Paul ADEPOJU

Nigerian Health Care System – A Ticking Time Bomb (1)

At the International Health Conference, New York, (19 June – 22 July 1946); an harmonized all-encompassing definition of ‘health’ was postulated, accepted and signed on 22 July 1946 by the representatives of the 61- member states of the World Health Organization (Official Records of the World Health Organization, no. 2, p. 100) and enforced on 7 April 1948. The pact defined health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity as widely assumed. And till date, this definition holds sway as the hallmark and foundational basis of all health systems in most regions of the world.
Apart from the WHO whose major role as an offshoot of the United Nations is to ensure that member countries have closely monitored health sectors, and that health episodes of intra and international epidemiologic interests are well documented, individual countries also have central roles to play in ensuring that their citizens are healthy. According to protagonists of medical history, the most viable and far-reaching effective National Health Programme is the one that encompasses the primary, secondary and tertiary tiers of government, and health infrastructures. This is the type we have in Nigeria.
Rais Akhtar in one of his numerous publications reiterated the fact that the Nigerian federal government’s role in health in recent years has been limited (restricted) to coordinating the affairs of the federal university teaching hospitals and medical centers, NAFDAC and other health- related agencies, while individual state government, through respective hospital management boards, manages the various general hospitals. The local governments in Nigeria on the other hand regulate the activities of dispensaries, pharmacies, community health centers, local maternity clinics and more recently, traditional healing homes.
In Ronald J. Vogel’s book—Financing Healthcare in Sub-Saharan Africa—Nigeria’s total expenditure on healthcare as a percentage of GDP was put at 4.6, while the percentage of federal government’s total expenditure on healthcare was (and still) a miserly paltry 1.5% when juxtaposed with the nation’s official (and muted) population size, enormous health challenges like the incessant ethnic uproars and disease-predisposing religious crisis up north. The nation is also groping with illiteracy, endemic malaria, ravaging HIV, astronomic population upsurge indicating the imminent need for improved birth control, poliomyelitis, drug adulterations (fake drugs) and several other Proudly Nigeria health-related debacles which point to the fact that very soon, if something urgent is not swiftly done, danger looms at all levels.
At the state level, the dividend of democracy—politicization of the administration and running of state-owned health institutions—spells great doom. Unlike past years when duly and ably qualified health professionals were at the helm of affairs at the General Hospitals, it is gradually becoming a familiar scenario, especially in South Western Nigeria, for opulent potbellied politicians to parade themselves as heads of the Hospital Management Board (HMB). Apart from the possibility of funds meant for the development of the state’s health sector growing wings or being used for a wrong cause, the yardstick with which the success or otherwise of the health sector is measured is gradually transmogrifying from the reputed overall assessment of the health of the citizens and residents, to the number of contracts awarded by the government. Oyo state is a good case study.
On its official website (www.oyostate.gov.ng), the state government’s webmaster highlighted the following state government pioneered projects as a sign that its health sector is vibrant.

• Hospital Equipment worth 70million naira was procured by the Ministry of Health to Government hospitals in the year 2007.
• Essential drugs and consumables worth N52million were procured during the period.  Contracts for the supply of Essential Drugs and consumables worth 298 million naira were also awarded to contractors in December, 2008.
• Commissioning of Health facilities, namely Cold Chain Laboratory, Eleyele, Primary Health Center, Odo-Oba, Ogo Oluwa Local Government, Butubutu, Ona-Ara Local Government and Primary Health Center, Ogbooro, Saki East Local Government.
• Construction of General Hospital, Iwere-Ile, Iwajowa Local Government is almost completed and will be ready for commissioning soon.
• Three buses were procured by Health System Development Project II [HSDP-II] for Health Institutions, namely schools of Midwifery, Nursing and Hygiene.
• Two other vehicles were procured by HSDP-II for Projects Monitoring.
• Several others

While these projects and undertakings are quite laudable, they are however inconsequential and of little significance in proving that every resident of Oyo state is healthy— physically, mentally and socially. Recent health indices give a clearer picture of the current status of the state’s health sector.
According to a recent edition of WHO Bulletin, the state still has a high incidence of poliomyelitis (a viral disease that has been declared extinct in most countries of the world). Furthermore, mental illness in Oyo state has escalated to the level that if INEC does a thorough job and fairness is ensured, mad men and women can now contest and win elections in the state. And socially, the health status of Oyo state indigenes and residents couldn’t be worse.
Social welfare services provided by the state are literally non existent, yet the state, like most Nigerian state governments, spends hundreds of millions of Naira absurdly publicizing procured equipment, renovated hospital infrastructures, free condoms, and prompt payment of health workers’ salaries as indications that the state’s Ministry of Health is healthy. The ravaging misplaced priority has also been extended to the grassroots—the primary healthcare—where the local governments had lost the confidence of the local communities.
Sometimes ago, I was at Alade Orthopeadic Hospital in Oke Adu Area of Agodi Gate, Ibadan where the owner—Dr. Moruf Alade—was happily having a busy day seeing to the health needs of his patients who religiously and astutely followed the expensive esoteric treatment regimens. While at the clinic, I coincidentally saw Egbeda Local Government’s Mobile Clinic drove bye. Unlike what is expected of an ambulance, the automobile was packed full with bananas, plantains and other perishable edibles.
Nowadays, sick citizens that can afford private services are gradually not seeing government-owned primary health centers as reliable clinics to get treatment when sick. In the same vein, privately owned motherless babies homes like the one in Total Garden, Ibadan, and Red Cross Home for the Motherless situated at Warehouse, Hospital Road Owerri, now enjoy more patronage than respective State Child Welfare Units which are fast becoming CICS offices where social workers lend and borrow money at will.
Local government chairmen nowadays are enthralled by the pictures of established health centers which would be used for canvassing for votes at the polls, and not actually meeting the health needs of the host communities. Little wonder that few months after the glamorous opening ceremony, thorns and bushes encroach on the new clinic while rats and termites become the attending patients of the drug-deprived, poorly lit and deserted Local Government Health Center. Good examples are some health centers found in Ibadan North East, Ogun Waterside and Isiala Mbano Local Government Areas of Oyo, Ogun and Imo states respectively. The National Primary Healthcare Development Agency (NPHCDA)—the agency responsible for the regulation and establishment of primary healthcare centers—is also haplessly helpless in the discharge of its saddled responsibilities of ensuring that our primary healthcare centers cater for our primary health needs.

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