The year 2021 has been a momentous year for Nigerians generally; however, in the health sector besides COVID-19 and low budgetary allocation to the health sector, access to quality and affordable healthcare remains an issue to Nigerians due to challenges such as inadequate capital spending, poor pay, outdated technologies, poor infrastructure and sharp disparities in the availability of medical facilities across the country.
Other factors that characterise the sector and hamper it to compete globally are high mortality rates, weakened primary health care system, incessant strikes by doctors, health workers, poor infrastructures leading to child and maternal mortality, malnutrition, and deaths from non-communicable diseases, among others.
According to the Best Healthcare in the World 2021 Legatum Prosperity Index (LPI), Nigeria was rated 144th out of 167th countries in terms of healthcare delivery, which stressed the need for urgent capital funding to boost healthcare delivery in the country.
In all, the COVID-19 pandemic and frequent strikes by the National Association of Resident Doctors (NARD) are the major developments that further marred the Nigerian fragile health sector in 2021. Amid these challenges, in 2021, Nigeria failed to meet the 15 per cent health budget commitment it made alongside other African countries 19 years ago on health funding. The federal government budgeted N547 billion for healthcare in the year under review, representing seven per cent of the total budget of N13.08 trillion.
In the advent of the COVID-19 pandemic, however, the fragile health system was further overwhelmed. Since the record of the COVID-19 index case in Nigeria, Nigeria’s capacity to manage local and community transmission swiftly has been stated to be of doubt.
This is because the alarming increase in the number of COVID-19 cases recorded daily overwhelmed the front-line healthcare workers, diagnostic capacities, and management facilities at some point in 2020 and 2021 respectively.
For instance, on the 28th of December 2021, 599 new confirmed cases and one death were recorded in Nigeria. As of yesterday, 31 December, 2021 a total of
3,823,309 samples were in the country; confirmed cases 241,513, active cases 24,480, discharged cases 214,003 and 3,030 deaths have been recorded in 36 states and the Federal Capital Territory.
While Nigeria struggled to cope with the pandemic, the National Association of Resident Doctors (NARD) in Nigeria, embarked on several strikes that nearly crippled the health sector.
The doctors embarked on a 10-day strike, that started 1st of April, 2021, due to outstanding wages owed by the federal and state government, and barely four months later, (on the 2nd of August, 2021), the NARD embarked on another strike, that lasted for 62 days.
According to stakeholders, the COVID-19 and the frequent strikes by doctors are the major events that marred the health sector in 2021, and can resurface in 2022, if prompt actions are not taken.
Speaking exclusively with LEADERSHIP Weekend, the chairman, Public Health Sustainable Advocacy Initiative (PHSAI) Barr Ayo Adebusoye noted that the federal government must start to prioritise the health sector.
Despite the many challenges that have marred the health sector over the years, Adebusoye said the federal government has not seen the reason to achieve 15 per cent budgetary allocation to the health sector.
Recall that on October 7, President Muhammadu Buhari presented before both sessions of the National Assembly, a proposed budget of N16.39 trillion (N16,391,023,917,692) for the 2022 fiscal year.
Out of the total N16.39 trillion proposed budget, a sum of N711.28 billion (4.3% of the entire budget) is earmarked for the ministry of health. Based on the proposed federal government budget, and its allocation of N711.28 billion to the ministry of health in pursuit of the goal of a healthy populace, N3,453 is what the federal government has earmarked to cater for the health of all of its 206 million citizens.
According to Adebusoye, “This figure is far from the Abuja declaration, Nigeria signed to commit at least 15 per cent of her annual budget to improve the health sector.
“With such an investment in healthcare, Nigeria cannot achieve universal health coverage, says Adebusoye, while urging the government to prioritize the health sector in 2022 by coming up with a complimentary budget for the health sector.”
To tackle the frequent strikes by Nigerian doctors, Adebusoye advocated for good working conditions for health workers.
He said, “Quality healthcare service is not about big structures, it is about the personnel and equipment. So the condition of services is key.
“For the country to restore the health sector to its former glory, the healthcare practitioners’ salaries should not be tied to the civil services, they are specialists. That is why doctors in other climes are being paid higher than ours. So the working condition of doctors must not be hinged or tied to the civil service. The condition of services must be made more attractive.
“The management of the general, teaching, and private hospitals must include local communities, the community groups, the traditional rulers among others. Of course, the National Health Act has all those structures in place, like the local government authority and the hospital management board, but implementation is a big problem. Government must implement the Act, to improve the condition of services.”
Adebusoye also advocated for compulsory health insurance plans for all Nigerians. To him, “We cannot fully move forward without the health insurance scheme. The state health insurance scheme, together with the national health insurance scheme must be made compulsory, because ‘out of pocket’ expenses for health services can never be the ideal way of financing the health sector.
“In addition, governments at all levels must scale up in financing the health sector. The Abuja declaration of 15 per cent of the total budget, must be fulfilled if we must go forward. It is high time the federal government moved from four per cent to 15 per cent. Lagos State is doing nine to 10 per cent, but it is still below the 15 per cent benchmark.
He said, “With COVID-19, we have seen how critical the health sector is. Without the health sector, nothing can actually work in the other sectors and the health sector has been found to be one of the sectors that can catalyse any country to become economically prosperous. So I, therefore, urge the Nigerian government to increase health financing. That would help to boost the other sectors of the economy.”
Also, former president of the Nigeria Medical Association (NMA), and consultant orthopedic surgeon with the Amadu Bello University Zaria, Prof. Mike Ogirima, told LEADERSHIP that the health sector needs more funding and the workforce needs motivation.
According to him, there is a lot of brain drain from the health sector as the rate supersedes other sectors. “Countries all over the world are looking for health workers because of the increasing demand for the workforce and for those countries who are training their indigenes at a relatively cheaper rate, find it very difficult to cope with the number of those trained to leave the system because of poor working environment. “
He, therefore urged the government to fund the sector, noting that there is the need for a better working environment, working tools, and better motivation of the workforce to retain the ones that are already trained, adding that it will go a long way to get more workforce for the increasing population.
On NARD’s strike, the physician said both parties should be proactive in the sense that they have reached agreement in the past and they should see on the implementation of the agreement and if challenges are coming up, the leadership of both sides should be able to identify those challenges, call for negotiation and reach an amicable settlement, rather than waiting till there is lack of communication, information and everything degenerate before they will start rushing the government to bring up emergency policies that may not last. “They should be proactive”, he said
On tackling the COVID-19 pandemic, Ogirima urged the government to improve the surveillance system and educate the masses as they are doing now to go for immunisation. He said this is important “Because at the end of the day, we are going to live with COVID-19 just as we are living with common cold and malaria, so ultimately, we may need to resort to immunisation either an annual boost so that we can increase the immunity to more than 70 per cent.”
In the same vein, the chairman, Expert Review Committee on COVID-19 and Virologist, Prof. Oyewale Tomori told LEADERSHIP Weekend that the federal government should embark on a massive sensitisation campaign to educate Nigerians on the importance of the COVID-19 vaccine.
“Over the years, Vaccines have been proven as an effective means to protect individuals, communities, and entire populations against infectious diseases,” said Tomori, adding that in the case of the COVID-19 pandemic, access to the COVID-19 vaccines is very critical if we must win the war against the pandemic.
While the World Health Organisation (WHO) predicts that the acute phase of the COVID-19 pandemic could end by July 2022 if every country ends up vaccinating at least 70 per cent of its population, Tomori said, Nigeria can achieve this target if the COVID-19 vaccines are available and accessible and the government enforced compulsory vaccination for all eligible Nigerians.
“I, therefore, urge the government to make the COVID-19 vaccines available, embark on a sensitization campaign to educate Nigerians on the importance of the vaccines, and make it compulsory for all eligible Nigerians. With this, we will achieve herd immunity by 2022. I also plead with Nigerians to observe the non-pharmaceutical preventive measures like wearing of nose masks, frequent handwashing and social distancing,” he added.
On how to better the health sector, the managing director, Society for Family Health (SFH), Dr Omokhudu Idogho, urged the government on the need to purposefully move forward with the Health reform agenda with a strategy to reduce the catastrophic cost of care at its heart.
“The Basic Health Care Provision Fund (BHCPF) should be expanded and states should implement an integrated health system that fosters both public and private sector with the primary focus of the government being better health outcomes for citizens,” he urged.
On local production of drugs and Vaccines, the head National Institute for Pharmaceutical Research and Development (NIPRD), Prof. Martins Emeje Emeje told LEADERSHIP Weekend that one of the positive things that came out of the pandemic is the fact that the Central Bank of Nigeria (CBN) now have a research grant for academic.
“Some pharmaceutical companies also benefited from the CBN’s intervention funds and I want CBN to sustain it in 2022 and beyond, because if we continue like this, in the next 10 to 20 years, Nigeria will not be where we are today, because by then, we will start producing our own medicine and even human vaccines,” he added.
With these recommendations, it is hoped that the government will consider prioritising the health sector by ensuring the implementation of health policies to better the sector.