Tales from around the country

It is fashionable in this present time to ceaselessly analyse what is wrong with healthcare delivery in our country. In doing so, people relate to the excellent facilities and dedicated personnel found in the OECD countries.

OECD stands for the Organisation for Economic Cooperation and Development, a group of some 38 of the world's most economically privileged nations.

Many of these nations also have some of the highest per capita rates of exchange in the world in addition to possessing large amounts of disposable income.

The last criterion knocks out countries like China and India from membership of this select group. The consequence of that exclusion means that Nigerians must stop comparing the quality of healthcare in our country with some of the members of the OECD because we can neither afford the capital investment necessary to bring our healthcare facilities to such standards nor afford the remuneration of the manpower that will run such facilities.

It is common sense, therefore, that we must reduce our focus on esoteric illnesses that afflict only a handful of our fellow citizens and concentrate on those which still afflict the majority of us.

According to the United Nations Children's Emergency Fund, preventable or treatable infectious diseases such as malaria, measles, pneumonia, HIV/AIDS and diarrhoea account for nearly three-quarters of all under-five deaths in Nigeria.

There is no doubt that Nigeria faces immense health challenges, and the statistics are quite sobering. Our country is responsible for a large percentage of the total number of under-five mortalities in the world. Within our borders, about one million children under the age of five years die every year.

Among this scary number, over 70 percent of the victims succumb to one or more of the five health conditions mentioned above.

Annually, an estimated 20,000 people of our country travel to India in search of medical solutions to their problems and this is mainly due to the fact that the referral system in our country is dysfunctional, and resources are allocated usually at the whim of the latest sheriffs in the capital.

Things are so bad that some states in the northern part of the country employ Egyptian, Indian and Pakistani doctors, and place them on a dollar-denominated salary scale when thousands of their countrymen stay without employment, principally due to where they come from.

These states also usually refuse to offer them proper employment and would rather offer them contract jobs. The results, especially in the states who engage in these practices are predictable because some of these foreign mutations are probably some of the least capable hands among their cadre and they look for a suitably corrupt country to make their livelihood.

In those states, it benefits the senior civil servants of the health ministries because, in a typically Nigerian fashion, they obtain a cut from every expatriate's income.

While it pays them handsomely in that regard, the majority suffers.

The statistics are not cheery as five countries of the world account for half of all newborn deaths and Nigeria is the third on that list.

Other senior members of the sad graphic are India and Pakistan.

Last year, almost ten percent of all newborn deaths in the world occurred in Nigeria, according to a report by the World Health Organisation.

Most of these fatalities involving the newborn cohort of the childhood population occurred in two regions of the world that are also among the most populous – south Asia and sub-Saharan Africa.

According to data from the Central Bank of Nigeria, in the 10 years between 2011 and the first quarter of 2021, our fellow citizens spent more than 11bn US dollars on health-related services abroad, and an average of 1bn US dollars per annum mostly expended across four main areas.

These are oncology or cancer-related treatment, orthopaedics, cardiology or heart-related ailments and kidney-related conditions. During the same period, there was a systematic decline in the proportion of allocations to the public health sector across the country. The bottom line in this sordid state of affairs is not just the above reality alone but the added fact that even within the country, there are very serious quality healthcare providers available for the right amount of expenditure. But how many of us ordinary citizens can afford a CT angiogram of a lower limb for a quarter of a million Naira in a private health facility in a country where the minimum wage is thirty thousand Naira?

Yet, the vast majority of the people whose children suffer and die from the five disease conditions mentioned above belong to the latter category of income earners or come from households that subsist on less than two US dollars per day.

While the highly trained specialists can remain in teaching hospitals, federal medical centres and some niche private healthcare facilities around the country, there has to be a way to encourage the deployment and retention in the secondary care facilities of those lower cadre professionals that would continue to provide for the underserved members of the population.

This is the irreducible minimum that needs to be applied if we are to significantly downgrade the scourge of preventable deaths currently plaguing that segment of the population.

And it does not stop there because even the physical condition of the facilities needs to be improved regularly in order to cater to an increasing population.

It is irrelevant to speculate on the static nature of a hospital or primary health care built some 20-25 years ago remaining just the way it was even as the population using the facility has multiplied three times over.

Sadly, except in reproducible circumstances, every project that is approved in Nigeria is often based on estimates of the catchment area's population that will make use of it.

The real census is a mirage and that is another unfortunate aspect of our ability to plan and project developmental patterns. The first step, however, in this direction is to significantly scale up the allocation to healthcare.

Very often, even planners at the ministry level of implementation of government decisions confuse recurrent expenditure mainly devoted to salaries and emoluments as reflective of spending for healthcare; it is not so.

There needs to be sustained increases in the level of qualitative hardware investment across all hospitals according to their category over a sustained period of time before we can claim that expenditure on healthcare has improved.

Besides, Nigerian professionals in that sector ought to be able to work anywhere in the country with the normal employment parameters.

It is unpatriotic to employ an Ibibio doctor in the Zamfara Health Management Board on contract while the Lagos Health Management Board would give regular employment to an Abia doctor. The former government shortchanges its citizens and the latter gains from locally available manpower without hindrances and the ordinary people benefit from the reality.

The implications for the vulnerable individuals who need to overcome the debilitating effects of those five disease conditions would be huge. Sadly, though, the healthcare facilities in the country have suffered from incompetent management, and an attachment to primordial considerations while the deployment of the most politically connected individuals to purely professional roles in those facilities will continue to diminish efforts devoted by others to produce the best outcomes.

When the people of Nigeria have decided at some point that enough unwarranted deaths have occurred in all these facilities, they will act with decisiveness to save the most vulnerable people among them. Nothing else will produce the kind of quality healthcare which we all want.