HEALTH INTERACTIVE WITH DR. AMINU MAGASHI

The Need to Reform Nigeria’s Health Sector (Part One)

Sadness, Anger and Frustration characterized my behaviour on Tuesday, 13^th March 2007 when I sent one email message  to more than 100 people ranging from friends , partners and senior colleagues about the sorry state of Nigeria’s Health Sector . In that email I mentioned that “if our leaders and many others are made to go to hospitals in Nigeria -- may be they will fix the Health Sector.” I also attached a picture to the message adopted from http://hrw.org/reports/2007/nigeria0107/index.htm . The pic shows an overnight patient facilities in a Comprehensive Primary Health Care Centre run by Etche Local Government in Rivers State . “The floors were caked with mud and strewn with vaccines ruined during a recent flood. The centre had no mattresses, toilet facilities, or other basic amenities.” In the same pic a Jet is shown purchase by  Rivers State Government "Our Lady Queen of Victories"... which claims doubles as air-ambulance... that  costs $US 11 million [ 1.375 billion Naira] .

I concluded my short message that “We shall never give up. We shall continue to raise issues until the right people step in to make changes.”  Within a span of two weeks, many events happened in Nigeria which were directly linked to our Health Sector that is approaching total collapse. Doctors under the auspices of Nigerian Medical Association were on strike and two presidential candidates reportedly over minor ailments were flown abroad seeking for medical care. The two events are a testimony and vote of no confidence on the apparent neglect of our health sector by our leaders at all levels.

Syndicating that short message to many people led to receiving more information that I bargained for reflecting the quagmire we found ourselves in Nigeria . A forwarded article written by Mr Idris Bello from Houston , USA “How the striking doctors killed my friend” revealed bitterly about the ordeal of his good friend “How do I relate how the striking doctors colluded with the Nigerian government to kill my friend? How do I narrate the events that led to the death of Mr AbdHameed on March 5, 2007 at the young age of 32” . From the sad story , his promising and brilliant friend working with an NGO had to be prematurely discharged from University College Hospital due to the doctors’ strike and his condition could not be attended to at a private clinic and invariably gave up the ghost . May his soul rest in peace.

Another story worth sharing was the Editorial Comment written by Tribune Newspaper of March 7, 2005 “Dying Abroad”. Although it was written 2 years ago, however I find it very relevant to this discourse . In that editorial , the paper argued that “This idea of getting both medical check-up and emergency medical attention in foreign lands is not foreign to the African ruling elite since independence. This trend has continued, and even increased in the last three decades, when that largely treasonable cabal that is the African post-colonial ruling elite, by their actions and inactions, began to devastate the health care delivery systems in the continent…… However, sometimes, by the time they get to Europe and the United States, it is too late for members of the African ruling elites to be saved by the medical expertise that they have failed to provide at home. Thus, they may also be choosing to die peacefully abroad.”

In many places in the past I have argued that  our hospitals especially Primary Health Centres are far away from where people live and work and are decorated with expired drugs , dilapidated structures , corrugated roofs and cob webs and have become in many places  inhabitants of domestic animals . In some tertiary and secondary health centres, ordinary water supply is not available, patients’ relatives have to resort to buying water in jerry cans, not to talk of unavailability of disposable globes, power supply and availability of essential drugs. According to 2003 National Demographic Health Survey , our Immunisation coverage is put at 13 % and that characterised why our children are dying everyday of preventable illnesses . Another health crisis is the rate at which women are dying of preventable and avoidable complications of Pregnancy across the entire nation. Nigeria accounts for 10 % of the global estimate of maternal death, even though our population only accounts for 2 % of the World Population.  This happens due to some cultural and social factors aggravated by lack of skilled personnel at birth and inadequate emergency maternal services to respond to the needs of the vulnerable women.

The neglected Health Sector in Nigeria is a typical example of mismanagement of resources , lack of priority and respect for the rights of citizens to health,  squandering of a mandate by our leaders , indifference  of  Health Workers unless on issues link to wages , complacency of the electorates to call their  leaders to order and say enough is enough . The resultant effect of that is a vicious cycle of health sector that will continue to dwindle and worsen off and increase migration of health workers to other countries where their services are needed and valued. In essence ‘Brain Drain’.

In his article “Why do health workers emigrate?” published by British Medical Journal ( BMJ : 2005; 331; 43-45 ) Dr Omar B Ahmad of College of Health Sciences , University of Ghana put it that “Studies focusing on why skilled health professionals emigrate have identified two broad categories: the “push” and the “pull” factors. Among the push factors are low wages, poor motivation, persistent shortages of basic medical supplies, dangerous working conditions, outdated equipment, lack of supervision, and limited career opportunities. Involuntary factors such as human rights violations, ethnic and religious tensions, political persecution, wars, and economic collapse also play a part. Economic reasons, access to professional development opportunities, and job security are among the most important pull factors.” The Nigeria’s Health Sector has perfectly fits in to this unfortunate description .

Astoundingly, Health Sector is not among the major issues of debate within the political cycle as Nigeria prepares for election by April 2007 . Reforming the health sector is left to the Federal Ministry of Health to permutate any kind of formula deem fit. The National Health Care Bill currently before the National Assembly is among the least known by Nigerians that are expected to make input before its passage . The National Health Insurance Scheme( NHIS )  , a very good mechanism of ensuring quality of life to the citizens and reducing diseases burden is not handle and implemented properly . The people driving the process lack the will, vigour , commitment and aggressiveness to pursue it in a manner that will yield positive result .

The debate and struggle about reforming and improving Health Care Delivery System in Nigeria should not  be surrendered  to only politicians and their  cronies .  It needs a lot of alignment and grouping of interested forces among health professionals, Media and Civil Societies who shall never give up the struggle until a light is seen at the end of the tunnel. Lastly the health system needs radical and vibrant leaders across all tiers of government  to lead the reform process not the current inept minister and some commissioners of health all over the federation .Recommending the way out of the doldrums and forging a reform strategy will form part of my discourse in the part two of this essay.

Dr Magashi is a Masters Student ( Public Health ) at London School of Hygiene and Tropical Medicine . He can be reached at  healthinteractive@hotmail.com or  gamagashi@gmail.com