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Good health is still a privilege, not a right in Nigeria. Here is why




DIRECTOR  General of the World Health Organisation, Tedros  Adhanom Ghebreyesus, in his speech during an event in Geneva to mark the 2019 World Health Day on Sunday said that all people deserve access to health services “when and where they need them, without financial hardship.”

He concluded by saying, health is a right and not a privilege.

The message of the WHO chief may have suggested that many Nigerians for years have been deprived of the rights to good health.

Nigeria’s investment in health care is low considering the budget of the country for some years. In 2018, Nigeria was rated 171  globally for its investments in health care and education. This ranking appears credible considering that the federal government budget on health is yet to reach the agreed African Union benchmark of 15 per cent for the health sector.  Nigeria has not allocated more than six per cent since 2001 when the agreement was signed.

The 2016 health sector budget accounted for about 4.1 per cent of the total budgetary spending in the country, while the 2017 health spending was restricted to 5.1 per cent in the fiscal year. For 2018, the total health budget amounted to a total of four per cent.

The trend of a meagre allocation for the health sector seems to be on continuity as the proposed 2019 budget earmarked 4.1 per cent for the health sector.

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Nigeria is ranked 187th of the 191 countries in terms of the overall health system performance in 2018. In other words, among a total of 191 nations, Nigeria was ahead of only four countries which included the Democratic Republic of Congo, Central African Republic, Myanmar and Sierra Leone.

The index was not hard to come by as the ratio of doctors to people in the country is unbelievably small. According to the WHO, a doctors-to-people ratio in Nigeria is set for 0.37 for 1000 people. That is, less than one doctor attends to 1000 population in Nigeria contrary to the WHO recommendation of one doctor to 600 people. It represented that for every 10,000 people, nearly four doctors are available.

Thus, the situation is obvious in the country as many patients have complained of long waiting hours before seeing a doctor in hospitals, or while in some emergency cases, there were reported cases of negligence in hospital. For instance, the ICIR in an investigation carried out in one of the government hospitals in Abuja, Nigeria’s state capital in September 2018, shows that it took patients not less than four hours to wait before seeing a doctor.

The condition is worse in Primary Health Care, The PHC centres in Nigeria, as they are poorly maintained, according to several media reports.  WHO reported that one-third of more than 700 health facilities have been destroyed in the country. Also according to the Legatum Institute’s Prosperity Index of 2018, Nigeria is seventh worst, globally, in basic health, health infrastructure and preventive care.

A study that was published in March observed that many of the health centres on a survey in the Federal Capital Territory were in deplorable states. Many lack access to water supply and suffer poor electricity supply as 43 per cent of the surveyed centres operate in darkness.

The main compound of a PHC centre at Amaechi Idodo in Enugu State. Credit: Regina Otokpa.

PHCs are the most crucial in providing basic health care services to the people at the community level. A PHC is therefore expected to offer effective delivery of healthcare services made possible through the availability of adequate infrastructures, diagnostic medical equipment, drugs and well trained medical personnel.

Another issue with Nigeria healthcare is the low coverage of the National Health Insurance Scheme, NHIS. The NHIS has the mission to guarantee the financing of health care costs through the gathering of financial resources to provide risk protection and cost-sharing for people against the high cost of health care.

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However, over 90 per cent of the citizens are not captured under the scheme,  according to the scheme former chairman, Yusuf Usman.  And according to Lancet Global Health, Nigeria’s health insurance coverage is estimated to be less than five per cent of the total population.

Thus,  many Nigerians, because few were insured, usually practice out-of-pocket payment to attend to their health needs.  WHO defines out-of-pocket as a direct payment made by individuals to health care at the time of service use.

Health spending in Nigeria is dominated with out of pocket with about 75 per cent total expenditures, according to Isaac Adewole, country’s Minister of Health on April 4 during an inaugural lecture in Abuja. The out-of-pocket payment which is estimated for 75 per cent is against the benchmark of 20 per cent recommended by the WHO. This means that Nigeria is 55 per cent away from the WHO recommendation.

The minister also said that “25per cent of households spend more than 10 per cent of their household consumption on health a sign that more people were prone to poverty traps if they fall ill”.Out-of-pocket payments affect the ability of households and individuals to meet basic needs and push many below the poverty line.

Millions of Nigerians would be included when the WHO chief said on World Health Day that around 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health.

As the negative indices keep surfacing in the Nigeria health, the number of years a Nigerian is to live is not above 53 years. Hassan Bashir, Acting Chairman of National Population Commission said at the 52nd Session of the United Nations Commission on Population and Development in New York on April 2 that the current overall life expectancy in the country stands at 52.5 years.

Thus, as another World Health Day is celebrated, it is a call for Nigeria to work towards universal health coverage so as to make health a full right and not a privilege.

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The Universal Health Care according to the WHO means that all individuals and communities are able to access the health services they need – from health promotion to prevention, treatment, rehabilitation, and palliative care – without suffering financial hardship.

When people are not protected from the financial consequences of paying for health services out of their own pockets, they may have to use up their life savings, sell assets, or borrow, destroying their futures and often those of their children.

Achieving universal health coverage is one of the targets the nations, including Nigeria, has pledged to earn by 2030, along with other sustainable development goals. The WHO also used the opportunity during this year celebration to ask countries to invest in primary health care which the director-general described as the “bedrock of universal health coverage,” covering the majority of health needs throughout a person’s life and keeping people out of hospitals and in the community.

Though he said there would always be outbreaks and other disasters with health consequences, investing in stronger health systems could help to prevent or mitigate them.

The minister of health, Isaac Adewole also stated during the lecture that for Nigeria to accelerate progress on Universal Health Coverage (UHC), “the federal and state governments would need to invest more significantly in health”.

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