I tend to think of Nigeria as a giant, and with a population of about 150 million, it may be easy to see reason with me. It is once again that time of year when the drums, gongs, and flutes roll out across the country for the National Day celebrations. This year’s celebration is extraordinary, as we are not just adding another year, but actually attaining a milestone, that of our golden jubilee as an independent country. Aside from the colourful cultural displays, smart military parades, and the relaxation of the bank holidays, this year’s celebrations also affords us the opportunity to reflect on our collective existence and engage in meaningful dialogue on how best to steer our ship of nationhood in the years ahead.
As one of the country’s young health professionals, for me this year’s celebrations provide an opportunity to reflect on the public health challenges Nigeria continues to face. Many of those who feel the country does not have much to celebrate cite the current state of healthcare delivery as one of the reasons for their dissatisfaction, and with Nigeria’s current health indices and vital statistics it is obvious that we still have a lot of uncovered ground. Nigeria has an average life expectancy of about 47 years and an under 5 mortality rate of about 186 per 1000. Maternal mortality is still a major issue, and together with infectious diseases and malnutrition, account for a huge chunk of our problems.
It is not possible to view the problems in the Nigerian health sector in isolation from the challenges the country continues to face in other sectors like education, security, power, and communication and other social problems like gender inequality. Nigeria’s health system would ultimately benefit from a significant improvement in other sectors just as these sectors would also benefit from a thriving health sector.
It would be unfair to the many men and women who have toiled in many different ways for our existing health system to continue as though significant achievements have not been made already, at least judging from the way things were 50 years ago. I am one of those who feel a whole lot has been achieved and a lot of lessons learned. However, I feel we are still far short of where we should be, given the immense resources, both human and material at our disposal. We need to make more concerted effort at proper planning and also seek ways of ensuring an efficient execution of our plans.
Healthcare worker motivation is one area in urgent need of attention. This would ensure we reduce our losses in terms of skilled manpower to other countries with a more pro active and progressive policy of motivating providers of health care. The situation where many Nigerians are left without access to public health services for months on end in some instances as a result of strikes by demotivated health workers is most distasteful, and does not help our already depressing vital statistics.
We need to ensure the continued growth of academic medicine by rethinking the funding systems for our tertiary health institutions. This is crucial if we are to continue to reap the rewards of knowledge creation and adaptation of existing technical “know how” for solving our peculiar problems.
We need to consolidate on some of our achievements and increase people’s access to basic health care. We stand to gain a whole lot if more people are able to benefit from the existing national health insurance scheme, while we move gradually to a situation where virtually everyone would be able to benefit.
While we embark on a deliberate campaign to ensure that the tertiary facilities continue to produce enough manpower to drive our healthcare system we must also ensure that the primary healthcare structures on ground remain relevant. In Nigeria today, many of these facilities remain underused, accounting for some of the waste that has continued to plague our systems. At the same time some grassroots informal healthcare providers, such as patent medicine vendors, enjoy great loyalty among the people. For this reason some argue that we need to explore ways of integrating some aspects of the informal structures into the primary care system, to make use of the popularity of the informal providers while improving the safety of their care.
Chibuzo Odigwe is a research medical officer at the Nigeria Effective Health Care Alliance Programme, Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria and a former BMJ Clegg Scholar.