Public Health: Nigeria; the Giant With No Health Care

Nigeria is an English-speaking country on the coast of West Africa with a population of over 200 million people. It is described as the giant of Africa having the largest economy in the whole of Africa. For most individuals living outside the shores of this country, the term “giant of Africa” may connote a country that has its affairs in order but anyone who resides or has ever set foot in it will agree unflinchingly that Nigeria is anything but great. Nigeria can be likened to a severely malnourished child who is hanging on to the promise of a decent meal from a wicked uncle who is busy planning his burial. It is a country plagued by mammoth corruption and chronic unapologetic incompetence of public office holders; a country where a small group of elites is holding very many to ransom. It is a jungle where the strong prey on the weak, the privileged oust the lower class, and where the tales of the tooth fairies are more practical than quality health care. So, the question isn’t what is wrong with Nigeria? No, it is not! The question however should be what isn’t wrong with Nigeria? Nigeria is like a machine with rusty parts that may give way at the slightest attempt at motion.

Nigeria

Nigeria

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A peculiar thing about Nigerians is their ability to make a joke out of literally anything. An average Nigerian man with his house on fire can still manage to muster a joke like “wouldn’t it be nice if I roasted a tuber of yam in this glorious fire?” or “at least I don’t have to worry about the rats anymore”. Hilarious! Many believe it is a mechanism that helps Nigerians cope with the heart-shattering realities of living in the country – in a way to anesthetize or numb their senses to wounds that a dying system has inflicted on them.

Despite this tendency to make jokes even in the most precarious of situations, there is one thing a Nigerian does not joke about – the thought of disease. The thought of a relative dying from a disease would wake a Nigerian from sleep during the wee hours of the day. This worry stems from the pitiable state of the health sector. Many describe the Nigerian public hospitals as a death trap. These assertions will make you wonder, what is the problem with the health sector?

Problems with the Nigerian health sector

The problem of the Nigerian health sector is multifaceted. To solve the problem crippling the system is to solve a generational riddle with an elusive solution. Calling it a riddle might imply we do not know the answer. Far from that! We know exactly what is wrong with the system. However, those who are in the position to solve it could care less about lifting a finger about it. The problem with the health sector can be summarized below;

  1. Gross underpayment/remuneration of medical practitioners
  2. A mass exodus of medical practitioners
  3. The huge cost of Health care
  4. Lack of political will
  5. Wanton corruption
  6. Inadequate structures and equipment in the hospital secondary to chronic underfunding
  7. Unfriendly rules of engagement.

Gross underpayment of medical practitioners

For most, especially the practitioners themselves, this is the marrow of their problems. Anyone keeping up with the Nigerian space will have noticed that it is almost impossible to go through a fiscal year without strike actions crippling activities in one or more sectors. During the COVID-19 pandemic that crippled all sectors, the only system that was meant to be at the forefront of the fight – the health sector, was hit by a strike by the National Association of Resident Doctors (NARD). This strike lasted for several weeks and the agenda was simple – increased remuneration of workers, a more conducive work environment, and provision of Personal Protective Equipment among other things. An average House Officer and Resident Doctor receive a monthly payment of about ₦175,000 ($426.83) and ₦250,000 ($609.76) respectively. Not only is this amount comparable to peanuts when compared to the volume of work they do, but it is also barely able to keep a family running considering the cost of living in Nigeria. Rice, a staple food in the country is sold at a skyscraping price of not less than ₦25000 ($60.98) for a 50kg bag. That is about 14% of a House Officer’s monthly earnings spent on rice alone. Imagine what the fate of salary is after the payment of school fees, water and electricity tariffs, road tariffs, etc. summarily, the pay is not commensurate with the work.

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The mass exodus of medical practitioners

Contrary to what was said by the current minister of labor Dr. Chris Ngige on Wednesday, 24th of April 2019 that the country has too many doctors and is not suffering from a “brain drain”, Nigeria is experiencing a massive emigration of its medical professionals to other countries. This mass emigration has resulted in an enormous decline in the doctor-to-patient ratio. According to the WHO, the doctor: patient ratio in Nigeria stood at 1:2500 as of 2015. Currently, professionals are pegging the ratio at 1:5000 (The Guardian, 2021). These ratios are against the WHO recommended ratio of 1:600. As of 2019, about 2000 medical doctors leave Nigeria annually. According to the then President of the Nigeria Medical Association (NMA) in 2019, Dr. Francis Faduyile, while speaking at the Annual Symposium of the Health Writers Association of Nigeria (HEWAN), about 33,000 doctors have left the country leaving about 43,000 to cater for the health needs of the 200 million Nigerians. The exodus of practitioners underscores the grossly inadequate ratio and paints a vivid picture of how badly things have deteriorated.

The huge cost of Health care

There is a popular saying among the medical community in Nigeria that “most Nigerian families are one chronic illness away from abject poverty”. This is not hyperbole. The cost of modern health care is so expensive that it is believed that quality health care is just for the upper class. An average Nigerian would rather visit a patent medicine dealer or herbalist to receive medications than visit a hospital. Health insurance is almost inexistent as the National Health Insurance Scheme can only cover a selected few out of the 200 million population hence, the need for out-of-pocket payment. Those who finally decide to visit the hospital would end up broke or in debt before they leave the hospital.

Lack of political will

The former Minister of Health, Isaac Folarunso Adewole, in 2018, when asked why Nigerian doctors would have to wait many years before getting into residency programs asserted that all doctors cannot be specialists and went ahead to suggest that doctors venture into other fields like farming and tailoring. As irritating as that may sound, it does not top the list of the most outrageous things we have heard our politicians say. Currently, the Nigerian government budgets about 7% of the total budget for health. This amounts to the sum of ₦2,735 ($6.67) per Nigerian. Compare this to that of developed countries you would agree that the government could not care less about the state of things in the health sector. This laisser-faire attitude of the government towards the state of the health sector is mostly because they do not depend on the dying health sector for their health needs. At the slightest headache, these big-bellied politicians will hop on the next available flight with tax payer’s money to countries with top-notch health care to get themselves checked out. So, they have no reason to allocate more to health care since they are not at the mercy of the system.

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Rampant corruption

Corruption is a cankerworm that has eaten deeply into the very fabric from which Nigeria is woven. This corruption is not just limited to the political class. One of the major problems faced by the health sector is the Chief Medical Directors of several health institutions in the country. Corruption among these people ranges from the employment of ghost workers whose salaries they will keep for themselves to the embezzlement of funds. They even withhold the salaries of health workers and deposit the money in commercial banks so that they can clear off the profit after a fixed period while these workers live from hand to mouth. When they finally decide to pay, they impose unnecessary deductions on the salaries of these workers to further satisfy their greed. The level of corruption in the health sector is so alarming that it is almost a norm to expect one form of it or the other in every health institution.

Inadequate structures and equipment in the hospital secondary to chronic underfunding

As stated above, the budget to the health sector is very minute and as expected, it translates into poor infrastructural development as well as poor maintenance of already existing infrastructure. Nigerian public hospitals are filled with oxygen tanks that have no oxygen in them, pharmacies with expired drugs, and ICUs that administer paracetamol and omeprazole.

Unfriendly rules of engagement

This problem was primarily created by the category of persons referred to as the “medical elders”. These are those who have gotten to the highest points of leadership in the medical profession. Instead of these persons helping solve the problems or sufferings they encountered on their way up, they turn into sadists and decide to make the situation worse than it was before. They devise more ways to overwork their juniors. These invariably result in the loss of enthusiasm in these workers which will translate into poor patient management that will ultimately lead to poor patient outcomes and increased morbidity and mortality.

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Conclusion

Nigeria is a sick giant with no health insurance. Its problems are multifaceted and require the cooperation of both the government and the people to achieve a good outcome. If concerted efforts are not made towards the resuscitation of this giant, it will only be a question of time before it will meet the great beyond. The sooner the better.

References

https://allafrica.com/stories/201912190053.html

https://www.who.int/workforcealliance/countries/Nigeria_En.pdf

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