BY SOLA OGUNDIPE

THE Nigerian health sector is reminiscent of Samuel Beckett’s “Waiting for Godot” – the famous play that depicts and explores the utter meaninglessness of life. In a playback of its repetitive plot, the play theatrically implies that in life, everything that is possible will happen. In one unending scene, the actors talk about life, the world, and everything else that occurs from cradle to grave. They talk, they wait, they anticipate. But they fail to do the most important thing – act.

To the casual observer, there is calm. There is an impression that all is well and that everything is on course. But to the more discerning, the lack of action and activity is a false calm – a façade. It is an indication that all is not well. In reality, underneath the apparent calm, unmitigated chaos is raging.

Nigerians asked for independence. They worked for it, prayed for it and waited for it, and it came on a platter of gold. Yet the people did not stop waiting. They continue to wait… and wait… and wait – for “something” to happen. But “nothing” has happened, not because it isn’t meant to happen, but more because nobody is making it happen. This depicts the state of affairs of the health sector today.

Long before Independence Day on October 1, 1960, in the 1940s and 1950s, Nigeria, with its population of around 34 million (at that time), was already considered the giant of Africa. It was the dawn of the oil boom and there were great expectations for the affluent, former British colony. The whole world could not help viewing the young nation through rose-coloured lenses.

At that point in time, every relevant resource imaginable was present. Medical supplies were in abundant supply. There were few (if any) centres of medical excellence in healthcare, but they were patient-focused. There weren’t as many experienced and well-trained health workers as there are today, but they thronged the local healthcare centres that were equipped with up-to-date, if not state-of-the-art medical equipment.

Brain drain was virtually non-existent because there was enough motivation for health workers in the form of good remuneration and almost unlimited career opportunities.

In the face of such efficient and effective coordination, the future was bright, rosy, almost fulfilled. Today, the picture has changed considerably, unfortunately, for the worse.

Sovereign independence

As Nigeria marks its 53rd anniversary of sovereign independence, it is a sad commentary that the nation’s strategic position in Africa is no longer commensurate with its standing in the continental and global health care sphere of five decades ago. It cannot be overstated that the health sector has, post independence, suffered several false starts and downfalls, but how did an outlook that was so bright and promising become one so grim and uncertain? The transformation is so palpable the whole world feels it.

Now with an estimated population of 170 million, coupled with the onset of internal strife, insecurity, bigotry, gluttony and other forms of deep-seated political instability, the elements of discord have conspired to rob the nation of its once-great potential. Lack of coordination, fragmentation of services, dearth of medical resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care, have been the hallmark of this sector over the past 53 years.

While these challenges have not any means been different from what other developing countries have faced or are still facing, the dividing line has been the level of political attention. Close watchers of the system have long recognized the absence of a step by step transformation of public health from Primary Health Care, to Secondary Health Care and finally Tertiary Health Care, required creating and sustaining an information-rich and patient-focused system that reliably delivers high-quality care.

Today, Non-Communicable Diseases, NCDs such as cancer, diabetes, hypertension, stroke and coronary heart disease have become a recurring decimal in the life of the average Nigerian and a major issue of survival and national security, unlike 53 years ago when it constituted a mere threat. That is no to say communicable disorders such as HIV& AIDS, tuberculosis, malaria, typhoid, cholera, polio, etc., are less of a threat.

Thankfully, it is now possible to track outbreaks of diseases and step up medical treatment and preventive measures even before there is a spread. Despite various reforms put forward by the government to address the wide ranging issues in the health care system, health facilities (health centers, personnel, and medical equipment) are no longer adequate, especially in the rural areas. But spending and implementation have not matched policies. For instance, Nigeria spends only 6.5 percent of its budget on health care as against the World Health Organisation’s recommendation of 15 percent.

The nation’s high maternal mortality rate remains worrisome. It is among the highest in the world. One Nigerian woman dies in childbirth every10 minutes. Nationally, the maternal mortality rate is 545 deaths per 100,000 live births, nearly double the global average. Children are hardly better off because more children die before their fifth birthday in Nigeria than any other country in Africa. At 5.7, Nigeria’s overall fertility rate has declined, but there is still a high unmet need for family planning, hence too many women are giving birth to too many children too often. While there may have been some measure of effective and even realistic implementation at the Federal level, more is to be desired at the State and local government area levels.

Capacity utilisation

Worse still, the problem of counterfeiting, faking and cloning of drugs are compounded by poor regulation and enforcement.  Capacity utilization is a hindrance and there is serious problem with the handling, storage and distribution of drugs which remains chaotic, with attendant ability to promote loss of confidence in all drugs whether imported or manufactured locally.

Essential functions are still desirable to protect public from major health threats. More efforts are also required at strengthening the health work force through planning, management, and training to have a positive effect on the health sector performance.

The bottom line remains is that it remains an unavoidable and unpleasant commentary that the state of the Nigerian health care system is worsening. The nation is not even on track to meet any of the targets of the eight Millennium Development Goals, MDGs before the 2015 deadline. Year after year, the indicators of health and life continue to go from bad to worse. The dynamics of health care are still not good enough and the search is on perpetually for effective and lasting recommendations/solutions to enable the sector meet requirements of the typical health care system of modern era.