I have finally decided to write again. This time, it is a subject that has been well discussed and well documented. However, solutions for the problems identified have not been actualized. That said, I have not only identified problems in the healthcare system in Nigeria, I have also proffered solutions to each of the "deadly sins", one at a time.
“There’s nothing more important than good health, it is our principal capital”
In a country of well over 200 million and a dysfunctional system of governance, it is no surprise that the health care system is in a state of such disarray. The healthcare sector albeit very important to the general well-being of a nation is unfortunately not immune from the problems facing the nation. My heart bleeds, knowing that the same problems in the healthcare sector identified some 30 years ago still persist. A look at the countless lives lost due to preventable causes and those with lifelong morbidities due to the dysfunctional state of health care in Nigeria will make even the hardest of hearts tremble. The conclusion is easy to find: we don’t care much about ourselves and our health as a nation.
As taught, “A problem is not really a problem unless you point it out to the person with the problem and he/she accepts that it is a problem”. The situation with our healthcare sector is, however different, we know there are problems. In fact, we know the problems! The number one citizen traveled to the UK for a simple ear infection a few months ago!
Nigeria is currently ranked 187 out of 191 countries by the World Health Organization in its ranking of the world’s health systems. This means the country’s health care system is worse than that of neighboring countries that are considerably poorer like Togo, Mali, and Chad and is only better than that of three countries, the Democratic Republic of Congo, Central African Republic, and Myanmar. The challenges in the healthcare sector emanated from poor planning and a lack of foresight on the part of the lawmakers. There is a dearth of knowledge, drugs and consumables, equipment, and staff, especially in rural areas. The problems are manifold, however, there are solutions in sight.
- Lack of infrastructure and proper referral system:
The provision of health care in Nigeria is controlled by the three tiers of government: the federal, state, and local governments which are in charge of the tertiary, secondary and primary health care systems respectively with the flow of referrals and sophistication of services moving from the primary health care system to the tertiary centers.
This is not the case in reality as the primary health centers are just mere dilapidated structures that lack manpower and drugs. Some of them are located so far away from some communities thereby making it impossible to access. Thus, a trader in Mushin would present first at the Lagos University Teaching Hospital – a tertiary institution; due to the failings of the primary health care scheme. Patients present first at tertiary institutions, starting a chain reaction that ends up with patients spending more time than expected to see a specialist, a larger workload for doctors in tertiary centers and atrophy of the primary health centers. One very important means of addressing the health challenges in Nigeria is to ensure that we have a functional and effective primary health care system because most Nigerians live in the rural areas.
Furthermore, there is a burning need to create more health care centers and hospitals so as to meet the requirements of the growing population. There are 59 teaching hospital and federal medical centers, 33,303 general hospitals, and 20,278 primary health centers - most constructed at a time when the population of the country was less than a third of the current population. There is a need for the current administration to create new state of the art federal health centers and teaching hospitals to meet the needs of the growing population.
Also, creation of new specialized departments at already existing teaching hospitals should be high on our list. The multiplier effect of this effect includes increased provision for internship places and resident training which is currently a case of eternal struggle due to the competition for limited spaces thereby accommodating the growing number of medical graduates and decrease the “brain-drain”