By Abujah Racheal
In the 25 years since Nigeria’s transition to democracy, the healthcare sector has experienced a journey marked by significant strides and but persistent challenges.
From policy reforms to personal stories of survival and resilience, the evolution of the health sector under this phase of democratic governance which commenced on May 29, 1999 reflects a complex interplay of hope and hardship.
Healthcare in Nigeria is managed collaboratively by the three levels of government, with private healthcare providers also playing a significant role.
Additionally, the use of traditional and complementary medicine has grown substantially in recent years.
Stakeholders in the sector have said that healthcare delivery in the country has progressively deteriorated due to a lack of political will from successive governments to address longstanding issues, including personnel and infrastructure gaps.
The situation directly impacts on productivity of citizens with rippling effects for the nation’s economic growth.
More than half of the Nigeria’s estimated 200 million population lives on less than N2,600 a day. This places the country among the poorest in the world.
When Nigeria transitioned from military rule to a democratic government hopes were ignited and optimism rose for brighter future. This was palpable in the health sector.
In spite of the challenges over the past 25 years, the democratic governance has ushered in significant changes across various sectors, including health.
The introduction of the National Health Insurance Scheme (NHIS) in 2005 was a beacon of hope for many Nigerians.
It was expected that in no distant time, most Nigerians, whether in private or public sector will have access health insurance.
However, as of February 2018, Nigeria was ranked 187 out of 191 countries in Universal Health Coverage (UHC) as an insignificant portion of the population was enrolled into the scheme.
The high reliance on out-of-pocket payments for healthcare results in significant household expenditures, with private spending constituting 74.85 per cent of total health expenditure, according to health economists.
Consequently, government spending accounts for only 25.15 per cent of all health expenditures in the nation.
Of the private health expenditure, about 70 per cent are out-of-pocket payments for services at both government and private facilities, according to available data.
In spite of having a huge number of health professionals, Nigeria has fewer health workers per population unit than needed. Many of the professionals migrate abroad due to poor welfare and other work conditions.
Mrs Grace Audu, a school teacher in the Nigerian capital, Abuja, said she was able to access healthcare for her family for the first time recently.
But there is hope at the grassroots level where some Primary Health Centres are meeting public expectations.
Audu said that the Primary Health Centre Under One Roof Initiative (PHCUOR) had translated to better equipment in many local health centres and the ability for them to handle basic medical needs, saving countless lives.
The PHCUOR policy is a national policy that was approved in May 2011 at the session of the 54th National Council of Health to reduce fragmentation and improve PHC performance thus contributing to better health outcomes.
It aligns with the National Health Act (NHAct) of 2014.
Increased investment in health infrastructure has also transformed many local health centres and hospitals.
The renovated Waddiya PHC in Niger State, in the North Central region of the country, for instance, meant that Mrs Amina Salihu, could be safely delivered of her baby in her hometown rather than traveling to urban areas.
Such improvements, while uneven, have had a profound impact on many families across the country.
Democratic governance has opened more doors for international partnerships.
Programmes supported by the World Health Organisation (WHO) and UNICEF have brought critical resources to the fight against diseases like malaria and HIV/AIDS.
Mr Samuel Idoko, lives in a village in Otukpa, Benue, received treated mosquito bednets and antimalarial treatment through such programmes. They have been pivotal in reducing the burden of the disease.
Successful health campaigns have also made significant strides in disease eradication. The 2020 declaration of Nigeria as polio-free country is a testament to these efforts.
Children like Mrs Fatima Maigari’s daughter in Kaduna State no longer face the threat of polio, allowing them to run and play freely, embodying the tangible benefits of sustained public health campaigns.
In spite of these improvements, many Nigerians still encounter significant challenges due to inadequate funding of the health sector.
Mr John Dasat, a nurse in Bwari, Federal Capital Territory, healthcare centres often faces shortage of essential medical supplies, making it difficult to provide adequate care to his patients.
The not impressive budgetary allocation to the health sector continues to be a major challenge. So, some of the best hands have to seek greener pasture.
Dr Chioma Chibuzor, a physician, shared her frustration over losing colleagues to better-paying jobs overseas, leaving her and others with more workloads and low morale.
This “brain drain“ exacerbates the shortage of medical personnel, especially in rural areas.
Corruption remains a formidable obstacle. Part of the funds meant for health improvements often disappear, leaving facilities in disrepair.
Mrs Mary Jimoh, a health advocate, speaks of her efforts to promote transparency and accountability, knowing that each misallocated or misapplied fund directly affects the lives of many Nigerians.
Accessibility to quality healthcare remains uneven. In remote areas like where Mrs Ile Adeojo lives in Kogi, where health centres are few and far between.
Adeojo said that the villagers usually travel long distances to receive even basic medical services, highlighting the stark disparities in healthcare access between urban and rural populations.
Nigeria has attempted major health reforms over the past 15 years, including programmes to strengthen primary health care and improve health financing and governance.
Reforms, such as the National Health Act and the National Health Insurance Authority Act|, aimed to address fundamental issues in the health sector.
However, in spite of being successfully adopted, they face significant challenges in implementation.
The health sector is enshrined in the concurrent list. This ordinarily should make its management easier. However, this is not the case as the seeming fragmentation of authority within the health sector made coordinated action difficult and costly.
This issue has often led to inefficiencies and overlaps in responsibilities, hindering the effective implementation of health reforms.
In spite of these initiatives, success has been limited because politicians seem less interested investing in public health.
One significant initiative is the Saving One Million Lives (SOML) programmme, launched in 2012 to strengthen PHC.
The programme focuses on improving maternal and child health, vaccination rates, and the overall quality of primary health services.
Nigeria has one of the worst maternal health ratios in the world.
In 2019, the World Health Organisation estimated the maternal mortality ratio to be over 800 maternal deaths per 100 000 live births with a neonatal mortality rate of 33 per 1000 live births.
In spite of its ambitious goals, the implementation of SOML has faced challenges, particularly due to the fragmented health governance structure and insufficient political support.
The 2014 passage of the National Health Act, particularly the Basic Health Care Provision Fund (BHCPF) component, was another milestone aimed at achieving UHC.
The BHCPF was designed to provide a basic package of health services to all Nigerians, especially the most vulnerable populations.
However, its implementation has been slow, due largely to political and institutional barriers.
Dr Mustapha Lecky, Chairman of the Health System Reform Coalition of Nigeria (HSRCN), underscored the importance of strengthening primary health care.
“Reinforcing the PHC system is essential for improving healthcare access, especially in rural areas.
“This involves better training for health workers, improved facilities, and consistent supply of essential medicines and equipment,” Lecky said.
Dr Aminu Magashi, Coordinator of the Africa Health Budget Network (AHBN), said combating was critical to effective healthcare delivery.
“Implementing robust anti-corruption measures within the health sector is necessary to ensure that funds are used appropriately and efficiently,” he said.
Magashi underlined the need for increased health funding.
According to him, Nigeria must prioritise health in its budgetary allocations to ensure sufficient resources for infrastructure, supplies, and personnel welfare.
“Without this commitment, progress will remain stunted,” he said.
Mrs Helen Ibrahim, a retired nurse with over 35 years of experience provides a critical perspective on the journey so far.
Reflecting on the changes brought by democracy, she there had been gains and concerns.
“Back in the 80s and early 90s, the healthcare system was struggling under military rule.
“We had limited resources, out-dated equipment, and morale was low. When democracy came, there was a palpable sense of hope.
“We started seeing improvements in infrastructure and an influx of foreign aid, which really helped,” said.
Ibrahim, however, noted certain challenges have persisted.
“One of the biggest challenges we have faced is the brain drain. Many of my colleagues left for better opportunities abroad.
“The government needs to do more to retain healthcare professionals,” she said.
According to Ibrahim, corruption is like a disease itself.
“Funds that should go to improving facilities and services often end up in the wrong hands’’, she alleges, adding that: `this has to change if we are to see real progress’.
She, however, said it was gladdening that the young generation of healthcare workers were dedicated.
She described them as passionate and willing to fight for better conditions.
“With the right support and reforms, I believe Nigeria’s health sector can reach its full potential,” she said. (NANFeatures)
