Issues that will shape Nigeria’s health sector in 2023

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NIGERIANS move into the new year with many expectations ranging from improvement in the nation’s economy, security, education, and health, among others.

They have gone through the past years with a blend of dashed hopes and democratic gains from the government.

The health sector has its fair share of the ills and growth the nation has experienced since it returned to democracy on May 29, 1999. 

While the past years, especially under President Muhammadu Buhari, have witnessed improved budgets and infrastructural growth in the health sector, the rate of brain drain arising primarily from poor welfare and insecurity has widened.

The ICIR reports that the country has strengthened its disease surveillance system through the Nigerian Centre for Disease Control (NCDC), which provides regular disease updates for citizens. It remains more committed to immunisation and other maternal and childcare issues through the National Primary Health Care Development Agency (NPHCDA).

While it has made significant strides in curbing drug counterfeiting and production and use of unapproved cosmetics in many cities in the nation, the National Agency for Food and Drugs Administration and Control (NAFDAC) fails to replicate the feat in sprawling villages and settlements across the country. The lapse puts many lives at the mercy of unscrupulous elements whose greed for wealth knows no bound.

In 2020, The ICIR published an investigation on how food vendors, fruit sellers, and farmers poison Nigerians with agrochemicals.

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ncdc covid-19 corruption
NCDC Headquarters
Photo Credit: Olugbenga Adanikin

The report, among others, exposed how NAFDAC failed to safeguard the health of Nigerians, which is the major reason it exists.

Similarly, after 62 years of independence, the Federal Government provided a pathway for universal health coverage for Nigerians through the National Health Insurance Authority Bill signed into law by President Buhari in May 2022.

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Issues to watch in for in the health sector in 2023

 Budget performance

The country has got its biggest budget ever – over a trillion Naira.

President Buhari signed the 2023 Appropriation Act containing N1,075 trillion for the sector on January 3.

In the new budget, personnel cost takes N564.4 billion, overhead gulps N16.3 billion, N404 billion goes to capital projects, and the government allocates N47.6 billion to the Basic Health Care Provision Fund (BHCPF).

Others are multilateral aids and grants – N2.5 billion – and retained independent revenue N62.6 billion.

How the government will implement the 2023 budget during an election year remains a concern to Nigerians.

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How health budgets have fared under Buhari

In 2016, the Federal Government had a budget of 6.06 trillion, out of which it earmarked N550 billion for the health sector. The amount represented 4.1 per cent of the budget. 

Some of the equipment purchased with the COVID-19 Intervention Fund at the ICU unit of JUTH

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In 2017, the total budget was 7.4 trillion. The health sector got 304.1 billion, representing 4.0 per cent. Capital allocation for the year was N51.3 billion, while recurrent expenditure gulped 252.8 billion.

The year 2018 saw a further decline in the percentage of the health budget to the national budget. The total federal budget was 9.1 trillion that year, from which the sector received 356.4 billion. Recurrent expenditure was 269.9 billion, while the capital budget was 86.4 billion.

In 2020, the government reduced budget allocation to the Basic Health Care Provision Fund by more than 40 per cent, from N44.4 billion to N25.5 billion.

The government’s 2021 budget was 13.6 trillion. It earmarked N514 billion for the sector.

Recurrent and capital took N380 billion and N134 billion, respectively.

Similarly, in 2022, of the N17.1 trillion budget signed by President Buhari, the sector took N724 billion, representing 4.2 per cent of the budget.

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However, the yearly budget for health by the Nigerian government does not include state and local government funds for health.

They do not include funds from international development agencies such as the World Health Organization, United Nations Children Fund, United Nations Population Fund, Bill & Melinda Gates Foundation, Marie Stopes, Pathfinder International, and World Bank, among others.

The ICIR reports that the Nigerian government has consistently failed to honour the 2001 Abuja Declaration, which requires all heads of government in Africa to commit 15 per cent of their annual budget to their health sector.

Maternal and child health

The World Health Organization (WHO) data shows that the neo-natal maternity rate per live 1,000 births is 35.45. The infant mortality rate (probability of dying between birth and age one per 1,000 live births is 72.24. Under-five mortality rate (probability of dying by age five per 1,000 live births) is 113.8.

Meanwhile, the Nigeria Demographic and Health Survey (2018 NDHS) shows that the maternal mortality ratio is 512 deaths per 100,000 live births. 

This newspaper notes that because of advancements in technology and further scientific breakthroughs in health, the nation should do more to save the lives of women and children in 2023.

Workers strike

Unlike the strike by the Academic Staff Union of Universities that crippled public universities in 2022, the health sector enjoyed relatively hitch-free services.

None of the national bodies of health workers’ unions, including doctors’ unions, declared a strike. But a few, such as the Cross River State chapter of the Nigerian Medical Association, embarked on strike over the abduction of their colleagues.

Nigerians will receive uninterrupted services if workers at the facilities shun industrial action and the government meets their needs this year.

Previously, the strike by different groups of professionals in the sector stalled services in public hospitals.

The ICIR reported in 2021 how health professionals in the country went on strike for nearly 300 working days in eight years – 2013 and 2021.

Brain drain

A major concern in the sector in 2022 was the alarming rate of emigration of health professionals from the country.

Multiple reports showed how doctors, medical laboratory scientists, nurses, midwives and other experts left the country in droves for jobs abroad.

Many of them blamed the migration on plummeting economy, unprecedented insecurity and poor welfare.

The ICIR reported how the nation lost nearly nine thousand doctors to the UK and others in two years.  

Other outlets have similar reports, some of which are herehere and here

Female health workers attending to patients in a Nigerian hospital.
Source: Citifmonline

Reports done by the ICIR in 2022 in select hospitals across five geo-political zones on the impacts of the COVID-19 Intervention Fund on the facilities further attest to the high rate of doctors’ migration from the nation. 

Some of the facilities are the Federal Medical Centres Makurdi, Benue State, Jalingo, Taraba State, Moddibo Adama University Teaching Hospital (formerly Federal Medical Centre Yola) Adamawa State, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Federal Teaching Hospital, Abakaliki, Ebonyi State, and Jos University Teaching Hospital (JUTH), Jos, Plateau State.

The Basic Health Care Provision Fund (BHCPF)

Part 1, Section 11 of the National Health Act (2014) established the BHCPF. 

The BHCPF is catalytic funding to improve access to primary health care. It serves to fund the Basic Minimum Package of Health Services (BMPHS), increase the fiscal space for health, strengthen the national health system, particularly at the primary health care (PHC) level by making provision for routine daily operation cost of PHCs, and ensure access to health care for all, particularly the poor, thus contributing to overall national productivity. 

Some of the investigations by The ICIR on the effectiveness or otherwise of the BHCPF in 2022 are available here.

There is a need for increased funding for the programme, while states yet to key into the scheme should embrace it in 2023.

Disease burden: More sensitisation and intervention needed

Nigeria currently leads the rest of the world in malaria burden and death, contributing about a quarter of global morbidities and fatalities from the disease.

Infographics by Rebecca Akinremi/ICIR

The country has the highest burden of tuberculosis in Africa and the sixth highest in the world.

Neglected Tropical Diseases need more government attention to free the nation from them. Nigeria has the most NTDs globally.

Non-communicable diseases (NCDs), such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, have continued to increase.

The National Cancer Society claimed in 2022 that only ten cancer machines (radiotherapy machines) worked in the country.

In 2023, the government should intensify the campaign against behavioural patterns or lifestyles that promote the conditions. It should also acquire more equipment in the hospitals to combat the diseases.

In 2023, the government will do more to tackle cholera, Lassa Fever and M-Pox, which have remained a yearly puzzle for the nation.

Family planning

The government should invest more in family planning commodities and fund sex education across age groups.

There should be more campaigns on the gains family derives from having the number of children they can train. 

More emphasis should be placed on the consequences of maintaining a large and poor family.

The country’s population is currently about 220 million, with the majority living in abject poverty and lacking jobs.

Tackling malnutrition, water and sanitation

The year 2023 should witness improved attention to malnutrition. Children with acute malnutrition need care.

At least 17 million children are malnourished in the country. Nigerians hope to see what the tiers of government will do to save the affected children.




     

     

    Besides, the government needs to increase awareness of the need for good sanitation in the new year.

    More safe water should also be available to people in the country to make the population live healthier and enjoy a happy life.

    In August, The ICIR reported how Kogi and Niger led other states and the Federal Capital Territory in open defecation.

    *Photo by Markus Frieauff on Unsplash

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    Marcus bears the light, and he beams it everywhere. He's a good governance and decent society advocate. He's The ICIR Reporter of the Year 2022 and has been the organisation's News Editor since September 2022. Contact him via email @ [email protected].

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