The decay, exodus and now the pandemic

The decay, exodus and now the pandemic

Tuesday, April 28, 2020 4:41 am

File: Doctors treating coronavirus patients

By Ajileye Omoniyi

The decay in the Nigerian health care sector had been festering for decades. The cause of the rot has always been a multi-headed hydra that has refused to be slain.

Some have said that it is just a reflection of the larger society with poor planning, corruption, incompetence , nepotism and an inefficient system that has clogged the wheels of progress.

No progressive nation takes its healthcare system for granted. All nations need a healthy citizenry to ensure that productivity is maximized and the future generations are guaranteed  a solid future.

The most populous black Nation had not always been in such a precarious ledge in terms of decay in its health care delivery systems.

Even before independence, we already had formidable hospitals like the University College Hospital, Ibadan in the late 50’s with several other colleges of medicine from  the University of Lagos, Ahmadu Bello University, University of Ife (now Obafemi  Awolowo University), and the University of Benin which were already established by 1975.

Nigeria has had progressive health Ministers like the late Prof Olikoye Ransome-Kuti, who strived to make qualitative healthcare available to every Nigerian, especially through his primary healthcare programme, which emphasised the grass roots. He introduced free immunisation for children and created HIV/Aids awareness through advertisements and media campaigns. He also gave a new lease of life to family planning programmes that previous governments had ignored. This programmes all saw a drastic reduction in our infant and maternal rates.

Fast forward to 2020, Nigeria is rated 187th out of 191 nations in terms of health care delivery worldwide. We are also ranked in the bottom 5 in terms of worst infant mortality and maternal mortality.

The World Health Organisation, WHO recommendation is for nations to spend at least  5% of its GDP on health care. In 2017

Nigeria- 3.76%

Kenya – 4.80%

Egypt – 5.29%

Rwanda – 6.57%

South Africa – 8.11%.

With healthcare being of little priority in Nigeria budget allocations, the decay has sunk to an all time low, leading to crumbling infrastructure, outdated medical equipment and healthcare personnel exodus .

It is estimated that Nigerians spent about N358 billion on medical tourism last year.

With the government not even trying to stem the tide or seek positive ways to address the situation, healthcare professionals have no choice but to take matters in their own hands and seek socio-economic  fulfilment elsewhere.

In an Interview in 2019 the current minister of labour and employment was quoted as saying “We have more than enough doctors. You can quote me,” Ngige said. “We have surplus. If you have surplus, you export. There is nothing wrong in them travelling out. When they go abroad, they earn money and send them back home here.”

Global benchmark exists in relation to the Sustainable Development Goals, which recommends a doctor to patient ratio of 1:1000

Cuba 8.2 ,United kingdom 2.8 ,United states 2.6 ,China 1.8 ,South Africa 0.9, Egypt 0.8, Nigeria 0.4.

A former health minister was also quoted as saying that Nigerian trained medical doctors who could not get into residence programme or training might as well become farmers or politicians. All these are not good mindsets for effective and efficient planning.

According to the General Medical council (UK medical regulatory body), over 1,000 medical doctors register to practise in the UK last year ,adding to the over 5,000 already practising in the United kingdom  alone.

It would appear the Nigerian government would rather bury their heads in the sand than address the decay in the health sector.

Then  came the Covid -19 pandemic, like a scene from a bad horror movie, it has swept across Nations before finally coming home to roost. It was met with the usual Nigerian way of dealing with issues’ denial,- Covid-19 does not affect people of African ancestry, it does not survive in tropical climate etc.

Meanwhile, in less than one Month the number of confirmed positive  cases has jumped from 20 to over 1000 . Slowly, this pandemic is highlighting the large deficit in our health delivery system.

While Private hospitals are shutting its doors due to lack of adequate PPE(Personal Protective Equipment), diagnostic  centres are also shutting its door to even cater to non covid-19 emergencies.

When the pandemic broke across the globe, we had a chance to formulate an action plan, but alas minimal action was taken.

Nigeria has been lucky so far in terms of the presentations of our covid-19 patients, most have been  mild-moderate symptoms, but for how long would we  continue to ride on the back of mother luck?

That been said, i would give high praise to the Lagos state government for their proactive stance and efforts done so far in the state, but more needs to be done, If and when patients with the more severe  respiratory compromise start to come, it will only be a matter of time before our fragile healthcare system  is totally overwhelmed.

We have seen how countries like Germany, Canada, South Korea, Taiwan, Australia and Vietnam  have all managed to stem the tide and bring the pandemic under control with early border closure, extensive testing and public health campaign.

Testing capacity so far vs population

South Africa – 100,000 vs  58million

Ghana – 70,000 vs 30million

Nigeria – 10,000 vs 195million.

Our leaders need to wake up to the realisation that covid-19 isn’t going anywhere, we cannot be doing things the same way and expect a different result.

While the following solutions are not exhaustive, i am sure they will offer practical answers that will help Nigeria as it battles the present covid-19 pandemic.

Proper co-ordination between all tiers of government and liaising with NCDC and the federal ministry of health to provide guidelines and a comprehensive action plan. Community heads, religious leaders, NGO’s and other stake holders should also be carried along to ensure  effective coordination.

Adequate funding must be made available in a quick and transparent manner with accountability and keys area targeted for maximal impact.

Key area like infrastructure (mobile and hospital testing),Training, publicity, provision of standardized PPE and also social welfare.

Testing ,Testing, Testing

Encourage local industries to produce to standardized equipments and disposable PPE (facemask, scrubs, gloves ,apron, goggles, etc),hand sanitizers and cleaning agents.

Public and private partnership:  Private hospitals are normally the first port of call for most people in the country when they become unwell, so the involvement of private hospitals cannot be over emphasised.

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