When Will Nigeria Reform its Health Care?

by Bolaji Aregbeshola

As many governments around the world strive to provide universal health care for its citizens in order to have access to care, one cannot help but wonder when the Nigerian government will begin to reform its healthcare. This is against the backdrop that Nigeria does not seem to have a clear, concrete and comprehensive health policy. Though I stand corrected but it will take the publication of a good, sound, efficient and coherent health policy document to prove me wrong.

It is most unfortunate that after 50 years of independence, Nigeria is yet to chart a course for the effective delivery and performance of her health system which rank low among the WHO member nations. Health leaders are not doing enough in ensuring that people with less means get access to care. They have been quite silent on the issue of health reforms may be because their hands are tied on the issue of reforming the health system especially under a democratically elected government which does not take the health of its citizens seriously nor the education system both of which demand urgent reforms. Apparently, if health leaders do not bring the issue of health policy to the front burner, the health system will collapse before their very eyes due to government’s incoherent health policy, lack of reforms and improper health finance and insurance.

There is no better time than now for healthcare professionals and all stakeholders to push for the reform of healthcare in order to save the health system from imminent collapse. Those concerned cannot afford to fold their arms at this critical moment in the history of the country’s health system development. All hands must be on deck like never before to achieve a health system that is fair, efficient and effective. For many years now, the state of the health system in Nigeria has been appalling going by reports and what everyone can see. Health leaders who have been in the system for many years can attest to this even though they have in one way or the other made their contributions towards its reform. Health leaders must put pressure on government to reform healthcare if it does not deem it necessary or important on its reform agenda which has seen the banking sub-sector among other sectors experience a total revamp, reinvigoration, re-engineering and restructuring with new policies that aim to improve and promote the system. No doubt, this move to ensure a healthy system in healthcare is needed. Most nations of the world have already begun debates and roundtable discussions on the way forward for their healthcare so that their citizens can be lifted out of poverty and have access to healthcare. Healthcare reform has now become a topical issue in the health policy of most developed and developing countries. It is amazing that the present health ministers are not discussing a controversial issue such as the universal health care which created a lot of ripples in industrialized nations where the health system is far better than ours by all standard and indices, Nigeria really need to take a cue from how they have been able to achieve much in their health system.

A government that fails in its responsibility to ensure proper health of its citizen must be told that its time healthcare became reformed just like the banking industry.

This is the reason why the attention of our leaders who have the means of getting the best medical care abroad must be called to the reform of the nation’s healthcare in order to meet the needs of the teeming population. Healthcare professionals need to brace up for the challenges of reforming the healthcare system no matter how long it may take and the complexities of the system. Though a complete reform may not be achieved immediately with an extensive debate and roundtable discussions among health leaders and stakeholders but the nation and its people will eventually benefit from the outcome of such debate and/or discussions in reviewing the health policy which is not comprehensive. What government does not understand is that universal health coverage and an investment in the health system are capable of increasing life expectancy, reducing maternal and child mortality as well as unnecessary deaths of the citizens. And that is why every responsible government are urgently reforming their healthcare so that they can have an holistic health policy that will respond to the health challenges of the 21st century and make healthcare affordable for the people. The ineptitude shown by leaders of government to the issue of healthcare reform in spite of the increase in number of preventable deaths tells us that Nigerian leaders do not have the interest of the masses at heart. If this view is to the contrary, how come none of them is talking about a reform of the healthcare system? They are less concerned since they have an alternative which is to travel out of the country for medical treatment even when it is just a slight headache. Everybody else can seek care in a health system that is less effective, inefficient, expensive and unaffordable. This attitude is what both Islam and Christianity preach against when it says that we should love our neighbors as ourselves and also help the poor/needy. Many of us claim to be true believers of these teachings but our behaviors are not reflective of the commandments of God. Our leaders do not know when to include health reform in their agenda. There is no other way of ensuring that all citizens have access to care than to provide universal coverage so that they can have social protection in order to reduce the catastrophic expenses they are confronted with when they fall sick. Reforming Nigeria’s healthcare would ensure that the health system perform and deliver in a way that will suit both the poor and the rich. Members of the National Assembly have ignored healthcare issues because they do not consider it important to be debated on the floor of the assembly. The legislative power given to the NHIS in 2004 under the administration of former President Olusegun Obasanjo with amendments to the original 1999 legislative act is not enough as many Nigerians still do not have access to the care which government at that time intended to provide. Countries that have succeeded in making healthcare accessible to a large number of their population have done that with the provision of universal health coverage and increased health spending. No country can achieve access to care for all its citizens without a universal system. Nigerians need new protection aside from the current National Health Insurance Scheme. This is evident in the fact that Nigerians with less means are yet to feel the impact of the NHIS on their health needs and status. The health policy in Nigeria which is based on primary health care is also yet to be fully implemented neither has its goals been achieved. After 23 years of launching primary health care plan as the cornerstone of the nation’s health policy by the government of IBB, health ministers still pay lip service to primary health care as contained in the national health policy.

It is time for Nigerian lawmakers with pressure from all stakeholders in the health sector to provide the legal framework for a new policy shift and direction in order to help poor Nigerians even though leaders of government do not see this as a right of the people of Nigeria. The recent call by the Minister of Health, Professor Christian Onyebuchi for the implementation of the current national health policy confirm the assertion that past ministers have been paying lip service to the statement contained in document despite its incoherence. This underscores the need for the passage of new healthcare laws that will protect Nigerian health consumers and provide access for the poor masses majority of whom have been made poor and die unnecessarily on account of their inability to pay out of pocket for health services. In addition, both the state and federal governments cannot continue to wait for an outbreak before they respond. If government does not have a responsibility to

ensure better health for the people, why does it intervene when there is an outbreak in the states? Government will rather arrest the situation when it happens than prevent the situation from happening. It is most unfortunate that different leaders of government come up with statements urging the people to observe environmental and personal hygiene only when there is an incidence of disease outbreak. Governments have only been responding to illnesses when they get worse and become a problem to the populace. Our leaders are not only insensitive but are nonchalant to the plight of Nigerians and this is not good enough.

In conclusion, Nigeria urgently needs to reform its healthcare. The National Assembly and those concerned cannot continue to assume that Nigeria already has a health policy in place that guarantee consumer protection and access to care for all citizens just because we have the NHIS. The NHIS cannot be equated with universal health coverage. While universal healthcare ensures that a larger percentage of Nigerians have access to healthcare, the NHIS provide access to only few individuals and groups of the society. The achievement of past government and health leaders in establishing and further strengthening the NHIS is no doubt laudable. But it is not comprehensive enough even though it has provided insurance for government employees and some private employees as well as a few individuals who have the capacity to buy insurance. Health leaders and leaders of government need to take a step further by reforming the health system so that Nigeria can improve its health outcomes in terms of quality and access to care both of which are among the factors that affect the performance of the health system and change its current state from being inefficient to contain and respond to the health challenges of the 21st century. This is the type of health system Nigerians want from the present government and governments to come.

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