The Early 60s Nigeria’s healthcare system has travelled the same route the Nigerian nation has travelled. Some forward movement and more backwards movement.
One constant thing in life is change and change could be positive or negative. As for the Nigerian healthcare system in the early stage of the 1960s, the general health situation was much better than it is today, say stakeholders.
Despite the fact that there were not many hospitals, the healthcare structures were in a better shape to cope with the population at that time, says a Nigerian professor of virology, Oyewale Tomori. “I remember in my region, children received free healthcare and we kept our environment clean. Sanitary inspectors made sure our surroundings were clean.
“Immunisation was not that good and so we lost many children to existing vaccine preventable diseases. Moreover, there was still a greater trust in traditional medical practices and the hospital was often the last resort,” he added.
For me as a person, the measurement of how well we have done, is the quality of the healthcare and life of majority of our People. We may have built more hospitals, more health centres more Pharmacies, more clinics, developed more policies but the outcome has fallen short.
Access to healthcare is still constrained, dependence on imported pharmaceutical remains high, rate of health insurance adoption is dismal and life expectancy is below expectation. When global health statistics and human development indices are evaluated our lacklustre performance becomes very evident as we occupy the bottom position on most scores.
The president, Pharmaceutical Society of Nigeria (PSN), Pharm Sam Ohuabunwa, said “As a child in the 60s, I enjoyed better public healthcare than the average Nigerian child today. I believe we got it wrong at the following point; When we passed primary healthcare responsibility to the local governments without ensuring they got adequate resources as in most cases, they were emasculated by the state governments.
“When we began to ask Nigerians to pay for healthcare out of their pocket when unemployment and poverty was growing, when our leaders began to ignore our healthcare institutions and preferred to go abroad for every small ailment, and in the process lost touch with reality of the situation on ground.
“When we allowed inter- professional domination and rivalry to take over from the team concept that operated before 1990 when the system changed, we got it wrong when one professional group began to assume political leadership and professional leadership at all levels of government, inadvertently shutting out meaningful contribution of other healthcare professionals in policy evolution and implementation.
“Finally we got it wrong when corruption became endemic in Nigeria and indiscipline multiplied. Then healthcare projects became abandoned after money was paid, fake and substandard drugs began to proliferate, and the health system began to deteriorate perhaps until recently.”
The chairman, Public Health Sustenance Advocacy Initiative (PHSAI), Barrister Ayo Adebusoye said, at the early stage of Nigeria gaining her independence, the teaching hospital at that time was recognised all over the world and then, the population of Nigeria was small.
Adebusoye said, “The Nigerian population was over 40 million with few doctors in the whole of Nigeria and one teaching hospital, which is the UCH, Ibadan. The condition was so good then, that doctors from all over the world do come to the UCH, to do their residencies because the salaries was actually better. Doctors had a better working condition then, than now,” he added.
The Turning Point
But right now, this sounds like a nightmare with the mass exodus of doctors from Nigeria to the United Kingdom. What went wrong? Where did we miss it?
The turn around for the worse, probably began with the political crisis early in 1962 which may have led to the first military coup, says Tomori, adding “I think we took a turn for the worst from there on. Military coup after military coup followed and with each, came a worse decadence than the previous.
“Everything related to progress suffered, health education, morality, patriotism and we are yet to recover. Even with the return to civilian rule, Nigeria has not begun the journey back to sanity.
“We are still groping blindfolded, lurching blindly from underdevelopment to each civilian government striving strenuously to be worse than the predecesor. I hope when we hit the bottom of decadence we will find our way back to decency,” he added.
The turning point actually came after the civil war, where the condition of services was a bit reduced, Barrister Adebusoye reiterated, adding that, “The real turning point came when the Nigerian government introduced the Structural Adjustment Programme (SAP) that devalued the naira.
“The foreign doctors that were in Nigeria had to leave en masse because the currency became devalued over night. The Nigerian doctors also leave because the naira had little value.”
Changing The Narrative
Changing the narrative should start from the leaders, whose duty is to create an enabling environment for orderly development, says Tomori. “We need a leader, just one leader- patriotic, humane, focused, selfless, caring and committed to a better Nigeria.
“But that looks like a dream. So the reality is that each of us as Nigerians must believe in ourselves and in our country. We must determine to make the next 60 years better and positively different from the past and wasted 60 years.
“I hear the government wants us to spend one whole year celebrating the past sickly 60 years. That is the first wrong step. Tell me, what is there to celebrate? That we are alive as a ragged poverty stricken nation of profound inequity?
“We should spend October 1st, 2020, in sober reflection with flags flying half mast and call for a national fast to replace the planned banquet of debauchery. Let our people engage in a creative thinking of national renewal so that the next 60 years will replace the last 60 years of sorrow, mayhem underdevelopment and progression,” he added.
Adebusoye however advocated for good working conditions of health workers. He said, “Quality healthcare services 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 etc. 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, that will help to improve the condition of services.”
Adebusoye also advocated for compulsory health insurance plan 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 the 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 that, it is one of the sectors that can catalyse any country to becoming economically prosperous. So I therefore urge the Nigerian government to increase health financing. That would help to boost the other sectors of the economy.”