The recent medical trip of President Muhammadu Buhari to the United Kingdom has raised a lot of questions about the health sector in Nigeria. I decided to field some questions via email to Dr. Davies Adeloye, a Senior Lecturer at Covenant University about his thoughts on the Nigerian health system. Below are his responses in part two of a two-part interview series.
Tell us about the National Health Bill of 2014?
Nigeria’s National Health Bill (NHB) was signed into law by President Goodluck Jonathan on December 9, 2014. In 2006, the NHB was first presented to the National Assembly, and passed by the Senate in 2008, but only made it through the House of Representatives in May 2011. It was however not approved by the then President Goodluck Jonathan due to diverse disagreements and interests among health professionals and various stakeholders.
In 2011, the Senate began another series of deliberations, and it was eventually passed in February 19, 2013. The aim of the Act is to establish a framework for the regulation, development and management of a national health system, to set standards for rendering health services in the federation and other matters concerned therewith. The act is set to achieve universal health coverage, eliminate quackery, and provide basic health funds needed by Nigerians.
It will address the provision of a package of basic healthcare services and insurance, including free medical care for children under five years, pregnant mothers, and elderly people with disabilities. It addresses provisions of improved funding of health care services at the grass roots so that Nigerians don’t have to travel far to access medical services.
It specifically addresses vexatious issues of medical tourism plaguing the health sector, stating that that ailments that can be treated in Nigeria will no longer be referred abroad. The basic health care provision fund shall be financed from the Federal Government Annual Grant of not less than 1% of its Consolidated Revenue Fund and grants by international donor partners, while the state and local governments will provide counterpart fund to support primary health care services. The challenge, as with other bills in Nigeria, is implementation. As it’s obvious now, the national system hardly respect or carry out the provisions of this bill.
What are the mortality health statistics in the country?
Infant Mortality Rate: 69 per 1000 live births
Under 5 Mortality Rate: 109 per 1000 live births
Maternal Mortality Ratio: 814 per 100000 live births
Probability of dying between 15 and 60 years: 341 per 1000 population
Life expectancy for men and women
Men: 53 years; Women: 56 years
Morbidity rate per thousand
Morbidity refers to number of people affected by a disease. So this has to be cause or disease specific. That is the prevalence/incidence of a specific disease.
What is the current state of response to health emergencies in the country?
Very Poor. Nigeria does not have a National pre-hospital system or an ambulance service. Some state and privately owned ambulance services are operational, eg. the LASAMBUS in Lagos. There is also the flying doctors rendering helicopter services. How many people have reported benefiting from their services? Any audit or research on these? There is no widely known central emergency call line. FRSC and police, perhaps, have…, how useful have these been? The NEMA, FRSC, police, military, and trauma centers just need to be overhauled.
Kindly let us know the prevalent terminal disease in the country?
There is poor routine health information and data collation in Nigeria. So this is quite difficult to state. However, based on the limited evidence we have, the most prevalent terminal illness in Nigeria is chronic kidney disease, chronic liver disease, and cancers (mainly cervical, breast, prostate and colorectal).
Are the medical facilities sufficient for 170 million Nigerians?
In the last NMA congress held in Sokoto, the Minister of Health announced plans to implement the National Malaria Strategic Plan 2014-2020. Malaria contributes hugely to the disease burden in Nigeria, hence, this is will have positive effects in the health sector. However, this is quite an ambitious project considering the current state of our health system, but I share the minister’s optimism, especially with what we were able to achieve during the ebola outbreak in Nigeria. The vision is to have a MALARIA FREE NIGERIA. The mission is to provide equitable, comprehensive, cost effective, efficient and quality malaria control services ensuring transparency, accountability, client satisfaction, community ownership and partnership. The goal is to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero.
What singular act of the President Muhammadu Buhari led administration will radically change the medical profession in Nigeria?
Bring experts together to work on a self-sustainable National Health Insurance Scheme (NHIS). We can learn from the NHS scheme in the UK and other insurance schemes in developed countries. From the funds generated in the NHIS and managed by credible Foreign Experts (at least for now), the Nigerian Health System may sufficiently provide free health services, pay her health workforce salaries, address ill-equipped health facilities, and see to further clinical and public health research.
Read Dr. Davies Adeloye responses to part one of this interview series where he covers doctor to patient ratios, specialists in Nigeria, and health workers going on strike here.