By Muhammad Hassan-Tom
NIGERIANS are still basking in the glory of the nation’s successful certification as a Wild Polio Virus (WPV) free country. Nigeria’s efforts in breaking free from the killer disease is also still being celebrated by all Africans. Nigeria’s certification also set the entire African continent free of the virus. The citizens of the world are indeed exceedingly happy with the government for this singular achievement. For, in ridding the country of the wild polio virus, the country has contributed immensely in shrinking the capacity of the virus to maim, cripple or kill children around the world.
Nigeria has won two tough wars; the war against the Ebola Virus Disease and the war against the wild polio virus. These are no mean feats. President Muhammadu Buhari has written his name in gold for defeating the WPV but then there are many more vicious battles ahead.
Over 70% of the Nigerian populace are dependent on PHC as their first and closest access to health care. Therefore, Nigeria cannot afford to sit pretty with majority of its primary healthcare centres looking torn apart, desolate and obviously incapable of providing care. Their infrastructures are poor and they are lacking in the human resources needed to render the required services. They are poorly funded by the states and local governments whose constitutional responsibilities are to build them, employ staff, equip and run them because the PHCs are their own. We must acknowledge without mincing words that most states and local governments have failed to effectively run the Primary Health Care Centres (PHCs). This has made it impossible to provide quality health service to majority of Nigerians who live in the rural areas and have neither the resources nor the alternatives to access care elsewhere.
Research has shown that there is a yawning gap of up to 78% of the required health workers to effectively man these PHCs. The sad fact, however, is that an avalanche of enough trained personnel are walking the streets, unemployed. Furthermore, over 60% of PHCs in Nigeria are without the minimal infrastructural requirements for basic PHC operations.
Data from the World Health Organization indicate that one in every five Nigerian adults, is likely to die prematurely from non-communicable diseases and most of these deaths would likely happen near a primary healthcare facility that will not be able to save them.
Nigeria accounts for about 917 maternal mortality per 100,000 mothers. In Nigeria, according to WHO, a woman has 1 in 22 lifetime risk of dying during pregnancy and childbirth.
One out of every 10 children less than-5 years that dies in the world is a Nigerian. A research has revealed that every day in Nigeria approximately 145 women die from preventable causes related to pregnancy and childbirth. This is equivalent to having one Boeing 737-300 series airplane, fully loaded with 145 women crashing every single day in Nigeria and killing everyone on board. The research also says approximately 2,300 children under-five years die mainly from preventable causes. This is equivalent to 15 Boeing 737-300 series airplanes, fully loaded with children under-five years, crashing every single day in Nigeria and killing all the children on board.
It is little wonder that because the nation has failed to appropriately prioritize its PHC system, a UNICEF report indicates that Nigeria has become the world’s highest contributor to the deaths of under-5 children. Nigeria recently overtook India to earn the unenviable position. Nigeria recorded an estimated average of 858,000 under-five deaths as against India’s 824,000 under-five deaths. India’s population is over one billion while Nigeria’s is about 200 million. This shows that a much larger chunk of the percentage of under-five deaths occur in Nigeria compared to any other country of the world. The World Health Organization has also described Nigeria as a country with the worst maternal mortality rate in the world.
These grim statistics are greatly unsettling for all well-meaning Nigerians. However, tackling the menace of poor funding for PHCs through a greatly improved funding will certainly improve the situation. Leaving the financing of primary healthcare in the hands of the states and local governments will do this country no good.
Often, many local government officials tend not to prioritize health matters; where they do at all, the amount of attention is highly negligible. They consider health workers’ pay as too huge, so they would rather employ non-health workers at PHCs. In some other states, few health workers are employed but they are subjected to massive pay cuts, monthly, thereby deepening the crisis, thus compromising quality health services across the country.
Considering the mind-boggling figures of child deaths and those of pregnant women and other Nigerians who deserve to have quality health service, it can as well be said that the PHC system in Nigeria, as run by most states and local government councils is a near failed system.
Perhaps, we can only, as Nigerians appreciate the level of the embarrassment when we compare the state of our PHCs with those of our smaller neighbouring countries. Ghana, Burkina Faso, South Africa, Rwanda, Kenya, etc., all have better PHCs than Nigeria and the general health statistics in those countries are better than Nigeria’s.
For instance, the percentage of Nigerians living in poverty is 54%, Rwanda’s is 39%, Kenya’s is 37%, in Ghana it’s 12%, Burkina Faso’s is 44% while in South Africa it’s 19%.
For maternal deaths per 100,000 live births, Nigeria tops them all with 917 deaths, Rwanda 290, Kenya is 324, Ghana’s is 319, Burkina Faso has 371 while South Africa’s is 138.
The percentage of health spending on PHC has the following statistics: South Africa has 30%, in Burkina Faso it is 69%, Ghana’s is 83%, Kenya has 57%, Rwanda’s is 71% while Nigeria trails behind with a lowly 8.1%.
These statistics clearly indicate how bad our situation is in relation to the nation’s poverty index and high death ratios for mothers, pregnant women and the under-5 children in Nigeria.
How did we get here? It’s surprising that Nigeria brags and dubs self as Africa’s superpower nation but when the chips are down in what matters the most, such as the health of the people, the country proves to be the giant on clay feet.
In consideration of the weakness in the primary healthcare delivery system, the federal government thought it worthy to initiate the Basic Health Care Provision Fund (BHCPF), a major component of the National Health Act of 2014. It was however, President Muhammadu Buhari that signed it into the 2019 fiscal budget. The BHCPF is designed to provide free minimum basic healthcare to the poorest and most vulnerable Nigerians in all the accredited PHCs in the 36 states and the FCT; a very laudable step in the right direction for which the federal government must be commended. However, the BHCPF gateway caters for only 1.2 million Nigerians. And this is a far cry from meeting the basic health needs of 200 million Nigerians.
A research has indicated that Nigeria will require about N2.5 trillion to fund PHC interventions in 10,000 wards from 2021-2030; significant amount of which will go to Human Resources for Health in line with the Federal Government PHC Revitalization Agenda.
While the initiative of the federal government to intervene in PHC revitalization by releasing the Basic Health Care Provision Fund is laudable, the fund is, however, grossly inadequate and needs to be substantially reviewed upward if the nation truly wants to avoid the human disasters that occur daily in the country as a result of the poor state of the PHC system.
To turn the table against avoidable deaths from the poor state of primary health care services, the federal government would need to take a few more steps; increasing the BHCPF includes the steps government needs to take, while Nigeria’s private sector players, donors, development partners and other stakeholders must do all that that it takes to bring huge funds on the table. This way, perhaps in 10 years, Nigeria’s PHC system might be at par with those of other sister African countries.
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Hassan-Tom writes from Kaduna.
