Posted by The Vanguard on
IT has never been rosy for Nigeria's health sector. The reality of several competing national priorities like education and physical infrastructures had been chronic under-funding of the health sector.
IT has never been rosy for Nigeria's health sector. The reality of several competing national priorities like education and physical infrastructures had been chronic under-funding of the health sector. The servicing of Nigeria's huge external debt burden with over one-third of the country's national budget further diverted funds that could have been allocated to the social sector, including health.
Nigeria was ranked a dismal 187th position among the 191 UN member states by the World Health Organisation in 2000. Nigeria was only ahead of Democratic Republic of Congo, the Central African Republic, Myanmar, and Sierra Leone! Nigeria had one of the lowest national health budgets in Africa. Nigeria in 2000 spent four dollars per capita on health compared to the 14 dollars, which was the global minimum recommended by WHO for developing countries.
Not surprisingly, many Nigerians, especially women and children and in particular the poorest of the poor, die from avoidable health problems such as preventable infectious diseases, malnutrition, as well as complications of pregnancy and child birth. This of course has translated to a perpetually tragically low life-expectancy for Nigerians.
Despite the conscious efforts of the current civilian administration, things have not considerably improved. Nigeria's per capita health expenditure in 2001 was $15 compared with $29 for sub-Saharan Africa (SSA), $222 for South Africa and $2, 841 for High Income Countries. Nigeria had 19 physicians per 100,000 people between 1990 and 1999 compared with 65 for South Africa.
Little wonder, access to healthcare is severely limited. The quality of health services and facilities is very low. Health service facilities at all levels are either dilapidated, poorly equipped or dysfunctional. The health referral system is simply non-operational. The poor management and deployment of the available health personnel translate to inefficient and ineffective health service delivery.
Expectedly, health consumers are disillusioned and dissatisfied with the general inaccessibility and low quality of healthcare. Fake, sub-standard, adulterated and unregistered drugs are widespread in the Nigerian drug market. Supplies of safe and affordable essential drugs and other health consumables are irregular and erratic.
While one, for patriotic reasons, may be reluctant to describe the nation's health sector as comatose, there is no doubt that Nigeria's health sector is distressed and unable to deliver a minimum package of quality primary healthcare, including routine immunization, emergency obstetric care, prevention and management of communicable diseases and infections, especially malaria, tuberculosis, and HIV/AIDS.
Little wonder that those who can afford it vote with their feet by flying to foreign lands for medical check-ups, routine health treatments and child delivery rather than trust their lives or those of their relations to our near-coma health delivery system. Unfortunately most of the lucky ones who can exercise this option and cast their vote of no confidence in our health sector are our political leaders and policy makers who should strengthen our health sector and their rich business counterparts who can and should invest needed funds in our health industry.
It is against this background that one must commend the courageous, even though slow, health reform initiatives of the President Olusegun Obasanjo's civilian administration. The objective is a comprehensive Health Sector Reform in order to reposition the public sector to be more responsible and responsive to the health needs of Nigerians and to ensure that we live healthier, longer and more productive lives. It is hoped that by year 2010, Nigeria will have an effective and affordable health delivery system that meets the needs of the empowered populace through the integration of relevant services by all stakeholders and sustained partnership with all sectors of the society.
One of the major strategies for effecting the needed change in function, form, structure and performance of Nigeria's health system is the National Health Insurance Scheme. Like all insurance schemes, the NHIS entails gradually putting funds aside while you are healthy to take care of you when you are sick or ill. It entails contributions from the government, employers of labour, workers and other prospective beneficiaries. A functional health insurance scheme would necessarily be participatory and inclusive as well as private sector-led and government-regulated. It at once ensures better funding and improved health expenditure as well as makes the health bill easier to bear by government, employers, employees and other users.
A well conceived and implemented National Health Insurance Scheme would ensure comprehensive healthcare coverage and improved healthcare delivery at primary, secondary and tertiary levels. Under it, there will be graduation of healthcare needs and problems to be attended to by the Primary Health Care, Secondary Health Care and Tertiary Health Care facilities as occasions demand. The referral system will be resuscitated as the community health centres, dispensaries and maternities, general hospitals, and specialist/teaching hospitals take their proper places in the health delivery chain.
The National Health Insurance Scheme will considerably improve access to health services and facilities (that is decrease physical distance to health amenities), enhance quality and increase affordability. However, like all reform initiatives, whose benefits are still in the womb of time, the NHIS needs to be sold through social marketing to would be beneficiaries of the programme. President Obasanjo's civilian administration will be bequeathing to Nigerians a great and enviable legacy if he could put in place a functional National Health Insurance Scheme before bowing out of office in 2007.
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