KWENU: Our Culture, Our Future

Poor healthcare system: Nigeria’s moral indifference



Dallas, Texas, USA


Thursday, July 14, 2005


The sustainability and viability of a country’s economic and social growth depend largely on vibrant healthcare sector of that nation. No country can maintain a steady economic growth in the absence an adequate healthcare system. Healthcare issues have been enigma in the life of Nigeria. Solving the puzzle requires an aggressive approach from the federal, state, and local government. Healthcare problem is a national emergency and it should be considered as such.


For instance, according to Pearson Education, publishing as Infoplease, the 2005 Nigeria’s population estimate is 128,771,988 with a growth rate of 2.4%. While Nigeria has a birth rate of 40.6 births per 1000, the infant mortality rate is 98.8 deaths per thousand birth lives with a life expectancy rate of 46.7 years. The statistics are pathetic and undoubtedly scary.


The continued stagnating healthcare system in Nigeria is of great social and economic consequence. Access to quality healthcare is either limited in Nigeria or nonexistent with staggering financial burden to families and the nation. While the prevalence of fake drugs and substandard products are compounding the problems, the AIDS epidemic and unhealthy lifestyles of many individuals are making the matter worse. Worse still is when people in the Diaspora receive messages about the deaths of their loved ones; I mean avoidable deaths.


In Nigeria, people die of minor illnesses that could have been prevented with simple medications and healthy lifestyle. The health crisis in the country has taken an added significance because of the absence of constructive comprehensive national health policy. The federal government seems to have no meaningful collaborative effort with the state and local governments. The implication this phenomenon is catastrophic. Citing Pearson Education, “In 2003, after religious and political leaders in the Kano region banned polio immunization, contending that it sterilized girls and spread HIV, an outbreak of polio spread through Nigeria and into neighboring countries the following year. The Kano region lifted its ten-month ban against vaccination in July 2004. On Aug. 24, there were 602 polio cases worldwide, 79% of which were in Nigeria.”


However, there are several individuals and Nigerian organizations that have adopted medical missions to Nigeria in order to help assuage the healthcare crisis in the country. The Association of Nigerian Physicians in the Americas (ANPA) is one of them. During the 11th Annual Convention & Scientific Assembly of ANPA on July 6-10, 2005 at the Gaylord Opryland Resort & Convention Center in Nashville, Tennessee, the out-going president of ANPA, Dr. Emmanuel Okafor said, “The convention is going well; we have a fairly robust attendance from US, UK, and Nigeria. The convention has been going on since the 6th of July and we have well over 150 people here now. The theme of the convention is: “Medical Missions”. We conduct about 8 to 10 medical missions in Nigeria per year. We see about three to four thousand patients, mostly in the rural areas.” He indicated that part of the medical mission involves university teaching during the period.


In his communiqué, the Program Chairman, Dr. Ajovi B Scott-Emuakpor said, “For our 11th convention, it is fitting that we have adopted “MEDICAL MISSIONS” as our theme. This has afforded us the opportunity of examining areas of medicine, which we have only paid marginal attention to. It has also allowed us to raise [rise] to higher level. Dr. Shoroye’s ideas of exploiting the visions of the foundations of Bill Gates and [President] Jimmy Carter and of affirming that we intend, through our medical missions, to be involved in the execution of worthwhile policies that will help achieve a healthier Nigeria in a healthier world.”


The CEO of Nnodum Corporation, a pharmaceutical company and one of the sponsors of the convention, Mr. Nnodum Iheme, pledged to supply prenatal vitamin to ANPA for their medical mission in Nigeria. Representative of Fidelity Bank Plc, another co-sponsor of the event, Mr. Chuck Chuckuemeka, addressed the plenary session singing nice songs about Fidelity Bank of Nigeria. He told the delegates that the bank is willing and ready to partner with ANPA to accomplish its medical objectives in Nigeria. Also, he informed the audience about the high rate of return on investment in Fidelity Bank Plc. “The bank is in the market to raise funds via their IPO, which ends on July 18, 2005. The bank is an excellent brand, which provides an excellent opportunity for us in Diaspora to jump in.  Hopefully, Fidelity will be a direct beneficiary of the Nigerian Stock Exchange message to ANPA, where returns on investment compares favorably, and in fact, outpaces investments in most part of the world. We the Diaspora Nigerians can’t continue to be skeptical about investing in our country or in brands like Fidelity Bank when foreigners see Nigeria as a gold mine. It’s time we change the mindset,” Chuckuemeka, a certified public accountant, concluded.


Some of the personalities in attendance were Dr. Ngozika & Mrs. Chinyere Nwaneri, Dr. Afam Ikejiani, Director General of the Nigerian Stock Exchange, Dr. Ndi Okerek-Onyiuke, Dr. Enyi Okereke, Dr. Oladapo Omitowoju, Dr Julius Kpaduwa, Dr. Iheanacho Emeruwa, Dr. Ola Akinboboye, Dr. Olusegun Salako, Dr. Henrietta Ukwu, Dr. Babajide Bamigboye, Dr. Emeka Ikeazu.


Emeritus Professor of Medicine, University of Ibadan, Nigeria, Professor O.O. Akinkugbe, enunciated the healthcare problems in Nigeria and some recent improvements in his address entitled, “Nigeria’s Heath Status: Two Steps Forward, and One Back—The Enigma of Success in Retreat”. The excerpts:


“It is pertinent to note that the Alma Ata Declaration that triggered Health-For-All 2000 came on five years later and that today these are still the same conclusions that are being reached in present day proactive seminars in Health. A revisit of the 1973 Symposium was undertaken in 1995 to examine how far Nigeria has moved down the road of rebirth and repositioning in health.”


“I will again quote from the mod-90’s revisit Symposium in which Professor Ransome-Kuti (now post-Ministerial) played a leading role. The preface to the 1995 Proceedings painted a series of scenarios:


A child falls ill with fever, chills and convulsions in a village over half-a-day’s journey away from the nearest health center. After three sleepless nights of agonizing helplessness for the family, it succumbs. A middle aged artisan in a State capital falls from a height at his workplace and sustains a compound fracture of the femur. He is taken to the general hospital where the surgeon, lacking the tools for the most appropriate treatment, undertakes what he euphemistically calls “conservative management” and watches helplessly as the patients deteriorates steadily and dies.


A 19-year old Polytechnic female student becomes pregnant following sexual indiscretion with a married schoolteacher. She is petrified of the consequences and seeks the aide of a traditional abortionist in the backwoods of a city center. A week later she is brought into the hospital with roaring septicaemia from pelvic infection. She rapidly passes from anuria to delirium to convulsions and eventually succumbs.


A Government Minister trip sin his bath and injures his ankle. Clinical and radiologic examination in the Teaching Hospital show a soft tissue swelling with no fracture. Yet he is promptly flown out for treatment in a European country – cost to the tax-payer: 20,000 Dollars


These four scenarios exemplify the cruel irony of our health care situation in Nigeria. The child with a fever and convulsions, probably malaria, need not die from it. Similarly, with good occupational health education the frequency of industrial accidents should be a great deal lower than it is today, and the mortality from relatively minor accidents should be insignificant. The young lady with the septic abortion, even if reckless, need not succumb had there been adequate measures to confront overwhelming infection and combat acute renal failure in a hospital setting. Her indiscretion may even have been averted with adequate and timely sex education of her “at risk” vintage. The fourth scenario, in which well over a million naira of public money is spent for overseas treatment of a minor ailment in a top government functionary, is clearly indefensible but all-to-familiar even today…”


Some other highlights were in Primary Health Care and its chronic deficiencies in terms of poor coordination of the functions of the Community Health Officers and the LGAs. Secondary Health Care was observed to be the weakest link in the chain, yet it is the area with the greatest potential for public/private sector partnership, and for the linkages both above all below that tier of health activity. It is observed that most secondary health care institutions had been totally run down and that a lot of funds were required to bring them back to shape.”


“On the Tertiary Health Care it drew attention to the cost-benefit implications of devoting a substantial portion of the country’s health resource to less than 1% of the entire population. But in doing so we must remind ourselves that Teaching Hospitals do much more than train undergraduates. Their other areas of responsibility include research that advances knowledge and training of high, intermediate and other levels of manpower. It is agreed that they should be funded a lot more than was being done right now so that they could discharge their various activities optimally and effectively.”


“With the dedicated leadership of Ransome-Kuti in the later half of the 80s considerable progress was made in articulating a National Health Policy in which Primary Health Care was positioned as its major thrust. Rural health effort was made synchronous in its distribution and shared responsibility with Local Governmental activities so that its benefits would readily permeate the communities that need it most. Rapid progress was made in the areas of Immunization, Communicable and Non-Communicable Diseases, Essential drugs and Vertical programs partly supported by international and non-governmental organizations such as WHO, UNICEF, UNDP and other development partners. The low funding of many laudable programs worked hardship on their successful implementation and by the end of the 1990s health care seemed to have reached its most pathetic nadir.”


“The emergence of a new civilian administration had sought to reposition and rejuvenate health and one has in this past quinquennium begun to witness palpable evidence of a turnaround. I will now present details to prove my assertion.”


“The first thing to do was to understand the true causes of the decline and devise a framework within which recovery can be made possible. Policies by themselves are normally laudable but lack the legal muscle for proper implementation. The obvious imperative was therefore to energize them through the articulation of a National Health Act, now being presented to the National Assembly with input from ALL Stakeholders in health. In the Bill the entire provisions of the Health Care System has been thoroughly reviewed incorporating proposals presented by the Committees appointed by the Hon. Minister of Health to restructure the system as it now operates, examine the roles of the Federal Ministry of Health and its parastatals and other health-related line Ministries. It also took on board the functional relationships with State Ministries of Health and constituent Local Governments, apart from devoting special attention to the management and local coordination of Tertiary Health Institutions. Once the Health Act is in place it will now be possible fast-track implementation by moving rapidly toward stated goals.”


“An address of this nature cannot begin to attempt detailing all the instruments that are necessary for a road-map to effective health care in Nigeria. I will nevertheless proceed to name a few general and programme-specific initiatives, to demonstrate the new wind of change that is destined to bring huge, health-driven dividends to the Nigerian populace in due course – short, medium and long-term,” Prof. Akinkugbe continued.


It is a sad reality that Nigeria has a healthcare crisis of ominous proportion. If the healthcare system had been adequate, we would not have countless wealthy Nigerians and government officials in foreign hospitals for medical check-ups. Some of these people are dying in hospitals thousands of miles away from the shores of Nigeria because they got there too late.


It is up to us!

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