More and more Nigerians are flocking overseas for medical treatment, seeking to escape the worsening health services here. This is worrisome. Things could degenerate further with a proposal to privatise the county’s leading teaching hospitals. While the Nigerian Medical Association is not totally against the plan, the Joint Health Sector Union warns that it will trigger a serious national health crisis. This divergence should not make us lose focus of the ultimate goal: achieving universal health coverage at affordable costs, particularly for the poor and vulnerable groups.

 

The current arrangement, a mixture of public and private system, is expensive. Most importantly, it is not working. The Federal Government has just 20 teaching hospitals, 22 Federal Medical Centres and 13 specialist hospitals, making a total of 55. In terms of access, this is inadequate to serve a nation of about 165 million people even when the hospitals owned by the state governments are added. The private hospitals are many, but they equally lack the equipment, resources and personnel, and are mostly located in the urban centres.

 

As our population rapidly grew, the government neglected the emerging dynamics. According to the NMA, there are 40,000 Nigerian medical doctors, but 19,000 out of them are practising abroad, while 70 per cent operate in “urban centres where 30 per cent of the population reside.” This is a dismal ratio. As a result, the World Health Organisation classifies the country among the 44 per cent of nations that have less than one per cent of physicians-per-1000 population.

 

The facilities are obsolete, too. General Electric, a United States firm, said last week that between 50 and 80 per cent of the equipment in Nigerian public hospitals “are out of service.” Drugs are sometimes not available. This generates constant friction between government and doctors. Strikes bedevil the system at every turn. The result is chaos, such that the military, in the 1980s, described the hospitals as “mere consulting clinics.”

 

The urge to make amends led former President Olusegun Obasanjo to designate five of the teaching hospitals “Centres of Excellence” after he assumed office in 1999. They are the university teaching hospitals in Ibadan, Enugu, Zaria, Maiduguri and Idi-Araba in Lagos. Today, we are not better off in spite of the acquisition of modern equipment for those centres. After the billions of naira spent on the project, it is clear that the problem is not money.

 

It is argued that capitalism has no place in health care provision. This explains why government-run health care is still in vogue in France, England and Canada. Cuba, the WHO health care delivery model, has consistently demonstrated how results can be better achieved with limited resources. With a life expectancy of 78 years, it spends just four per cent of the United States annual health outlay of $2.4 trillion ($7,900 per person) to outperform developing nations and be at par with the developed economies.

 

 

Nigeria ranks dead last on almost all health care indices. Malaria alone accounts for 30 per cent of childhood deaths in the country, with 25 per cent of deaths in children under-1, 11 per cent of maternal deaths, and 60 per cent of all out-patient visits to hospitals. This is horrendous. Apart from the loss in man-hours, the financial cost is huge, standing at N132 billion for treatment and prevention on an annual basis, according to the Federal Ministry of Health. Yet, Cuba had eradicated malaria from its shores by 1967.

 

Not only does Nigeria have one of the highest infant and maternal mortality rates in the world, the country also harbours 3.4 million HIV sufferers, going by WHO estimates. WHO said 200,000 Nigerians died from AIDS-related complications in 2012. This has made many to put their fate in the hands of quacks.

 

Consequently, Nigerians who can afford it troop abroad for medical treatment. Statistics from the FMoH state that for the past few years, Nigerians have been spending $500 million annually on medical treatment overseas, with India, the top destination, raking in $260 million of that amount from our ailing nationals. But there is a major problem for those who cannot treat themselves, whether at home or abroad.

 

So, what works? There are several models, depending on the environment and the political will. Sweden, for instance, is leading the world in allowing private companies to run public hospitals. But government picks the bill. In 1970, Oman tweaked its convoluted programme, increasing government investment. This has reduced maternal mortality and improved system performance. Britain’s National Health Service, which started in 1948, is worth studying. More than 90 per cent of the British population are on the NHS, but medical treatment is free for the citizens, paid for by tax. The United States has a mixed system, with most employers sponsoring health insurers for their staff. But the US government insures the poor (Medicaid), the elderly, veterans, federal employees and Congressmen (Medicare), while state government-run programmes insure other public employees.

 

However, having studied the different models, health experts recommend the one in Cuba. In spite of debilitating US economic sanctions and limited funding, Cuba guarantees free medical treatment for all of its nationals. Its consultorio system, based on research, depends heavily on preventive care. Most diseases are nipped in the bud before they can spread through a neighbourhood treatment and assessment programme in which doctors live close to the people. Illnesses that can’t be cured at this level are referred to the 444 polyclinics.

 

This has worked to a telling effect. At a time New York City had 43,000 AIDS cases, Cuba had just 200. There, measles was eradicated in 1983, meningitis (1989), diphtheria (1979), polio (1962) and rubella (1995). Cuba exports 29,000 doctors to 69 nations around the world, including the US, and 22,000 students from different countries are studying medicine on free scholarships there. In 2014, Margaret Chan, WHO Director-General, praised it, saying, “We sincerely hope that all of the world’s inhabitants will have access to quality medical services, as they do in Cuba.”

 

As a starting point, the National Health Act, a December 2014 law, should be implemented. The law prescribes “not less than one per cent from the Consolidated Revenue” to fund health in the country, while state governments and local governments are to provide counterpart funding. The money generated is to be deployed in providing free health care for women, children under-five and those aged 65 and above.

 

The National Health Insurance Scheme, established under Act 35 of 1999, should be reviewed and be made to attract membership as pooled resources benefit a health system. Above all, the government and stakeholders should take a critical look at how to reform, fund and equip the system for optimal performance.

 

By: The Punch