemies.
The NHIS’ current shape is shameful hence an understudy of the UK’s NHS and US’ Medicaid is suggested as this would enable Nigerian health insurance policy formulators to have an idea of

how national health insurance should be operated with the interest of care seekers, and not care providers, at heart. If Guilder and other beer brands could get to every corner of the nation, health insurance policies should.

There is an urgent need for meaningful health campaigns aimed at informing and attracting citizens to government health facilities. At government hospitals, healthcare seekers should be treated with courtesy, confidentiality and mutual respect that are accorded law abiding citizens of the nation by the Nigerian Constitution.

The frequent sojourns of Nigerian leaders abroad in search of quality treatment for minor ailments connote more doom for our already disarrayed health sector than a bioterrorist’s anthrax threat hence such travels should be stopped. If government officials are satisfied with, and could boast of the quality of healthcare they’ve put in place at our various health institutions, they should be confident enough to fell asleep under the influence of anesthesia in our hospitals without any doubt on their minds.

Whichever way we choose to progress, let’s have it on the back of our minds that time is fast running out. Sooner or later, the only thing that would be safe is our last breath because the next, might actually be the last.

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