HEALTH INTERACTIVE WITH DR. AMINU MAGASHI

Health Sector Reform: What Model (Part One)

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The last time I wrote on this column was in February , this year  and a lot has happened in our dear country since then ,  that are related to Health Care Delivery System which need to be looked upon for the benefit of the larger society . The reader may wish to remember that the disappearance of this column has generated a lot of comments from stakeholders both in the print media and its internet version with a lot of speculations and perspectives as to what necessitated the disppreance of the column. In a simple language, its disppreance was as a result of communication gap and it was resolved on Wednesday, 18th May, 2005 at a meeting with the management of Trust Paper. Let me use this opportunity to thank the reading public for their concern over the disappearance of the column.

 

Coming back to our discourse on Health Sector Reform, keen observers and to some extent implementers of health projects will agree with me that, we are operating almost  a collapse health system, our problems seem to be insurmountable and couple with the fact that, we have a lot of mis-priority projects that are yielding poor result due to poor planning and performance.  In a recent research conducted by Society of Gynecologist  and Obstetricians   of Nigeria  ( SOGON ) in 6 states of Nigeria ( Lagos , Enugu , Cross River , Plateau , Borno and Kano ) , the Maternal Mortality Ratios (MMR ) of some of the states is above 3000 death /100, 1000 live birth . At the rate women are dying during pregnancy, we are approaching a scenario of having one death out of every ten live birth. Nigeria is accounting for 10 % of the global estimate of maternal mortality ratio, even though our population only accounts for about 2 % of the world population. And the irony of this aware some figures is the fact that, the majority of the causes of maternal death are preventable using simple and basic means. In line with such discovery, Nigeria has become the most unsafe place for a woman to be pregnant and go in to labour.

 

Our overall health system performance is ranked 187th among 191 member states by the World Health Organization, We only seem to be fairing better than countries devastated by war, famine and drought such as Angola , Sera Leone  and Somalia . When one looked at the efforts by the Federal Ministry of Health under the leadership of Professor Eyitayo Lambo to engineer the entire stakeholders towards achieving Health Related Millennium Development Goals (MDGs ), such as Malaria Control, which also link to reducing the impact and the burden of the disease by 50 % by 2010, one is left in a dilemma as to what the Minster and his cohorts are prescribing to the Nigerian populace towards reducing the burden of the disease.

 

Any opportunity they have, the advocacy is to replace the use of Chloroquine as a first line of drug to the use of Artemisinin derivatives as the most effective measure. The argument always is that,  Chloroquine resistance is very high  in our society and it is no longer effective and reliable.  Such argument is based on a research conducted else where, and in coastal areas to warrant eliminating a cheaper drug and replacing it with far more expensive drug beyond the affordability of many Nigerians. The Minister and his cohorts are not interested in what led to the resistance; whether it is the drug it self or behavioral factors in the society such as over and /or under dosages, fake, expired and adulterated drugs in the market and so on. Since the generality of the populace cannot afford the exorbitant price of what is been forcefully recommended, they resort to traditional form of medication despite its set back.

 

Other problems of the health sector are: poor performance of existing health systems, consumers unhappy about poor treatment, public expenditures skewed toward rich and neglect the poor, particularly women, resources are scarce, demands increasing, forcing governments/donors to be strategic, and of course there is a Donor fatigue by development partners and partly their own fault and issue of sustainability and economic crises. Other problems are related to Routine Immunization coverage rate which in the past had reached up to 80 %, but quite disheartening, currently it is about 13 % coverage. There are a very high proportion of primary health care facilities which serve only about 5-10 % of their potential patient load due to consumer’s loss of confidence in them, our secondary health care facilities are in shamble and terrible condition, diagnostic and investigative equipments in tertiary health institutions are outdated and lastly the referral system between various types of facilities is non functional or ineffective.

 

I can go on and on, but, having said that, there is a strong need for Health Sector Reform at all the three tiers of government, the reform that is needed, has to be sustained and purposeful change to improve the performance of the health sector. It has to be motivated by the need to address fundamental deficiencies in health care systems that affect all services including Reproductive Health   and also it need to be a political process and to be implemented on a sector –wide level .

 

Looking at the Nigeria’s health sector reform document ( 2004-2007 ) emanating from the Federal Ministry  Of Health  and the expected Health Care Bill which if passed will become an  Act , also jointly drafted by Federal Ministries of Health and Justice  , one can say that most of the strategies raised are in line with the National Economic Empowerment and Development Strategy (NEEDS ) , Nigeria’s home grown poverty reduction strategy aimed at building a solid foundation for the attainment of Nigeria’s long term vision of becoming the largest and strongest African economy and a key player in the world economy . The thrust of NEEDS is to reform government and institutions ensure growth of private sector, implementing a social charter and ensuring economic growth.

 

I am very much convince that our health system need to be reform, but however it has to be reform in such a way that the common man will be at the center and the reform will be geared towards achieving the reduction of maternal mortality, child mortality and involving the poor masses and beneficiaries in designing and implementing programmes under the reform

 

Dr Magashi is the Executive Director of Community Health and Research Initiative, Kano, Nigeria