Corruption in the Nigerian Health Sector: Time to Right the Wrongs

By

Dr. Rabiatu Hadi

docrahad@yahoo.com

 

 

Chinua Achebe in his book, ‘The trouble with Nigeria’ (1983) wrote ‘’ the trouble with Nigeria is simply and squarely a failure of leadership. There is nothing basically wrong with the Nigerian character. There is nothing wrong with the Nigerian Land or climate or water or air or anything else. The Nigerian problem is the unwillingness or inability of its leaders to rise to the responsibility, the challenge of personal example which are the hallmarks of true leadership…………I am saying that Nigeria can change today if she discovers true leaders who have the will, the ability and the vision”. Nigeria, once heralded as the beacon of Africa, has since fallen short of this potential. Years of kleptocratic, repressive dictators coupled with widespread corruption, have resulted in large -scale neglect and deterioration of public services. No where is this more apparent than within the health sector! A renowned political analyst once said “there are 3 vital areas a responsible government must never allow the private sector to dominate – Health, Education and Security”.

 

Nigeria bears witness to some of the worst health-care statistics in the world and comes close to the bottom of virtually every development index. Most of other countries that are ranked higher than Nigeria have suffered significant internal conflict and have considerably lower per capita gross domestic products. In 2000, the World Health Organization ranked the Nigerian health system in 187th place out of 191 countries evaluated. According to UNDP, life expectancy in Nigeria has declined to 43 years (2006) from 47 in 1990.  In contrast, life expectancy in Malaysia, which attained nationhood at the same time as Nigeria, has now reached 70 years. Over 50,000 Nigerian women die from child birth every year (equivalent to a plane carrying 140 people crashing every single day). Nigeria accounts for 10% of the world’s maternal deaths in child birth whereas the country represents 2% of the world’s population. One in five Nigerian children dies before his/her 5th birthday.  About a million Nigerian children die of preventable causes every year. Only 18% of Nigerian children are fully immunized by their first birthday. Malaria kills more Nigerians than any other disease, and yet less than 5% of its population have access to insecticide treated nets proven to be effective in preventing malaria. The Nigerian Government at all levels spends less than 5% of public expenditure on health, despite being signatory to the 2000 Abuja Declaration to increase this to 15%. For crying out loud, Over 75% of the Millennium Development Goals are health related!

 

A poorly structured health service that relies on vertical programmes for HIV, TB and Malaria means that coordination is chaotic, and already scanty resources fail to reach the lower levels in which they are needed most. Each component of the three-tier governance structure – Federal, State and Local government is involved in the provision of health care, which results in chaotic coordination and communication, poor accountability, and considerable disparities throughout the country.

 

Now back to basics, the Nigerian Primary Health Care system is in a state of total collapse. Primary Health Care centres are dilapidated structures decorated with expired drugs and cob webs and have become in many places inhabitants for domestic animals. In many tertiary and secondary health centres, ordinary water supply is not available, not to talk of availability of power supply and essential drugs.

 

Corruption is defined by Transparency International as ‘misuse of entrusted power for private gain’. Corruption occurs when public officials who have been given the authority to carry out goals which further the public good, instead use their position and power to benefit themselves and those close to them. Corruption is a pervasive problem affecting the Nigerian health sector. At the level of individuals and households, there is mounting evidence of the negative effects of corruption on health and welfare of citizens. There is increasing interest among Nigerians and international donors in how corruption affects health care access and outcomes, and what could be done to combat corruption in the health sector. The table below shows the types of corruption in the health sector and their resultant effects on health care delivery as cuddled from the book, Fighting corruption in developing countries’ by Vian T.

 

In the face of the immediate and enormous need, improvements within the health-care sector are not yet encouraging enough. International support exists but, the benefits have not yet reached a local level, and there is pressing need for the government to move from rhetoric to solid commitment if these benefits are to be seen in the near future.

 

Whether the next Health Minister can rectify the damage of the past and the present and weed out a systematic level of corruption remains to be seen. Either way, monumental challenges lie ahead! Good luck Nigeria.