Last week was not the best of times for the immediate past rulers of Nigeria. Bill Gates, the world’s former richest man, foremost philanthropist and co-founder of the Bill and Melinda Gates Foundation took them to the cleaners.
Gates lamented that Nigeria spends an average of $10 (N6, 663 at current exchange rate) annually on the health of each Nigerian. He argued that Nigeria’s miserable average spending on its citizens’ health was a far cry from the development in impoverished sub-Saharan Africa where average annual expenditure on health stands at $31.
Nigeria’s average health expenditure on each of its citizens pales into insignificance even in impoverished Sub-Saharan Africa.
That explains why Nigeria musters the world’s fourth highest maternal mortality rate. Gates lamented that the few hospitals available are ill-equipped, grossly under-staffed and poorly funded.
The situation is so bad that in some communities women in labour are ferried on the back of donkeys to the nearest maternity.
In some communities, the nearest general hospital is 30 to 40 kilometres away. With the tripling of fares as petrol price escalates with the withdrawal of subsidy, thousands more would die in silence in their homes as they cannot afford the transport cost to the nearest hospital.
Zamfara State may enter the Guinness Book of Records for its notoriety in the provision of healthcare facilities. In 2017 the state with five million people had 23 doctors in its 24 general hospitals.
During the kleptomaniac rule of former governor Abdulazeez Yari, there was an outbreak of cholera apparently due to dearth of potable water. Hundreds of people died from the infection.
To everyone’s consternation, Yari gleefully announced that the cholera outbreak was God’s punishment for the immoral behavior of the people of the state.
The appalling state of healthcare delivery due to poor funding explains why Nigeria, Africa’s largest economy, has one of the world’s highest infant and maternal mortality rates. At 512 deaths for every 100, 000 births, Nigeria remains one of the world’s deadliest places for pregnant women.
The infant mortality rate stands menacingly at 54.74 per 1, 000 births. A third of Nigerian children die before age five.
For the same reason that Gates berated its immediate past rulers, Nigeria is one of the five countries with the world’s shortest life expectancy. Life expectancy for Nigerian men is a paltry 55.7 years.
That again explains why 60 per cent of the population is made up of people below 30 years. Nigeria has a very short supply of people in their 70s and above because the healthcare facility to sustain them is just not there.
Even as Nigeria is noted for mustering some of the world’s best brains in medical practice, a princely sum of $1.6 billion was spent on medical tourism in 2022. That is largely because rich Nigerians do not trust the country’s ill-equipped general hospitals or even the teaching hospitals to provide the necessary medical succour in difficult times.
The appallingly low average expenditure on each citizen’s health by the federal government is the consequence of the skewed income distribution system.
Successive rulers of Nigeria have fashioned out an income distribution system that allocates a disproportionately heavy chunk of the country’s income to very few but powerful politicians, while the inconsequential majority toil in penury.
The 2023 budgetary allocation to 469 members of the National Assembly is larger than what is earmarked for thousands of doctors, pharmacists and nurses working in the country’s ill-equipped public hospitals.
Nigerian universities churn out close to 10, 000 doctors every year. Ironically, patients have to queue for hours to see the few doctors employed by the three tiers of government. Nigeria has an abysmally low doctor-to-patient ratio of 1 to 10, 000 when the World Health Organisation (WHO) recommends 1 to 600. Government employs very few doctors.
At the primary healthcare centres, two nurses attain to 150 patients daily. Because of the long hours of waiting, the patients often become so impatient with the nurses that they sometimes trade abuses.
Many are so frustrated with government hospitals that they often switch to private hospitals which are even less equipped and staffed than government hospitals. The private hospitals are very expensive. Consequently, the impatient poor end up being treated by quacks.
Nigeria’s healthcare delivery system is in such a shamble that government is surreptitiously incorporating the deadly traditional birth attendants (TBAs) into the system.
There was a time when government was determined to phase out the TBAs because they were primarily responsible for the country’s alarming maternal mortality rate.
They only refer women in labour their to government maternities when the woman is close to drawing her last breath. Now government is incorporating the killers into the healthcare delivery system because the few maternities are overwhelmed by the inflow of patients.
Government now believes that it can train the illiterate, killer TBAs to do what nurses and midwives were trained for five years in universities.
The worst part of the crash programme for the TBAs is that they are being trained by equally ignorant trainers. They are trained by community health officers (CHOs) who are trained to mobilise people in the rural communities to use government primary health centres.
The CHOs know nothing about the female anatomy. So it is a case of the blind leading the blind. Government is simply worsening the nation’s deplorable maternal mortality rate by incorporating the TBAs into a failed system.
Nigeria can rescue its failed healthcare delivery system if government is willing to tame its colossal cost of governance and divert funds to healthcare delivery.
Some of the foreign hospitals where rich Nigerians are treated during the medical tourism that consumes $1.6 billion annually are handled by Nigerian doctors.
All that is needed is for such facilities to be provided at home. With the appropriate motivation, many Nigerian doctors would return home, serve the motherland, safe the billions of dollars in medical tourism and above all safe lives.
