Quality and affordable healthcare is critical to sustainable development and national progress because it is human capital that drives the other factors of the economy. Over the years, the Nigeria health sector has been epileptic in its operations owing to several factors. In a recent study conducted by WHO to measure the overall health system performance for 191 countries, Nigeria healthcare system was ranked 187 in the world. This is far behind countries like Togo, Somalia and Afghanistan.
Considering the happenings in the nation, it seems the challenges in the health sector are only a reflection of the general picture of what's obtainable in the country, of which a friend termed “Systemic Failure”
Taking an overview of the sector, Nigeria’s healthcare delivery system consists of a network of primary, secondary and tertiary facilities. In 1992, primary care was largely provided through approximately 4,000 health clinics and dispensaries scattered throughout the country. As for secondary care, there were about 700 health care centres and 1,670 maternity centres; tertiary care was handled through 12 university teaching hospitals with about 6,500 beds spaces.
Over the last 3 decades, the health sector has witnessed tremendous increase in the number of healthcare facilities. Data from Federal Ministry of Health as at 2011 revealed that Nigeria has about 78 tertiary facilities and over 30,000 primary and secondary healthcare facilities widespread across the country.
However, in respect to the nation’s population rise, there is a significant infrastructural deficit to meet the healthcare demand of the current over 201Million Nigerians.
Poor funding has always been a major problem in the health sector. Over the last 10years, percentage budgetary allocation to the heath sector has consistently fluctuated between 3.9% - 5.8%, contrary to the “Abuja Declaration” that specified a minimum of 15% by African states. As a result of this, the health sector rely heavily on external and internal funding from several donor agencies. The contribution of development aid to health care financing in Nigeria was estimated at N27.87 billion, 4% of Total Health expenditure (THE) in 2003. This increased by 29% to N36.04 billion (4.6% of THE) in 2004 and by just 1% to N36.30 billion (4% of THE) in 2005. Although the international assistance to the Nigerian health sector is increasing, it accounts for a small proportion of public health expenditures.
Out-of-pockets spending account for the highest proportion of health expenditure in Nigeria. Out-of-pocket expenditure accounted for an average of 64.59% of total healthcare expenditure from 1998 to 2002, and 68% by the year 2005. The implication of this is that the burden of healthcare expenditure is majorly borne by the individuals. In terms of human personnel, there has been a significant fall in the doctor - patient ratio with current value standing at 1 to 5,500.
It is estimated that Nigeria produces 2,000-3,000 doctors yearly. With this value, it is assumed that in 10years we should be able to further cut down the ratio. However, with the advent of massive exodus of doctors and other health workers out of the country, this target may not be realistic.
What’s Wrong with Nigeria Health Sector?
If the health sector will thrive, there is a need to address some fundamental issues in the frame of the sector. Poor funding, lack of adequate equipment and needed skilled personnel may account for a significant chunk of the challenges in the health sector. But, I doubt if they are truly the fundamental problems of the sector. In fact, if the entire Nigeria budget is diverted into the health sector, the sector still won’t work until these fundamental problems are sorted out
1. Lack of Effective Management Structure
Effective and a well laid down management structure is the foundation of any successful organisation. A faulty management structure overlaid with the best of brains is sure to fail.
The current management structure of our tertiary healthcare facility consists of Federal Ministry of Health at the apex, followed by management board, then the Chief Medical Director, followed by the various directors and the departmental heads. Key in this structure is the management board.
One thing common to highly ranked health systems in the world, is a strong management board, consisting of individuals with a track record of effective leadership and managerial experience. But it is disheartening to know that in most government hospitals, the management board is largely non - functional, giving room for CMDs to operate as an autonomous entity. The effect of this, is lack of accountability on the part of the CMDs, and this has largely resulted in the gross mismanagement of the country’s healthcare facilities.
Secondly, the current management structure of our hospitals is largely influenced by politics, such that who you know, academic qualification, management certificate and how long an individual has been in the system are the key factors for management consideration, rather than true managerial exposure, experience and track record of excellence.
2. Faulty Model of Operation
Central to highly rated healthcare system in the world is effective and efficient patient care. The result of this is a sense of value for life. For such system, patient need, positive patient feedback and patient’s satisfaction are important indices for resource allocation. Contrary to what's obtainable in those systems, central to the Nigeria healthcare system is health workers satisfaction.
In contrast to the private sector, services at government facilities are designed to be cheaper and better.
However, it should be noted that government facilities are not charitable organisations, and as such, revenue generation is important.
Between 2011 and 2017, there had been budgetary allocations ranging from N100m to over N11bn to all university teaching hospitals, FMCs and other tertiary health institutions across the country, amounting to over N4.5tn. However, over the years, the institutions reportedly collected N7.97tn IGR and remitted about N200bn to the federal account
3. Poor Working Conditions
Health workers well-being is crucial to quality service delivery. The Nigeria health workers are one of the poorly paid worldwide coupled with the poor working conditions. This over the years has resulted in massive migration of health workers out of the country, some to countries that offers lower pay, but better working environment.
4. Industrial Disharmony
One of the major factor dragging down our healthcare system is the frequent industrial action embarked upon by various professional associations operating in the health sector. Issues of contemplation mostly revolve round salary disparity, hospital leadership, work definition and working conditions, with little emphasis on patient care.
It is worthy to note that on an average tertiary hospital in Nigeria operates 8 - 10 months of uninterrupted service delivery, with 2- 4month of partial to total disruption of services from industrial actions.
Way Forward
Considering the enormous challenges in the health sector, there is a need for key stakeholders meeting to review the management structure and operations of our health facilities.
Secondly, professional bodies are meant to advance the course of their members, however, this should not be at the detriment of the institutions they serve. Therefore, there is an urgent need by the Federal Ministry of Health to tapper the excesses of all the professional association operating in the health sector.
Thirdly, the services of SERVICOM should be strengthened and operated as an independent entity outside the influence of the hospital management. Also, evaluation of the quality of service across all our health facilities should be done routinely with a feedback report.
Lastly, there is a need for detailed work description for all bodies operating in the sector, alongside a proper pay structure.
In conclusion, it is interesting to know that considering the numerous challenges facing the health sector, the sector continues to break new grounds. However, If we hope to improve our health indices, there is a need for a collaborate effort from all stakeholders in the sector.
WHO| Nigeria
Abuja Declaration
NJCPP online | Article
Punch Newspaper
Wow nice write up
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