November 03, 2006

A brief Look at The Nigerian Health Sector


Nigeria is a country with an estimated population of 126 million with age structure as described below :

Age structure:0-14 years: 43.71% (male 27,842,225; female 27,514,197) 15-64 years: 53.47% (male 34,456,738; female 33,259,194) 65 years and over: 2.82% (male 1,780,862; female 1,782,410) (2001 est.). The population growth is estimated at 2.61%.
The current infant mortality rate is 73.34 death/1000 live births (2001 est.) and life expectancy at birth 51.07 years (this mean that a child born in Nigeria toady is only guarantee to live for 51 years).

This situation is even worse if we look at the quality of healthy life a child born in Nigeria today we live. For the first time ever, the World Health Organization assessed the performance of health systems of its 191 member countries in achieving three main goals for the health system: health, responsiveness, and fairness in financing. The primary summary measure of population health used is disability-adjusted life expectancy, or DALE, which measures the equivalent number of years of life a child born in Nigeria today is expected to live in full health, (i.e. without disease, injuries and disability) or healthy life expectancy.

Of all the 191 countries Nigeria was ranked (163).

Most countries in sub-Saharan Africa such as Nigeria do not have a reliable death certification system and so useful information on deaths outside hospital is virtually non-existent.
Mortality in Nigeria and other sub-Saharan Africa is higher than the other major regions of the world. Several issues of major concerns suggest that mortality decline in Nigeria and other African countries may have slowed further or been reversed in recent years. The reasons for this pessimism can be related to the following factors; the economic difficulties that have afflicted most African countries since the 1970s; the mortality trends in parts of Africa due to civil, ethnic warfare and other conflicts. Furthermore, another development in Africa in relation to which it is hard to find any grounds for optimism is the epidemic spread of HIV.

Nigeria and Africa as a whole, lack adequate vital registration system.

Mortality data are a standard information resource to guide public health action. Nigeria does not have a representative morbidity and mortality surveillance and adult risk behavior surveillance system. Hence, it is very difficult for the government to plan adequately for their citizens.
Out of the estimated 27 million women of reproductive age, one in thirteen die due to causes related to pregnancy. Recent figures indicate that the maternal mortality ratio (MMR) is 800/ 100,000 live births in Nigeria. However, there are wide regional disparities in the statistics. Whereas the Southwest region reports an MMR of 165, the Northeast region reports 1,549. Maternal mortality rates are twice as high in rural settings as they are in urban ones. Of the annual 3 million pregnancies in Nigeria, approximately 170,000 result in death that is mainly due to complications during pregnancy and childbirth. The main causes of maternal mortality in Nigeria are hemorrhage, which accounts for about a quarter of all maternal deaths, sepsis 15%, complications of unsafe abortion 13%, hypertensive diseases of pregnancy 12% and obstructed labor 8%.---UNICEF

Only 36% of Nigerian women are in the adult work force according to the United Nations’ World Women Report 2000, which ranks Nigeria at 151 on the gender-related development index among 174 countries. Reasons for this are the low social status and inequality of women which limits their access to education and ultimately, economic resources. This in turn limits their ability to make decisions about their reproductive health.----WHO

Approximately 35% of Nigerian women experience their first pregnancy by the age of 19. The Nigerian Demographic Health Survey (1999) further states that only 15.3% of married women are currently using contraception, of which only 8.6% are using modern methods (e.g. condoms and birth control pills).

Only 60% of women receive antenatal care and approximately 31% of all deliveries take place in a health care facility. Moreover, only one-third of all deliveries are attended by skilled attendants in Nigeria. A study conducted in the northern part of the country indicates that 25% of all deliveries take place in the home with no assistance or attendance present.---WHO

Health care facilities in the country are generally in poor condition with chronic shortages of essential equipment, drugs and human resources. The most severe is the lack of adequate skilled attendants which are the most essential element of quality health care, because they often leave to the private sector, or move to other facilities due to lack of resources or proper remuneration.

Hope for Solution
"Where there is will there is hope". The immediate response and solution to this grimly statistics is for all the governments in Nigeria to declare a state of health care emergency.
The second step will be to convene a "Sovereign National Health Conference" to discuss and design a national health policy for the adequacies and economic optimization of the macro-allocation of the health care funding.

There is a common Yoruba adage that says "your medicine will be as big as the money you pay" ("Bi owo se mo l’ogun mo"). A government can not be spending less than one percent of its GDP (gross domestic product) on healthcare and expect anything better than the picture described above. You can not sow corn and be expecting to harvest wheat.

The third steps should be the cost-effectiveness of the micro-allocation of the healthcare funding.
Communicable diseases including maternal and perinatal conditions and nutritional deficiencies are responsible for the causes of about 41.5% of burden of disease in disability adjusted life years (DALY) and non communicable diseases such as cancers, stroke etc., are responsible for the causes of about 46% of burden of disease in disability adjusted life years (DALY) in Nigeria and other African countries.---WHO (DALY means quality of year of living without disease, injuries and disability). T o reverse this trend, the country needs to direct their healthcare funding to the following priorities:

Increase public health funding-The core functions of public health are to prevent epidemics, to protect the environment, the workplace and to ensure safe housing, food and water. To further promote healthy behavior, to monitor the health of the states and the country, to help mobilize communities for action on health related issues, to respond to disasters, to target outreach communities for health services, to train employees for the investigation and prevention of disease, and to protect policies to protect the health of the environment and the people.----Institute of Medicine

Environmental sanitation: Most of the causes of infant and maternal deaths are preventable infectious diseases that can be reduce by providing sanitary environments, such as provision of portable water, sewage, sewerage control and refuse management and reduction of overcrowding.
Free prenatal and neonatal care: The care of women when they are pregnant, every pregnant woman should have access to quality and free medical care through out their term of pregnancy and delivery. Trained public health nurses and community health aides should visit mothers at home until when their children are three years old.

Health education and behavioral change enlightenment programs for the people of Nigeria. This should involve area of diets, smoking, sanitation, exercise, sexual transmitted diseases and other behaviors that may impact the health of the country.

Proper education and empowerment of women in the country to take care of themselves. This singular action has been described as one of the most important factors responsible for the improvement of the health status of women and general health status indicators in Costa Rica and Cuba.

Nutrition: The government should ensure that every child from age 6 yrs till 13 years eats quality breakfast and lunch (provision of school mid day meal and lunch by the government).

Immunization: Vaccination against the deadly communicable diseases.
Improve infrastructures like roads to allow farmers to move their products with ease from the farmlands to the markets, and easy transfer of emergency cases to the hospital for medical care. Injuries are responsible for the causes of about 12.4% of burden of disease in disability adjusted life years (DALY)

Provision, improvement and proper staffing of the community health centers and hospitals, and adequate remuneration of the hospital personnels.
Improvement of morbidity and mortality data collection and managements to enable the policy makers to plan and implement effective healthcare policy.

Tobacco regulation: Tobacco and its products has been associated as the leading cause of most noncommunicable diseases like cancer, heart disease, diabetes, stroke etc., a government policy on the control of this product is very essential in order to improve the country health status indicators.

The Ominous Nigerian Health Care System: Is there a hope for solution?
Debo Awosika-Olumo MD MS.

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