For 82 Million Nigerians, Poor Healthcare is Only a Symptom of an Underlying Disease

This February, Nigeria overtakes India as the poverty capital of the world. With 42.5% of its 194,319,961 people living in poverty and away from good education, healthcare and other necessities of life. This equates to 12 people plunging into poverty every minute. To reverse this trend and meet the United Nations Sustainable Development Goal 1 of No poverty by 2030, six Nigerians will have to get out of poverty every minute.

For the 82,535,311 Nigerians that live in this condition, 2030 cannot come any sooner.

Poverty in the midst of plenty

Aisha, a 19-year-old mother of 3, lives in a Hausa community in Idi-araba and is pregnant for the seventh time since she started getting pregnant at age 11 when Alhaji “married” her.

Her first and fourth pregnancies did not make it to the full 9 months, she lost them in their first and second trimesters respectively. All her children experienced series of febrile illnesses between their first 18 months of life, her third child succumbed to one of such episodes 2 years ago. She hopes her 14-month-old daughter would make it and live past this illness.

Aisha does a fine job of combining motherhood, and wifehood – on days when her husband is around to demand such of her – with a career in petty trading. She sells groundnuts and kulikuli at the corner of the street.

She has been really hopeful about taking her business to the next level with savings from profits but she has been forced to spend them all on two occasions to keep her children alive when the usual fever struck and she had to pay for hospital admissions when medicines from the local herbalist were not producing the desired results. She hopes the little baby on her back can fight off the fever without needing hospital admission, it will do a lot for her business and their collective well-being.

How did we become so poor?

At the time when it was established, the University College Hospital Ibadan was pretty standard and Ben Murray-Bruce further adds that when he was a kid in the 60s the same hospital served the Saudi Royal family. Economically we were not doing so bad either, so how did it all go wrong?

It Starts with A Little Structural Adjustment

Structural Adjustment Programmes were proposed by the IMF and the World Bank as conditions for loans and repayment. To attract investment, developing countries enter a spiraling race to the bottom to see who can provide the lowest standard, reduce wages and cheaper resources. This has led to cutbacks in health and education and other vital services leading to increased poverty and inequality for most people.

Then some grand theft

Again, according to Oxfam, between 1960 and 2005, about $20 trillion was stolen from the treasury by public office holders. This amount is larger than the GDP of the United States in 2012 (about $18 trillion). The bulk of Nigeria’s inequality stems from this industrial-scale plundering.

More of Nigeria's wealth lies in the hands of elites close to power than with the people. Those who have access to the oil wealth through politics have been the major recipients of the country’s wealth.

The high rate of unemployment, endemic corruption, the lack of basic social amenities for millions of people, the difficulty in doing business and the millions living in poverty are all consequences of the huge inequality in Nigeria.

Nigeria’s wealth is concentrated in the hands of people not employing others, as a result of which, every time a billionaire is created it equally means creating thousands of impoverished people.

- Sanusi Lamido Sanusi

Reduced budgetary allocation for healthcare

In 2012, Nigeria spent just 6.5 percent of its national budget on education and 3.5% on health – by comparison, Ghana spent 18.5% in 2012 and 12.8 in 2015. With little funding, facilities are under-equipped and understaffed, and the available staffs are poorly renumerated.

Gender inequality

Women like Aisha represent as high as 79 percent of Nigeria’s labour force but are five times less likely to own their own land than men. Women like Aisha are also less likely to have had a decent education. Over three-quarters of the poorest women in Nigeria have never been to school and 94% of them are illiterate. This reckless disregard for one half of Nigeria’s population worsens the outcome of children and the general well-being of citizens.

How much does healthcare cost?

How much exactly would have helped Aisha cater for the care of her babies and still remain steady on the journey to economic success? 

Aisha’s baby was admitted to a private hospital and then in a Tertiary Institution. Upon discharge from the hospital, jer bills totaled, N175,680 on her last admission minus an additional N38,450 for other minor expenses. 

In 2014, Nigerians spent N1.2 trillion on healthcare at an average of N72,450 for every Nigerian of which 76.19% was paid by Nigerians as the 3.7% of the budget allocated for healthcare could only cover 23.1% of our healthcare needs. This 3.7% allocation is less than the 5% average among other low-income countries and less than the 9.2% global average. 

Is the grass greener on the other side?

Not every Nigerian lives in poverty, however, 111,784,650 live free of poverty and can confidently pay for basic healthcare.

Like Bola a 49-year old diabetic woman, who presented at the emergency with an ulcer on her left big toe. The ulcer had failed to heal like an ulcer would be expected to. At some point, it started turning gangrenous. She would later learn that she had Diabetes Mellitus Foot Syndrome and would need to undergo a quick surgery to salvage her leg before all of it becomes gangrenous. She managed to pay up all her bills timely and was regular on her medications. In no time she was discharged from the ward and could be home with her family. Perfect. Right? Except it was not.

Mrs. Bola would regularly complain about the stress she was made to undergo. She would complain about the delays, she would complain about the incessant power outage in a tertiary hospital and the failure of the elevator to work even after the power had been restored. No, she did not just like to complain, her complaints were genuine and should be a cause for concern.

Quality vs Cost

The higher we go on the social class ladder; a trend begins to emerge. People complain less about the cost of healthcare and more about convenience and quality.

It is relatively better to be able to complain about the quality of healthcare than to not be able to afford it at all. What does it take to move a family from extreme poverty, out of poverty, so far out that one risky pregnancy or febrile illness in a child does not throw them right back into poverty?

Health is Wealth but more importantly, wealth is health

Hans Rosling, explains that the United Nations target of Zero poverty by the year 2030 is indeed a feasible one. He argues that to make this possible, countries will have to invest in healthcare and human development to help citizens be healthier so that citizens can further help improve the economy. He asserts that the countries do well economically when people are healthier.  He cites examples like the eradication of smallpox and the introduction of vaccines as factors that helped improve health outcomes and also the economy of countries since the 1800s.

What are we paying for?

In the last ranking of health systems by World Health Organization, Nigeria ranked 187 out of 190 countries, only ahead of Democratic Republic of Congo, Central African Republic, and Myanmar. So even before affordability becomes a problem, it is easy to be frustrated by the poor quality of care patients have to pay for.

For those who can pay for the alternative to public healthcare in Nigeria, Private health facilities offer their services albeit limited in scope and expertise and exclusive to well-to-do members of the urban population.

We cannot crowdfund our way to better healthcare

Along these lines, the weakness and gaping holes in our health system especially from an insurance point of view are evidently manifest in the rise of crowd-funded medical cases. Remember Mayowa of blessed memory, Baby Ade and most recently, Sadiq Daba as well as many other Nigerians who have resorted to platforms like Gofundme to raise funds for medical reasons. The National Health Insurance Scheme, which largely caters to public service employees, is also, as currently constituted, very limited in scope. Neither existing solutions can cater to the healthcare needs of the majority of Nigerians, who are either rural dwellers, unemployed or involved in the informal sector. In view of the aforementioned, the importance of reforming our healthcare system cannot be overemphasized.

Putting an end to poverty

How can we design a system where people are free of medical shocks from medical bills, to ensure that what should normally be happy events like the birth of twins do not become financial catastrophes so we can keep emerging families steadfast on the road to prosperity?

Governments have tried and failed

Leaders seem to be at a loss on what to do with poor people, yet they sit and watch as more poor people are created on a daily basis. Series of poverty alleviation programmes starting from 1972 with National Accelerated Food Production Programme and national Agricultural Co-operative Bank to the most recent National Poverty Eradication Programme in 2001 to take over from the recently failed Poverty Alleviation Programme.

At the current rate of 6 per minute, 8,640 people are pushed into extreme poverty every day, at this rate, in 39 years every single Nigerian alive today will be living in extreme poverty.

Poverty and inequality in Nigeria are not due to lack of resources but due to the ill-use, misallocation and misappropriation of such resources. At the root of this culture of corruption combined with a political elite out of touch with the daily struggles of the average Nigerians. This explains why too often these programmes serve as a terrible band-aid for the problem of poverty and barely lead to better outcomes in healthcare.

Chicken or Egg?

Healthcare or economic growth, which should come first? Many countries in the world today take the proven shortcut of investments in education, health and human capital development followed by massive economic growth which can further sponsor additional investments in healthcare, education, and human capital development.

This suggests that, with improvements economy, developing countries can leapfrog into the future by investing in the health and development of its citizens. These investments have been shown to yield massive returns in further economic growth and shared prosperity.

In conclusion, “Our dream is a world free of poverty”

Nigerians pay relatively less for healthcare; any further cuts will grind the system to a halt. Instead, improvements should be made to quality to encourage patronage from those who can afford it and with economies of scale coming into play, healthcare can become more affordable.

The solution to this problem would be the formation of a credible policy aimed at eradicating poverty, educating people and improving healthcare. The clock is ticking.

Recommendations

Bring education to the extremely poor to enable them to have better jobs – To solve the problem of healthcare, we first have to solve poverty. Most of our healthcare problems feed on poverty and a side of ignorance. Empowering people to help themselves be better is a guaranteed shortcut to shared prosperity.

Focus on human capital development over GDP – People should be trained to add value and provided with work opportunities so they can earn a living to take care of themselves. In the race against poverty to better healthcare, it is people first, infrastructure second.

Better channeled aid – Aid should be specifically applied to regions that need it. A blanket approach to aid delivery would no longer produce the desired results in this final stage of poverty eradication

Leave no child or woman behind – Immunization and education of all children is the key to breaking poverty. Keep children free of diseases, in school and on the path to success.

Reward hard work, not wealth – People should be rewarded for the input they make and not for how much they already have.

Depoliticize solutions – Take them out of the hands of government and away from the corridors of politics and into the hands of independent, trustworthy organizations that uphold fairness and equity.

Quality over affordability – Improve quality of healthcare to encourage patronage from those who can afford it, this will help keep the system revolving and open to lower income earners

Governments should invest in programs and projects that will be beneficial to improving the lives of the poor – to open opportunities for them to lift themselves out of poverty. More schools, better sanitation, a cleaner environment and more income opportunities.

Basic infrastructure should be provided - Give people living without electricity access to renewable energy, good roads, and proper sanitation.

Active involvement in governance – Given the critical nature of poverty and how lives can hang in the balance when health needs come knocking, citizens now more than ever need to participate in government. Platforms like BudgitNg, Trackka, and Public Senate are doing a good job of making open the activities of the government.

Primary care is primary – People should seek healthcare as soon as possible to avoid delays that would make otherwise simple conditions become complicated.

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