Sunday, June 02, 2019

The Agony Of A Collapsing Healthcare System


Prof. Isaac Adewole, Minister of Health eventually confirmed what has been speculated for several years now.

Last week, Nigeria’s lame-duck Minister of health told the Senate of the Federal Republic of Nigeria that the nation’s primary and secondary healthcare delivery systems have practically collapsed. Diarrhea and malaria are now being treated at the tertiary health institutions which were designed to handle referrals from the collapsed two institutions below.

Adewole was not making news. What he said was mere confirmation of what every watcher of Nigeria’s tottering health institutions have since realised. The Babel of voices calling on the three tiers of government to protect thousands dying from avoidable ailment was answered with deafening silence.

Everyone from the officials of the Nigerian Medical Association (NMA) to the leaders of the National Association of Nigerian Nurses and Midwives (NANNM) had warned the states and federal governments of the collapse of the nation’s primary healthcare delivery system and the secondary institutions made up of specialist hospitals strewn across the length and breadth of Nigeria.

When the federal government declared a state of emergency on the primary healthcare delivery system in March 2019, the action was greeted with condemnation as it was considered to be too little too late.

Sometime in the first quarter of 2018, Bill Gates, the richest man on earth raised the red flag about Nigeria’s collapsing healthcare delivery system. He warned that Nigeria was one of the most dangerous places in the world to deliver a baby. Gates argued that Nigeria was not investing in its stupendous human resources and that the airports, rail system and roads being constructed by the federal government may not have the healthy manpower to manage them as the healthcare delivery system has collapsed.

He stressed that one in every four babies born in Nigeria dies before reaching age five. Gates lamented that Nigeria has the world’s fourth highest maternal and infant mortality rates after war-torn Central African Republic, Chad and Sierra Leone. The signs of collapse in the nation’s healthcare delivery system are everywhere in the economy. Nigeria’s life expectancy at 55 years is clearly shorter than what obtains in the world’s low income countries where life expectancy stands at 62 years.

Recent statistics published by the United Nations Fund for Population Activities (UNFPA) shows that only three per cent of Nigeria’s population of 201 million live above 65 years.

Health industry observers were worried that even as the declaration of state emergency in the primary health care delivery system was rather belated, a comprehensive remedy to the ugly situation would have been the declaration of state of emergency on the nation’s entire healthcare delivery system. The federal government ignored the warning only to admit rather belatedly through the out-going minister of health that the first two tiers of the system have collapsed.

Even the state of emergency declared on the PHCs amounted to mere verbal expressions. Nothing concrete has happened in the crippled system since the declaration.

The only thing that has happened is that the situation is getting worst. Health industry statistics from all the states of the federation show a people abandoned by their rulers to the cold and cruel hands of diseases and death.

Nigeria is an outlaw when it comes to the issue of observing health industry standards set by the World Health Organisation (WHO). The WHO has set the doctor-to-patient ratio at one to 600 for every country. Nigeria is not interested in observing that standard. Sources at the Nigerian Medical and Dental Council (NMDC) contend that there are 72, 000 doctors in the register of the NMDC, but that only 35, 000 are actually practicing in Nigeria. Close to 40, 000 Nigerian doctors have fled the shores of the country for greener pastures in Europe and North America. With a population of 201 million people Nigeria defiantly maintains a ratio of one doctor to more than 5, 000 patients. That explains why Nigeria has one of the highest maternal and infant mortality rates in the world. It also explains the atrociously low life expectancy in a country that has no business with poverty.

There are very few PHCs and general hospitals in the whole federation. In some rural communities the sick travel for 40 kilometres to the nearest hospital. People leave home by 4am to get the first 100 tallies in hospitals to see doctors. Those who leave by 7am might have to spend the whole day in the hospital.

Kwara state, where the outgoing Senate President, Bukola Saraki, ruled for eight years has not recruited a single medical doctor in the last 15 years. Among the few that were recruited, many have fled to other states of the federation where salaries are more regular.

In September 2018, a nurse whose children were admitted in the Ilorin General Hospital for ailments induced by contaminated water lamented the deplorable state of affairs in the hospital.

The doctors and nurses have not been paid their salaries for several months. The pharmacy in the hospital was empty. Nurses and doctors report for duties with essential drugs that they sell to patients. The sale of drugs had become the lifeline for the hospital’s medical personnel because no one could predict when the next salary would come.

The doctors and nurses were the first to predict Saraki’s defeat in the election that was just five months away at that moment. Lamenting that the Senate President was the problem of the state, they all vowed to ensure his defeat during the 2019 elections. Their prediction was fulfilled with the precision of an electronic calculator as a political neophyte trounced the Senate President at the pools.

Zamfara state has less than 50 doctors in its pay roll. An outbreak of cholera in 2017 was interpreted by the outgoing governor of the state as divine rage over an ungodly people.

Cross River state has just four doctors in St. Margaret Hospital, the oldest hospital in the state. St. Margaret is even blessed. The hospital in Oban in the north eastern flank of the state has no doctor at all. Oban is about 70 kilometres from Calabar. With the only hospital deprived of the services of a doctor, critically ill patients have to be transported to St. Margaret in Calabar to add to the congestion in the oldest hospital in Canaan City.

The NMA contends that there are 34 hospitals in Edo state out of which only three are functioning. The only hospitals functioning in the state are Central Hospital, Benin, Stellar Obasanjo Hospital, Benin and General Hospital, Auchi. No one cares what happens to the unfortunate 31 non-functional hospitals and the millions of people they are supposed to serve.

The tale of woes in Nigeria’s embattled healthcare delivery system is worsened by endemic corruption dotting every rung of the healthcare strata. Bill Gates withdrew the massive support from the Bill/Melinda Gates Foundation to the fight against malaria in Nigeria because of massive diversion of free malaria drugs to private clinics.

The immunisation process funded by the United Nations Children Emergency Fund (UNICEF), WHO and other donor organisations is plagued with cooked up data that gives the donor organisations exaggerated picture of the number of children immunised during each of the campaigns. Corrupt government officials cook up immunisation figures to draw huge sums from donors.

In some instances nurses carrying out the exercise in a community with 30 children are given vaccines for the immunisation of 300 children and ordered to ensure that the target set in Abuja is met.

Where there are no children to meet the set target the workers fill the figures decreed from Abuja and pour the vaccines into the gutter and return home with the satisfaction of someone who accomplished his mission.

Nigeria is in trouble.

By Jerry Uwah
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