By Sola Ogundipe, Health Editor
IN several ways, the war against COVID-19 pandemic in Nigeria had begun long before the confirmation of the index case in February 2020. Even before the first test was carried out and admission of the first patient, there were concerns in all quarters about Nigeria’s state of readiness and level of preparedness. The reason for the concerns was not unconnected with the nation’s “weak” health system.
The concerns were not far-fetched, especially as the health systems of the United States, United Kingdom, and a number of high-income-countries were already being overwhelmed. For weeks, the weakness of the Nigerian health system had been a major topic for discussion.
With plethora of under-equipped, under-staffed and under-resourced hospital facilities that could not provide the high quality and culturally appropriate healthcare and vital services required to tackle the raging pandemic, Nigeria was practically a sitting duck. But even though the health threat was new, challenges of the health sector were not.
Years of pride
Long before Independence Day on October 1, 1960, in the 1940s and 1950s, Nigeria had earned the position of the giant of Africa. The nation’s health industry was vibrant and medical supplies were in abundance.
There were a few centres of medical excellence in healthcare, but they were patient-focused. There weren’t as many experienced and well-trained health workers as today, but they thronged the local healthcare centres that were equipped with up-to-date medical facilities and equipment.
Brain drain was non-existent because there was enough motivation for health workers in the form of good remuneration and almost unlimited career opportunities. The future was bright, rosy, almost fulfilled.
But since Nigeria returned to democratic governance in 1999, the picture changed for the worse. Although health challenges are a typical teething symptom of evolving democracies, after 21 years of uninterrupted democracy, the effect is expected to rub off positively on our healthcare system.
In the past 21 years, Nigerians have battled numerous disease outbreaks including Ebola Virus Disease, Lassa fever, cholera, monkey pox, among others. Previously, Nigerians managed to get by without tracking disease outbreaks or stepping up medical treatment and preventive measures, or strengthening health systems but COVID-19 has been a different ball game all together. Besides non-communicable diseases, such as cancer, diabetes, hypertension, stroke and coronary heart disease, the COVID-19 pandemic has come to rewrite the rules. With less than adequate health facilities, personnel, and medical equipment especially in the rural areas, the spendings on Nigerian health system have not matched policies. Low government health spending over the last 21 years has limited the expansion of highly cost-effective interventions, and stunting health outcomes as against global standard and recommendations.
No substantial change
In the view of the National Chairman of the Joint Health Sector Unions, JOHESU, Comrade Biobelemoye Joy Josiah, there is no substantial change in the state of healthcare in Nigeria in the last 21 years. “In fact, it has become worse, hitherto what we had, the pre-1985 glorious era; remains the best that we ever had because healthcare was basically managed at that time by managers of cognate experience and seasoned administrators.
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That is not what we have now and that is why we have continued to be in crisis. We had some semblance under former President Olusegun Obasanjo, when Professor Eyitayo Lambo, an economist, was in charge.
Politics of our health sector
“Nothing has changed from that unfortunate rating of our health system at 187th out of 191 health systems around the world. This is because the politics of our health sector encourages the trampling of other professions and health workers.
“It is a destructive development that should be ameliorated before we can begin to make the kind of progress that we should make.
“Basically, our rating in health remains low because we still contend with a lot of negative health indices. This has been there before all through the years but this government has not done enough to change the perception. One is inclined to look at it as a repetitive lethargy when you begin to repeat and repeat. All our hospitals are loaded with dead equipment and gadgetry. Look at what is going on with COVID-19. We have never invested in Research and Development and this is one of the reasons we are now paying very dearly for this lack of foresight.”
Josiah went on to highlight specific areas that have been stunted in the nation’s health system. “One is the poor quality of appointments. There has been neglect in equitable choice in appointment of ministers of health and in the various ministries, departments and agencies, MDAs, in the health sector. For a lot of these appointments, the President needs to go back to the drawing board and make an appraisal of the appointments that he is making.
“For instance there are five medical doctors in the Federal Executive Council, FEC. Two medical doctors are in charge of the Federal Ministry of Health, one is in the Labour Ministry, another is the Head of Service and yet another in a key position. This type of spread does not allow capacities and competencies within the other arms of the health workforce. Healthcare is evolving, and is ruled by international best practices. The health system suffers invariably when you try to grow one profession and bring down others and expect a perfect system. It doesn’t work that way in other climes. You cannot have a Nigerian way or style of healthcare.”
He called for funding of the numerous research institutes in the health sector. “Recently, the US government approved the sum of $1 billion to an American pharmaceutical company, Astra Zeneca, to pursue research for a COVID-19 vaccine. This is just a sample of what happens in the advanced world. But what do we have here? Research and development and drug development and discovery is very expensive and all the pharma in Nigeria cannot even raise this. We have wasted those fortunes; we have spent the fortunes that should have been preserved for tomorrow, yesterday.”
How to halt vicious cycle of failure, delinquency – Iyiola
Reviewing the health system in consonance with transition day, Chairman of the Lagos State Pharmaceutical Society of Nigeria, Gbolagade Iyiola, emphatically stated that nothing fundamental has changed in Nigeria’s healthcare 21 years after. “The past 21 years have been a vicious cycle of failure and delinquency, but this is another opportunity to have a departure from the status quo in the larger interest of our nation and all consumers of health,” he said, adding: “As pharmacists, it is apparent to us that government does not have the right managerial capacity in the health sector. On record are the negative health indices that have continued to be intractable and escalated along with the many actions and inactions. One of the fallouts of the very poor management is the fake drug syndrome.
“It was government of former President Goodluck Jonathan that came up with the National Drug Distribution Guideline, NDDG. One of the “windows of amnesty” provided through the NDDG was that open drug markets would relocate in tandem with the existing laws to the Coordinated Wholesale Centres, CWC.
“But government, over the years, has continued to shift the posts, and it appears that the players in Lagos and Onitsha were complying with the order, but as things stand now, we appear to have completely lost that momentum. The Federal Ministry of Health is not saying anything about that issue again; even the concerned state governments have turned the CWC project into a political and economic platform. Many of such projects are stalled, yet if we cannot demonstrate political will in matters that will guarantee better health for the average Nigerian, the nation will continue to be doomed.”
Giving a run down of the effects of the failures of the health sector on the COVID-19 response, Iyiola recalled the recurrent fake drug challenge. According to him: “The real drug scourge is problem of fake drugs. With COVID-19 situation in Nigeria, it is glaring that the fake drug scourge in Nigeria is the fake drug syndrome. It is a national emergency that must be tackled.
“A nation that has a national drug policy that prescribes a situation whereby 70 percent of the essential drugs must be available through local industry, but the reality is the opposite, 70 percent of our drugs come from China and India, and that was why we were going to experience drug scarcity at the onset of COVID-19. As of today, most Nigerian drug importers have their consignments still trapped in places like China and other places. They cannot bring them in, and these are drugs necessary to manage serious clinical diseases. There is no nation that really wants to make progress that will continue this way.”
Appealing to the Federal Government to invest the pharmaceutical sector, he said: “I’m appealing to President Buhari to be interested in this sector. If the Federal Government invests in the pharmaceutical sector and encourages investment, this sector can reorientate Nigeria to compete with India and China where the pharmaceutical sector accounts for about 10 percent of the GDP. Today, the pharmaceutical sector contributes just one percent to the Nigerian industry, yet it is probably the most buoyant industry in the health system. We need to reverse this kind of unfavourable trend.”
He said there is no argument that the Nigerian health sector desires investment and the pharmaceutical sector can provide that. “We must become a nation that can generate a hub for pharmaceutical excipients, Active pharmaceutical industries, APIs, and packaging materials, but we can only do this if we invest in the pharmaceutical sector. Government needs to fund research, a lot of the efforts in drug research and production units, the faculties of pharmacy, the Nigerian Institute of Pharmaceutical Research and Development, NIPRID, etc., are viable, but we do not have the necessary incentives from government to take the products of these researches to the next level.”