Nigeria’s Health Policy and Health Care Delivery
(Conscience Triumph Editorial of August edition, 2013)
Health is complementary to education and is second in the development of human resources – in fact, in many developing countries. To bring more development in the health sector, there is the need for free medical services, which is a major requirement for the citizens. There is a second school of thought that the country cannot afford the provision of free medical services because of the cost implication. We believe that the strategy should aim at ensuring that the average citizen has access to medical care and other facilities to enable the individual attain a reasonable high health status and long life expectancy. All we have seen are strategies directed to promote the wellbeing of the few privileged minority. The specialists/teaching hospitals are urban-based and highly centralized.
Nigeria’s national health policy states broadly how the nation’s health problems will be tackled so that our citizens can be in a “state of complete physical, mental and social well-being, and not merely have an absence of disease or infirmity.” Most diseases that disrupt their lives and even cause deaths are easily preventable, or can be treated, with simple remedies if diagnosed early. It is also stated in the constitution that primary health is the responsibility of local governments and to be assisted by States and Federal Government.
Late Professor Ransome-Kuti, the then Federal Minister of Health, and based on many studies from various parts of the country, which provided a good picture of their state of health concluded that, “the majority of the diseases are caused by factors in the community. The absence of potable water supply and poor disposal of solid waste are recognized predisposing factors to the appearance of diseases in any community. There are other equally and, perhaps more important, social and economic factors, which contribute to the morbid state of the environment.” He further said that, 80% of babies were delivered in an unhealthy environment and by unskilled attendants.
When they delivered in a hospital or health centers, they were discharged into a contaminated environment within 48 hours, and they soon returned to the hospital ill and infected. We know that there are many cultural blocks to the attainment of good health.
In a National Health Policy Declaration, the Federal, State and Local Governments committed themselves to “intensive action to attack the goal of health for all citizens by the year 2000 and beyond; that is a level of health that will permit to lead – socially and economically, productive lives to the highest possible standard.” At present, the health service showed major defects in that the coverage is inadequate. It is estimated that only 35% of the population has access to modern health care services. The rural committees and the urban poor are not well served.
There appears to be disproportionate high investment curative services to the detriment of preventive services. The financial resources allocated to the health services, especially to the Local Government areas, are being stolen by the respective State Governors and so the Local Government Councils health services are not functioning, and if some are, the meager funds made available to them are inadequate to permit them to function effectively. In all, the basic infrastructure and logistic supports are often defective owing to inadequate maintenance of buildings, medical equipment and vehicles, unreliable water and electricity supply, poor management of drugs, vaccines and supplies systems.
The Primary Health Care ought to have been established by now at the level of government nearest to the people. The strategy of setting up the system at Local Government level for the attainment of health for all Nigerians by the year 2000 remained unattainable. It is sad that we cannot make health services available and accessible to every Nigerian at a cost they can afford and maintain, at the level of their present development. Based on the pattern of our health problems and services designed to tackle them, we need the proper cadres of staff identified to man the primary health care services such as the community health officers, supervisors, assistant supervisors and their aides. The Aides can be continuously trained in our schools of Health Technology. There is also an urgent need to resuscitate the Sanitary Inspection Office in our health service – a service which was very much beneficial during the colonial era. The Sanitary Inspectors could be equally trained in institutes of Health Technology to meet the demand of our present health challenges.
The present development ensured the provision of medical care for a substantially smaller proportion of the population rather than its reverse. The focus should be geared towards medical education and manpower development. At the moment there is gross inadequacy of medical manpower doctors and all skilled health workers. The ratio of doctor-to-persons in the population is most inadequate. Government should develop alternative strategies to emphasize the in-training of middle-cadre workers because of the group is more or less the corner-stone of health manpower in the country. More funds should be channelled towards preventive measures to prevent the major causes of death. The country’s health sector should take into consideration the reality of the country’s well-being of the nation rather than that of a small proportion of the population. The drug scene is in a mess. It has resisted all measures taken to bring it under control. The high cost of drugs and its heavy consumption by our people are major contributors to the problem. Moreover, there is evidence of gross misuse of drugs and the appearance of large quantity of fake drugs in the market. The size of the problem is far beyond the resources of the law enforcement agencies and the Inspectorate Division of the Ministry of Health to tackle. The methods of drug procurement and its utilization in our health institutions need to be subjected to strict accountability, to minimize theft and misuse. There is the need to monitor the traditional medicine practitioners so that they maintain high ethical practices since they have been exerting a great deal of influence at the Primary Health Care level in the communities where they are well known and respected for their skills.