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The Nigerian Health Sector: 2017 In Retrospect



Prof Adewole, Health Minister

Health, one of the most critical sectors that drive the Nigerian economy, was crowded with issues in 2017; ranging from meager health budget, frequent strikes by health workers to disease outbreaks. ODIRI UCHENUNU-IBEH reviews most of these developments.

Health Budget

An Abuja Declaration, signed in 2001 by all member countries of the African Union (AU), including Nigeria, recommended that for the continent to be at par with other nations of the world in terms of healthcare provision, at least 15 percent of their annual budget, should be allocated to the health sector.

Nigeria’s 2017 health budget fell short of that promise as only a meager 4.17 percent of the budget of N7.298 trillion presented by President Muhammadu Buhari to the National Assembly for approval was allocated to the health sector.

Further analysis by Partnership for Advocacy in Child and Family Health (PACFaH), a health policy advocacy project led by Nigerian NGOs, shows that as a percentage of the total annual budget, the 2017 health budget is one of the lowest in the last 10 years. Over the last decade, the 2012 health budget was the highest (5.95 percent) as a percentage of the annual budget.

Although proposed capital spending for health in 2017 is 80 percent higher than in 2016, PACFaH said the real increase, considering the devaluation of the naira, is just 16 percent. Also, in nominal terms, the proposed capital expenditure for 2017 is virtually the same as the 2007 health capex.

The implication of this is that the federal government spent only N304 billion on the health of over 180 million Nigerians, amounting to N1,688 per citizen for the whole year. This is so insignificant when compared to issues like the high maternal and child mortality rates, poor primary health facilities, lack of functioning cancer machines, malnutrition and poor health emergency responses that have marred the improvement of the Nigerian health sector over the years.

Frequent industrial actions

Government hospitals in Nigeria have in recent times been bedeviled with several chronic problems which have led to frequent strikes by health workers; in 2017, the story was the same.

Part of the reasons for the strikes by health workers in 2017 were issues relating to withholding of staff emoluments and denial of other legitimate privileges such as annual increment of salaries, inadequate or obsolete equipment in wards and clinics as well as security breaches among others. The inability of government to grant their demands has led to some of them going to other countries to look for better offers.

Stakeholders believe that if not tackled, Nigerians very soon will go to government hospitals and not see a doctor because statistics from University Teaching Hospital (UCH), Ibadan shows that the health crisis in Nigeria is unprecedented as the mass exodus hits alarming proportions.

From the statistics, Nigeria has 80,000 registered doctors; more than 50,000 are practising abroad; 92 per cent of Nigerian doctors in Nigeria are considering finding a job abroad and 70 percent of them are making plans to leave for foreign lands and are taking exams to that effect.

A total of 236 doctors wrote Primaries for West Africa College of Physicians in 2017 to gain admission to Nigerian Teaching Hospitals whereas five years ago, over 1,000 wrote the same exam. Similarly, 660 wrote the Professional and Linguistic Assessments Board (PLAB) test which provides the main route for International Medical Graduat to practice in the United Kingdom over this primaries exam. Over 1000 have registered for the next PLAB.

Already it takes an old patient two hours and three hours for new patients to see a doctor on the average and over 100 doctors have resigned from UCH this year, 800 doctors have resigned from Lagos state hospitals with 100 this month alone.

Over 200 Doctors and nurses have resigned from Ladoke Akintola Teaching Hospital this year and Kebbi state has been unable to employ a single doctor in two years despite multiple adverts for employment.

Across the nation the story is the same and the scary part is no one seems to be bothered.

Disease Outbreaks

The first quarter of this year witnessed an outbreak of meningitis. The World Health Organisation (WHO) was notified of the outbreak by the Government of Nigeria on 20 February 2017. The first case was reported in Zamfara state during epidemiology week 50 (December 12-18, 2016).

Between December 2016 and 23 June 2017, a total of 14,513 cases with 1,166 deaths (Case Fatality Rate=8.0 percent) had been reported from 24 States. Of the reported cases, 1,002 (6.9 per cent) were laboratory tested; of which 463 (46.2 per cent) were confirmed positive for bacterial meningitis. Neisseria meningitides serogroup C was the predominant (75.4 percent) cause of meningitis amongst those who tested positive.

Children between five to 14 years age group were the most affected, accounting for 6,791 (46.8 percent) cases. The states which were most affected by this outbreak were Zamfara, Sokoto, and Katsina, which accounted for nearly 89 percent of these cases.

In the same year, Nigeria witnessed another Lassa fever outbreak that affected 17 Nigerian states (Anambra, Bauchi, Borno, Cross-River, Ebonyi, Edo, Enugu, Gombe, Kaduna, Kano, Kogi, Nasarawa, Ogun, Ondo, Plateau, Rivers, and Taraba) that have reported at least one confirmed case. The outbreak is currently active in five states (Kaduna, Bauchi, Edo, Ondo and Plateau).

On 18 June 2017, the Nigerian Ministry of Health notified WHO of an outbreak of hepatitis E located in the north-east region of the country. The outbreak propagated rapidly due to the ongoing humanitarian crisis in the region which arises from the volatile security situation in north-eastern Nigeria and continues to persist.

Since the peak of the outbreak in Borno state in week 25, the number of cases has been re-increasing from week 42 to week 46, mainly due to the spread of the outbreak in Rann and Balge. No case of acute jaundice was reported in Mobbar since week 35.

On 7 June 2017, WHO was notified of a cholera outbreak in Kwara State, and between 1 May and 30 June 2017, suspected cholera cases in Kwara State were reported from five local government areas; Asa (18), Ilorin East (450), Ilorin South (215).Ilorin West (780), and Moro (50). Meanwhile, information for local government areas is missing for 45 of the suspected cases.

The first cases of acute watery diarrhea were reported during the last week of April 2017 and a sharp increase in the number of cases and deaths has been observed since 1 May 2017. However, the number of new cases reported has shown a decline over the last four reporting weeks.

As of 30 June 2017, a total of 1558 suspected cases of cholera have been reported including 11 deaths (case fatality rate: 0.7 percent). 13 of these cases were confirmed by culture in laboratory. 50 percent of the suspected cases reported are male and 49 percent are female (information for gender is missing for 1 percent of the suspected cases). The disease is affecting all age groups.

On 26th September, 2017, an outbreak of monkey pox was reported to WHO and suspected cases geographically spread across 21 states and the Federal Capital Territory (FCT). On the other hand, 59 laboratories confirmed cases have been reported from 12 states (Akwa Ibom, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Lagos, Rivers, Imo and Nasarawa) and FCT.



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