The cost of life

What is the cost of life to human creation? Health is often neglected when it is supposed to be accorded an important place; a lorry load of people die almost everyday on Nigerian roads; citizens die mostly from preventable deaths; Nigerians continue to be pauperized — all because we have failed to invest properly in health. Despite these tragedies, policy makers do not see the need to address the needs of the health sector.

Due to the insensitivity of leaders of government, Nigerians lose their lives on a daily basis. The leaders’ lack of care has led to their seeking medical care abroad while the poor Nigerians are left at the mercy of an ineffective health care system. The health sector is not well funded, leaving it to provide poor services to the citizens. How do we improve the health status of Nigerians?

As Nigerians die at an alarming rate (16.31 deaths per 1000 population), one would have thought governments would take proactive steps to address this issue but that is not happening. Little wonder the Nigerian economy remains unstable. The country’s manpower which should be contributing to its productivity is lost on a daily basis. And nobody cares. This same manpower is what country’s like China , Japan , USA , Russia , Brazil , India , Indonesia etc are using to improve their economies. They put to productive use their citizens to increase the GDP. How wise of these countries to capitalize on the number of their citizens to become leading manufacturers in the world.

As the country continue to lose its citizens due to lack of care, governments goal of becoming one of the top 20 economies by 2020 becomes elusive. Countries that are ranked among the top 20 economies in the world make a better investment in the health of their people. Without this, they would not have grown their economy –the way Nigeria intends to grow hers despite placing no value or importance on the lives of its citizens who are needed to attain this feat. No country can be among the top 20 economies if it does not care about the well-being of the people. There is a need for leaders of government to study the countries already occupying the top 20 spots on the world economic chart to know whether the lives of their citizens are lost at a rate like ours as they strove to improve their economies. Statistics show that China which is fast becoming the number one manufacturer in the world has a death rate of 7 deaths per 1000 population while the U.S which is the third most populous country in the world and currently the number one manufacturer has a crude death rate of 8 deaths per 1000 population. Conversely, Nigeria has a crude death rate of 16.31 deaths per 1000 population which is double those of the leading manufacturers in the world.

A country that wants to be counted among the best must be ready to make an investment in the health of her people whom without them little or nothing can be achieved in terms of progress. The 15 per cent budgetary allocation to health agreed upon by African Health Ministers in the Abuja Declaration of 2001 is still a mirage. Nigeria ’s total health expenditure which is currently at 4.1 per cent is a far cry from what is expected to improve the health status of Nigerians. This is essential for economic growth.

Report on loss from economic growth penalty of malaria endemicity between 1980 and 1995 by J.L Gallup and J. Sachs indicated that Nigeria lost 18 per cent of its income due to malaria during this period. This shows that inadequate funding of the health sector leads to a loss of the nation’s meager income which government hope to increase in the next nine years. Economic historians have suggested that as much as 30 per cent of the per capita growth rate in Britain between 1780 and 1979 was as a result of an improvement in health and nutritional status (WHO, 1999) but Nigerian policy makers have not deemed it necessary to make more investment in the health of Nigerians so that governments’ vision 20:2020 can be achieved. Or what more evidence do they need? Disease and sickness reduce the productivity of the citizens and this in turn affect the country’s GDP. Need I say more? Despite getting a debt relieve in 1999 based on the argument that malaria slowed economic growth in African countries by 1.3 per cent per year and that over 35 years, the GDP for African countries was 32 per cent lower than it would have been in the absence of malaria; the health sector’s contribution to the nation’s development is still underestimated. If Africa lost about $100 billion to malaria during that period, the health sector contribute to development in no small way.

The ill are unable to contribute maximally to the economic and social development of the country hence an improved investment in health makes sound economic sense because part of the investment would save cost that would be incurred due to illness. It is obvious that the defense and police Ministries which gets the largest chunk of the nation’s budget have failed to justify the allocation of huge funds to it over the years. But must we continue to vote a larger percentage of our budget on security? In spite of this, Nigeria is yet to secure the lives of its citizens rather what we have experienced over time is threats to human lives. It is not known why governments at all level will not increase allocation to health even though it has been proven that it contributes to the development of a nation. Policy makers who also double as decision makers must ensure improved investment in health from the current 4.1 per cent of GDP to at least 13 per cent of GDP if they truly are committed to governments’ vision 20:2020. Governments’ approach to attaining this height without adequately funding the health sector remains to be seen.

Trends in life expectancy in Nigeria shows that people are dying young. Policy makers need to wake-up and improve investment in health. Increase in life expectancy of the people of a country does not come cheap. It is as result of adequate funding of the health system. Countries like Australia, Canada, France, Germany, Japan, United Kingdom, USA, Italy and Spain which Nigeria intends to join in the next nine years would not have been in the league of top 20 economies in the world if their life expectancy were around 47.2 years; infant mortality 92.99 deaths per 1000 live births; physicians per 4000 people (1); nurses per 1000 people (1.5); per capita expenditure on health ($6) and percentage of government revenue spent on health (4.1) just like it is currently the case in Nigeria.

If only government can change this demographic profile and improve the health status of Nigerians, then, we are assured of achieving the country’s vision 20:2020. Government’s plan whether short-term or long-term for the economy without considering improved expenditure on health may not be achieved. The Minister of National Planning has said that about $3 trillion is needed to put Nigeria on the economic map. This amount can only be realized if the citizens are healthy and productive besides investing in health will help meet national health policy objectives and also the imperative of promoting social justice and national security. Health sector is not a consuming and non-productive sector as believed by some policy makers hence it deserve increasing allocation of funds. Investment will improve health indices and reduce disease burden. This is true. Its high time Nigerian economist began to have a rethink on funding health if they want to increase the country’s GDP and ensure economic growth. There is a need for economists in government to weigh the consequence of a continued improper investment in health and what the country stands to gain if the health status of Nigerians improved.

The 2010 World Health Statistics by WHO have revealed among other things that general government expenditure on health as percentage of total expenditure on health for Nigeria i

s 25.3 per cent while private expenditure on health as percentage total expenditure on health is 74.7 per cent. But what is most worrisome is that out-of-pocket expenditure as percentage of private expenditure on health for Nigeria is 95.9 per cent. This further confirms the need for governments to improve funding of the health sector besides it is obvious the Nigerian government is far from being strongly involved in providing health services for the teeming population of Nigerians. The over 70 per cent of Nigerians who live below less than $1 per day cannot wait for a day when governments will be responsible at least to a larger extent for the health of their citizens.

Maternal mortality ratio for Nigeria is quite alarming with about 1,100 deaths per 100000 live birth compared with countries like USA, Canada, Japan, France, Spain, Italy, Germany and United Kingdom which have their maternal mortality ratio between 3-11 deaths per 100000 live birth. While these countries have made maternal mortality a rare event, Nigeria has a maternal mortality ratio which is more than 100 times those of the countries ranked among the top 20 economies in the world. Despite the fact that high quality, accessibility and affordability of care in the above countries have led to a reduction in their maternal mortality ratio, many policy makers still do not see the need to improve investment in the health sector so that all our pregnant women can have access to affordable care and ultimately become lifted out of poverty. The problem of poor quality and accessible health care will continue to persist if governments do not increase funds for health thereby ensuring that Nigerians get affordable healthcare. Funnily enough, majority of Nigerians are in the lower socioeconomic group, unable to afford health care and when they have to pay for health services from out-of-pocket, they are plunged into extreme poverty.

For many years now, governments have been trying to alleviate poverty among Nigerians. The National Poverty Eradication Program (NAPEP) was established to address this problem. This was in response to the assertion that poverty affects the development of a nation but if governments must alleviate poverty, the main cause and consequence of poverty which are ill-health, disability and death must be addressed in order to avoid a situation where the cost of illness further pauperize the citizens.

The agency has not been able to justify the huge resources committed to it over the years. This was also the view of the Senate Committee on National Planning, describing the performance of NAPEP as dismal. Almost every month, a lot of people die of diseases such as cholera, malaria, measles, meningitis, pertussis, poliomyelitis, tuberculosis, leprosy, rubella, tetanus etc. Many Nigerians do not seem to be bothered about the number of persons who die from these diseases. We see them as normal occurrences in our daily lives and so, not quite important. We feel about 964 deaths per 100000 population from communicable diseases alone is not something serious after all, besides, this age-standardized mortality rate by cause according to WHO is not peculiar to Nigeria. This definitely does not portray Nigerian leaders of government as being responsible enough for their citizens, most of who cannot afford to pay for health services. The number of persons who died from cholera alone in the last quarter of 2009 and in 2010 should spur policy makers to proper and increased investment in the health sector.

In some other countries, their governments raise the alarm when there are only a few causalities in an accident or disease outbreak. Both the local and international television stations around the world report these few cases of death and how concerned the governments of those countries are to about avoiding such an occurrence in the life of their nations.

This is how concerned a good government should be about the welfare of its citizens. Governments that quickly rise to the occasion when only less than five of their citizens die are worthy of emulation and often, are made up of people who believe investing adequately in the heath sector will ensure economic progress of the nation.

Between 2008 and 2009, the numbers of reported cases for meningitis increased by 49,343 cases while the incidence for measles, cholera, tuberculosis, pertussis, tetanus, leprosy and poliomyelitis also increased considerably.

According to the 2010 World Health Statistics, the probability of dying between the age of 15 and 60 per 1000 population is 424 for male and 399 for female –this group comprise of the most productive segment of the Nigerian population who are needed to move the nation’s economy forward. But one out of three Nigerians between the age of 15 and 60 die on a yearly basis. Can Nigeria continue to lose the lives of her citizens at the expense of the economy?

From the foregoing, it is apparent that the lives of Nigerians cost a lot. Whether a citizen becomes sick, come down with a disease or die unnecessarily; the country experience a loss in her income which is the least Nigeria needs as it strives to be among the top 20 economies in the world by the year 2020.

Written by
Bolaji Aregbeshola
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