By Sola Ogundipe
From one of the richest and most promising 50 countries in the late1960s and early 1970s, Nigeria is today among the 20 countries in the world with the widest gap between the rich and the poor.

The nation has gradually declined in fortunes for its people to become among the poorest in the world.

As one of the world’s top 10 crude oil producers, Nigeria currently fares very poorly in all development indices. Average annual percentage growth of GDP from 1990 -2000 was 2.4.

The Gross National Income, GNI, per capita is less than US $260; under-five mortality rate per 1,000 live births is 153; average maternal mortality ratio per 100,000 live births is 545; and life expectancy at birth is 48 years for males and 49 years for females.

Even as a signatory to the United Nations Millennium Declaration to eradicate poverty, promote human dignity and equality and achieve peace, democracy and environmental stability, the Nigerian context and progress remains a real cause for concern.

Doctors attending to mothers and their babies in one of the wards of the Ondo State’s Mother and Child Hospital in Akure, the state capital weekend.

Year-in, year-out, the pitiable state of the nation’s health care system defies reason.

Fifty two years after independence, exhibitions of poor development, consistent backdrops, especially at the Primary Healthcare level, with inadequate functional surveillance systems in tandem with the modern era are just a few of several flaws that punctuate fortunes of healthcare in the country today.

To say problems encountered by the Nigerian health care system are huge would be an understatement.

From wasteful allocation of funds, poor planning and implementation of policies to unreliable documented evidence of how much of the annual federal health care budget actually goes into improving health outcomes and improving quality of patients lives, the list of barriers on the path of progress of healthcare delivery in the nation today is too long to enumerate.

Challenges of leadership, infrastructural advancement, and manpower, to clinical training and standardization, subsist.

Weakened referral system and lack of supportive services for specialist treatment, uncoordinated chronic diseases management and prevention, poor health campaign and awareness drive, and non-committal knowledge base/research culture are all hallmarks of the ineffective system.

Sundry health requirements

From the foregoing, it is hardly surprising that no past or present government official patronises government health institutions in the country.

So frail and unhealthy at many levels is the system, that the era of jetting out to Europe, India and the United States of America has taken root. It is now the rule rather than the exception to fly abroad for sundry health requirements.

A close review of the health statistics from state, local and federal levels shows that Nigerians do not enjoy among the best human development indices on the continent or in the world for that matter.

Since independence, quality of life of the average Nigeria has been on free fall with respect to global standards. At 52, Nigeria has among the highest maternal mortality rates in the world.

From maternal mortality to infant mortality, the outlook is grim. A child born in Nigeria today is more likely to die within the first five years of life, than in most other African countries.

Statistics from the United Nations population division, as it pertains to infant mortality and under-five mortality of children in Nigeria tell a grim story. Equally as discomforting as the nation’s infant mortality rate is the high death rate of children under the age of five years.

The nation equally has one of the worst mortality ratios for women on the continent and the world. Nigeria has the ignominy of being one of the worst places on Earth to be a mother.

Worse still, Nigeria is among only a handful of nations in the world still fighting “outdated” disorders such as polio. Other preventable or treatable infectious diseases such as malaria, pneumonia, diarrhea, measles and typhoid still hold sway even in the face of the rising profile of non-communicable disorders.

Problems of industrial unrest, poor healthcare financing, challenges of drug safety and distribution, continue to trouble the system as Nigerians are enmeshed in an eternal battle with problems of squalor and underdevelopment.

Hence outbreaks of diseases of extreme poverty such as cholera remain rampant while vaccine preventable disorders such as polio continue to hold sway even though one in four of the deaths are preventable through routine immunization.

Routine childhood vaccines

Coverage of routine childhood vaccines remains lower than global benchmarks and, in many parts of the country, is among the lowest in the world. It has not been all gloom.

There have been successes of sorts in achieving major improvements in immunisation coverage rates of late. Some key strengths include strong support by high-level policy makers and technocrats at the federal level, specifically from the NPHCDA and the Ministry of Health.

Other strengths include a federal budget line for immunisations and a record of success with polio eradication in most states of the federation.

There have been demonstrated efforts of the ability to disseminate pro-immunization messages and increase demand for vaccines. But, overall, systemic weaknesses remain paramount, structurally and logistically.

Universal drawbacks such as a lack of accountability, weak monitoring and ineffectual evaluation systems, low perception of routine support, especially at the sub-national level are hallmarks of the system.

A close study of the healthcare system indicates that disbursement of designated funds has been problematic, and fiscal decentralization has resulted in inconsistent funding levels across states and Local Government Areas.

For healthcare delivery, the passage of time has eroded much of the momentum garnered at independence. Over the decades, the nation’s health history has been a one-way traffic – downhill – on a roller coaster imbued with a medley of bottlenecks and failures, challenges and obstacles much more than one of successes and opportunities.

In this regard, numerous efforts aimed at energising commitments and redirecting national agenda towards the ultimate realization of “health for all” cannot be said to have been truly realised.