By Sola Ogundipe
PEOPLE the world over confess that life gets easier   after 50.
Suddenly they know who they are and what it is they want out of life. At 50, there is not much more to find out about oneself. On the contrary, there are many benefits to being 50.

At 50, you are entering what is arguably the best time of your life. Not only will you find life is getting simpler, you will also discover you are wiser than when you were in your 20, 30 or 40. At 50 you are bound to have more control over your life. No longer will you be taken along by the tide and be pushed into unintended directions.

For so many reasons Nigeria being 50 years old ought to mean entering the golden years of care free living. Nigeria has not attained its best in health at 50. In 1960, there were not many hospitals, but records show they were usually full and there were enough medical personnel to attend to patients.

By 1979, there were 562 general hospitals, supplemented by 16 maternity and/or paediatric hospitals, 11 armed forces hospitals, six teaching hospitals, and three prison hospitals. Altogether they accounted for about 44,600 hospital beds.

In addition, general health centres were estimated to total slightly less than 600, general clinics 2,740, maternity homes 930, and maternal health centres 1,240. All these hospitals have been full to bursting ever since, but over the years, health services have not advanced.

Colonialist health system

After independence, the new government adopted the colonialist health system that primarily responded to the needs of the elites. Healthcare was not understood the way it is understood today, but there were clinics or dispensaries in almost every nook and cranny where people went for minor ails.

Health needs of the larger rural population were gradually being met, and after a while people began to appreciate why the nation was excelling in things like child survival thanks to “basic” immunisation programmes, control of diarrhoea in children, malaria treatment and acute respiratory infections.

Fifty years later, health indices are daunting. Infant and maternal mortality rates have deteriorated to all-time lows. Infant mortality began to slump from the first decade, but the real worry started from 85 per 1000 live births in 1982. According to the Nigeria Demographic and Health Survey 2008, infant mortality ratio is now 118 per 1000 live births.

Maternal mortality ratios have similarly plummeted and are estimated at 1100 per 100 000 live births in WHO’s World Health Statistics 2008. Today more women die in Nigeria than any other country in Africa from pregnancy-related causes. On a global scale, number of maternal deaths in Nigeria is second only to India which has the world’s second largest population at 1.16 billion – more than nine times Nigeria’s population of 120 million.

Government health policies increasingly became an issue of policy debate and public contention since the late 1980s. During the Constituent Assembly in 1989, the Assembly proposed free and adequate health care as right to all Nigerians within certain categories – all children younger than 18, all people 65 and older, and all those physically disabled or handicapped. The provision was rejected.

Health care delivery in Nigeria has always been a sort of albatross to the welfare of the average Nigerian. There is absence of comprehensive, intensive medical intervention, higher-value primary care and preventive medicine and management of chronic illnesses.

There has never been a single national entity or set of policies guiding the health care system for the overall benefit of the individual. Even the fragile primary care system that would have seen to this oversight has all but collapsed. Secondary healthcare is struggling for relevance while tertiary healthcare is an island unto itself.

Quality of life
In 2010 life expectancy had dropped to an average of 47 years. The quality of life has not improved significantly either.

These days, healthcare personnel go on strike with total abandon and diseases such as polio, guinea worm and cholera that have been eradicated in other parts of the world are the run of the day here because primary and secondary healthcare hospitals really do not do much to prevent diseases.

They are more adept at treating and curing the sick.
Attempts at establishing community medical and health services have not hit the mark.

In the mid-80s when Nigeria joined the international push for primary healthcare after the 1978 Alma Ata Declaration of “health for all”, hopes were high for a better health management process.

There was a little progress in improvement of health services between then and the mid-1990s, but by and large, the nation’s health indices have deteriorated ever since.

The World Health Report 2000 ranked Nigeria 187 out of 191 countries for health service performance and the noted inadequacies have since persisted.

While annual budget allocations have never exceeded the five per cent recommendation of the World Health Organisation (except for 1998–1999 and 2002–2003), the Second National  Development Plan in the post-independence era of the 1960s did not articulate a system with clear responsibilities for each level of government to address basic healthcare issues of the young nation.

In the 70s, the ambitious Third National Development Plan was designed to focus on the Basic Health Services Scheme, but failed to share responsibilities between the governments for resource generation, manpower development, health professional deployment and service delivery.

Then in the 80s came the Alma Ata Declaration and there were serious attempts at health system reform resulted in the National Health Policy of 1988.

Alas, the policy failed to create a unified system of care or address financing and staffing for competent local leadership.  Consistently, failure to decisively advance a workable healthcare industry is steeped in Nigeria’s colonial past and cannot be separated from it.

This has been aggravated by the mix of lack of political will, poor policy-thrust and misappropriation of resources that have routinely failed to divide responsibilities effectively between federal, state and local government have permanently stunted healthcare services at all levels.

Solving Nigeria’s health care problems requires removing health care from the politics, in which well-organised special interests can cause great harm to the larger public.

Health care needs to be subjected to the rigours of the competitive markets, and creating market-based institutions in which individuals reap the full benefits of their good decisions and bear the full cost of their bad ones.

Expectations are that as the nation moves into its sixth decade of  independence, implementation of health care processes and programmes will address the peculiarities of a decentralised political system, a much more dominant private sector, increasing demand for a reliable health information system and expanded roles for non-health sectors.

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