The health sector in Nigeria under President Muhammadu Buhari has had a lot of media attention. Not much of this has however been about the government delivering on its promise to provide functional healthcare system to Nigerians. Instead, the headline has been grabbed by epidemic outbreaks in parts of the country, underlining the challenges that still face the sector.
During the electioneering campaign, candidate Buhari essentially promised to reposition healthcare service delivery in the country. After his election, his government said it would reduce import dependence by providing incentives for domestic manufacturing of pharmaceuticals, ensure that unadulterated drugs are easily available and affordable, get states to provide free ante-natal and maternal care for pregnant women, and free healthcare for children up to 12 years of age.
It also promised to collaborate with states to raise the gross national health expenditure per person per annum from less than N10,000 to about N50,000 and raise the quality of federal government-owned hospitals to global standard within five years through investment in infrastructure, diagnostic equipment and continuous professional development.
However, the government later focused its health agenda on reviving primary health facilities so as to bring healthcare closer to the people. This, it said, would ensure that the poor have access to qualitative and affordable health care services as the health system in Nigeria has only favoured the rich.
The Minister of Health, Isaac Adewole, a professor of Medicine and former University of Ibadan Vice-Chancellor, has since constantly emphasised the goal of revitalizing the primary health care sector which the government believes to be the bedrock of healthcare provision in the country.
“If all primary centres were functioning well, at least 70 percent of Nigeria’s problem would have been solved”, Mr. Adewole had stressed.
Early in January during the commissioning of the Model Primary Healthcare Centre in Kuchingoro, Abuja to kick off the revitalization scheme, Mr. Adewole said the exercise would touch about 10,000 primary healthcare centres, with at least one in every ward across the country. He said the scheme would avail poor Nigerians with qualitative and affordable healthcare services.
The National Primary Healthcare Revitalisation Initiative is to be carried out through the National Primary Healthcare Development Agency, NPHCDA. The facility in Kuchingoro, as the model for the revitalization scheme, was adequately staffed and provided with all the medical equipment necessary at the primary healthcare level, ambulances and drugs.
Since the flag off and in spite of the minister restating the plan several times, special investigation by PREMIUM TIMES in May revealed that the scheme has yet to take off across the country. Most of the PHCs visited remained in dilapidated buildings and lacked manpower, equipment and power supply. The health workers and their patients generally decried the poor state of the facilities and work environment.
OUTBREAK OF MENINGITIS
The epidemic outbreak of Meningitis C and its spread to 24 states was attributed to the lack of functional primary healthcare facilities which should have quickly detected the disease when it broke and nipped it in the bud.
And despite the revitalization project being a priority of the administration, the NPHCDA, which is overseeing implementation of the project, was allocated only N19 billion in the 2017 Budget.
Response to public health emergencies in the country was put to test by the outbreak of different types of diseases such as measles, Lassa fever, cholera and meningitis.
Though most of these diseases were not of epidemic status, the meningitis C outbreak, however, exposed the low level of response and lack of preparedness for health emergency situations by the country.
The Meningitis outbreak started in Zamfara in November 2016 and recorded over 1,114 deaths and 14, 005 suspected cases before it was contained.
The Nigeria Centre for Disease and Control, the agency under the Federal Ministry of Health in charge of disease control, claimed that it became aware of the disease very late. The ministry said it did not know about the epidemic until three months after the outbreak, because the health workers on ground were not able to identify the disease and alert the government.
Even after the ministry was made aware of the outbreak of the disease, however, it could not immediately provide the vaccine for curbing the spread. The vaccine was not available in the country, although the World Health Organisation WHO, and NPHCDA, had issued a warning well ahead of the likely outbreak of meningitis C in Nigeria due to previous occurrences and the epidemiological cycle of the disease.
Due to the recurring nature of the disease, it was expected that public health authorities would have some vaccine in the vaccine store to tackle the outbreak. Unfortunately, the government had to start sourcing for vaccine weeks after the outbreak, resulting in the spread of the disease to 226 local government areas in 24 states of the country.
Trying to provide explanation for the anomaly, the Minister of State for Health, Osagie Ehanire, said the drugs and vaccines are “extremely expensive” and have short shelf life. He added that there was limited stock of the meningitis type C vaccine around the world, as it is not in much demand.
Nigeria did not get enough vaccine before nature mercifully intervened to contain the disease: meningitis ravages only during the dry season and washes away when the rain season begins.
Polio eradication effort in Nigeria also suffered a setback last year as two new cases were reported in Borno State. This means that the country will not get the polio-free certificate which was expected to be issued in July this year.
The new cases were attributed to the Boko Haram insurgency which had made it difficult for immunisation process to be carried out in some communities. The federal government has, however, restated its commitment to eradicating the disease in the country by making funds available early for the purchase of vaccines for immunisation, more so that Boko Haram has been beaten back.
NIGERIA STILL DEPENDENT ON DONORS
Nigeria has over the years depended heavily on international agencies and donors for most of its activities in the health sector.
This was evident in the meningitis type C case whereby the government relied on foreign intervention for the vaccines. Many of the vaccines for immunization activities in Nigeria are still imported and largely come from foreign donors, as the country is not producing them locally.
The Federal Vaccine Production Centre in Yaba used to produce some of the vaccines used in the country and exported to some neighbouring countries, but it has been moribund since 1987.
Most of the drugs used in Nigeria are also imported as the pharmaceutical companies operating in the country do not have capacity to meet the need of the sector.
Mr. Adewole, however, raised hope of local production of vaccines by 2019. He said the federal government has signed a Memorandum of Understanding (MOU) with May and Baker Nigeria Plc for the production of vaccines Nigeria under a Public Private Partnership.
He said it takes two years to produce a vaccine, so the first batch of local vaccine cannot come earlier than 2019. The MOU was approved by the Federal Executive Council on Wednesday.
There were also reported cases of acute malnutrition in the north-west and north-east of the country. The therapeutic foods used in combating malnutrition in the country are being imported and majorly sponsored by foreign agencies which are at the forefront of tackling the issue.
SHORTAGE OF STAFF
One of the major complaints of workers in the health sector has been the shortage of staff to carry out necessary services.
The National Association of Nigerian Nurses and Midwives said its members are leaving the country in search of greener pastures because of the working condition in the country.
Against that backdrop, Gombe State Government recently had to defer the retirement of 100 nurses and midwives due to the shortage of personnel.
The government also introduced a policy of a three-year waiver for nurses and midwives from their legally allowed 35 years of service.
But the nurses’ association said the challenge is not about the inability of the country to produce enough nurses, but getting them employment opportunities as most of the health institutions in the country are not employing even though they are short-staffed.
The President of the Nigerian Medical Association, Mike Ogirima, also said most hospitals are under-equipped and short-staffed. This, he said, has had an effect on the training of doctors to become specialists and is affecting the quality of healthcare service in the country.
HEALTH WORKERS DEMAND BETTER WELFARE
Health workers across the country at federal government and state levels also embarked on strikes, protests among others, over their working conditions, state of amenities in government hospitals and their welfare packages.
The NMA had called on the Federal Government to shelve its plans to harmonise salaries of health workers, in another face of the crisis in the country’s health sector.
Mr. Ogirima noted that although other health workers also face many health hazards in the discharge of their duties, their output could not be compared to those of doctors who perform the bulk of the work. He said the government’s attempt to harmonise salaries in the sector was causing a lot of disharmony in the sector.
These and many other issues stand in the way of President Buhari achieving his agenda in the health sector.