It is no longer news to the Nigerian system that any new government that takes over power promises to place healthcare as a priority among other sectors in the country. Nigeria's health situation continues to be of growing concern with various statistics revealing the country as one of the worst health care delivery records in the world.

According to the World Health Organization (WHO) analysis of the global health system, using performance indicators, including overall level of health, distribution of health in populations, finance and responsiveness, Nigeria ranked 187 out of 191 countries in health care delivery, leading only Democratic Republic of Congo, Central African Republic and Myanmar.

WHO further stated that one-third of more than 700 health facilities have been destroyed in the country and about 3.7 million people are in need of health assistance. Meanwhile, each government in Nigeria would promise to do the following, which are: prioritise the reduction of the infant mortality rate substantially, reduce maternal mortality rates to the levels acceptable by the WHO, better the healthcare delivery systems and quality health education, increase the number of physicians and the national health expenditure per person per annum, increase the quality of all federal owned hospitals to world-class standard, boost local manufacturing of pharmaceuticals and make non-adulterated drugs available, end quackery, as well as ban medical tourism, which includes politicians, but these issues have not been implemented.

More worrisome is the fact that Nigerians spent $1bn (£690m) on foreign medical trip. Not only that, the government allocated N340.45 billion, representing 3.9 percent of the N8.6 trillion expenditure plan to the health sector, a fraction of the 15 per cent target set during the 2001 Abuja Declaration by the Heads of State of member countries of the African Union (AU).

Going by the budget proposal, it revealed that health came 12th as Power, Works and Housing got the highest capital project proposal with N555.88 billion, almost eight times that of health. The allocation to health is less than the 4.16 per cent and 4.23 per cent made to the health sector in the 2017 and 2016 budgets. These statistics do not speak well of Nigeria's image as the giant leader and most populous nation in Africa and it also indicates that the government does not prioritise healthcare.

Lamenting on the state of healthcare in the country, the President, Nigeria Medical Association, (NMA), Dr Francis Faduyile in an interview with The Guardian berated the governments inability to resolve the other challenges facing the health sector, which include, poor infrastructure, roads, inadequate facilities, lack of equipment, poor salaries and remuneration to managers, doctors and other health workers, lack of medications and funding among others.

On why the country is still recording low health indices.
Dr Faduyile said, Why the health indices are low in the country has lots of reasons. It has a lot to do with the government putting adequate things in place. For example, all the primary health care centres in this country have collapsed, most of them, let me not say all are not functional. We don't have doctors, machinery or proper health personnels in place. Meanwhile, many primary healthcare centres across the country are still in dilapidated states, low staffed, poorly equipped, lack electricity, water, and cannot effectively cater to the people in the rural areas.

This reveals government's inability to deliver on its promise to bring healthcare delivery closer to the people, which were meant to be achieved with the revitalisation of 10,000 primary health care centres across the country according to the Minister of Health, Prof. Isaac Adewole, who said the primary healthcare revitalisation was one of the top priorities of the government.

The NMA president explained, We suppose to see 70 per cent of our patients in the primary health care level, but most of them go to secondary healthcare centre and then they spill over into the tertiary health centres. Tertiary health centres, which are the teaching hospitals or federal medical centres are supposed to do very highly specialised cases, but we see cases that are supposed to be taken care of at the primary health care centre coming to clog the tertiary health centres.

What it means is that, what we should have used X naira to take care of in terms of prevention or adequate information, we have to put 10 or 100s X naira to take care of it at the tertiary institutions and today, we don't have enough doctors in place.

On the doctor-patient ration in Nigeria
The government had promised to increase the number of physicians from 19 per 1000 population to 50 per 1000. Faduyile explained that practically nothing has improved in this regard, noting that due to the ailing economy and hardship in the country, a lot of medical personnel are leaving the country to other countries where better pay and job security are guaranteed, unlike Nigeria with the dilapidated healthcare infrastructures and deficient equipment that define its hospitals today.

The doctor-patient ratio in Nigeria is terrible. We have a myriad of the problem that accumulated to cause these low health indices, but it's solely on the part of the government to do what is needful. More than 40, 000 of the 75, 000 registered Nigerian doctors are practising abroad. The first question we want to ask is that, why do we have consistently low ratio? is it because we are under-producing or we are not retaining? And the answer is that, when we are under-producing, 50 to 60 per cent of what we are producing is going out of this country. If we were retaining all our medical personnel that are trained here, it would have improved the ratio.

However, we must also know that even within the country, we have so much disparity in the doctor-patient ratio that we have a very high number of doctors in the urban area compared to the rural areas. Why are we not having equal spread and distribution for the benefit of Nigerians? We have poor remuneration, the working environment is not good, we have very unstable government funding, most times you get to the teaching hospitals or giant hospitals, you see the chairs, beds and equipment that you need to use to take care of patients are not there. We have doctor seeing patients dying and he knows that he can intervene but there is nothing he could do because he can't work without other equipment, by the time you see two to five patients dead, you get disenchanted and want to leave.

Again, if you are talking about the work environment, it is so hostile, there is nothing that is keeping doctors happy, there are no car loan, housing loan, a doctor comes out from the hospital and is struggling to go home and most doctors cannot stay in the city, they stay kilometres far away from the city because those are the places they can afford and by the time you have emergency you expect the doctor to get to that location at that appropriate time. You can't get it because he has to find a way since he stays so far away from the centre.

If you have all these things in place, the doctors and the other healthcare professionals may be more stable and decide to continue doing the job here in the country. Again we have states, if we are blaming the federal government, it is the smallest, we have stated that are not even putting any attention to health, we have states that are owing their workforce six to seven months, we have states that are paying doctors less than half of what their counterparts are receiving in the federal government. Doctors will not stay there, they will be looking out.

Thirdly, we have doctors and other health practitioners being overworked, where you suppose to have ten doctors to see some number of patients we have one doctor having to see them day in day out, it is either they get tired of the debt, sacked out and say look, they are done for. For a doctor to see a patient it is not elastic, it is inelastic. For you to see a patient adequately and be able to treat properly, you need about 10 to 15 minutes. Let's go to 10 minutes, which is the shortest time to see a patient, that means in one hour you see six patients, that is, between eight and four for the eight hours, one hour a doctor takes it up for break, it means seven hours multiplied by six, it's 42, so the maximum a doctor should see is 42 patients a day, but you have a doctor seeing 150 to 200 patients in a day and there is no way they can cope. These are the reasons why we have a lot of our medical personnel leaving this country in their numbers.

Recall that the proposed increment of the national health expenditure per person per annum from 10,000 naira as it was before May 28 2015, to 50,000 naira, as the president promised, is a far cry from today's reality.On the NMA's expectations from politicians for the health sector as we enter the electioneering period,

Faduyile said: The NMA is poised to set up a lot of town hall meetings so that that we can bring out some blueprint to challenge them. We have observed that many of the politicians are unaware of the proper way in which health is supposed to be managed. But NMA will not stay back. For example, in our National Executive Council (NEC) at Oshogbo, Osun state, we engaged some of the contestants, we had about three hours debate amongst them. It was basically on health and we are going out fully so that by the time we are there we are going to hold them accountable for what they have said on health and we can set up a good thing for them on how they can improve health.

The issues of reconstituting the board of the Medical and Dental Council of Nigeria (MDCN).
He said: We are hopeful that the federal government would do the needful, we have September 30. 2018 as our deadline and we are going to stick to that date and if they have not done what is proper we will take the appropriate action.

On the NMA's president agenda for the health sector going forward
He, however, added: It is important for us to know that there is a need for improvement in the health status of Nigerians and also to see that the welfare of physicians is also taken care of. As the president of the Nigeria Medical Association (NMA), one of my major focus is to see how we can harness all the specialists and ensure all are managed together to see to the improvement of health in this country.

We know that Nigeria, being the most populous black nation and the giant of Africa, have a very poor indices in terms of health and if we have to apportion blame apportioning blames will not resolve the poor health indices, we need to pragmatically look at how we can improve it.
One thing that we are going to do is to is that we are going to constructively engage the government to do the needful by making sure that we have the Universal Health Coverage (UHC) taken its strength and its position within the health. We are going to see how we can improve the hospitals by adopting our slogan that we say our hospital must work, because if hospitals are not working properly it is the doctors who should be able to lead the movement of getting it back.

We want to see that we improve the treatment policies or management by making sure we have Standard Operating Protocols (SOPs) so that every doctor knows that this is how the profession goes. We have different ways of treating or managing patients, but what we believe is that we can standardise it. We are going to engage the government constructively in making sure that they provide adequate funding for health as agreed in the African Heads of State meeting that 15 per cent should be budgeted for health, but it has been abysmally low since then, that's 2001.
And we want to also look at Primary Health Care centres to see that they are working optimally. These are things we believe are geared towards improving the health status of Nigerians.

On the part of doctors, we are going to see that they are well taken care of. As it is, we have some of our colleagues in the private hospitals there are multiple taxations, the government has nothing in stock to ease their practice. If you look at the amount of money that is pumped into India's health system this day, it is a humongous amount and most people who go to India for medical tourism, 90 to 95 per cent of them go to private health institutions. This is because the government has put things in place to make them flourish, so we want to see how we can make our private health institution flourish in this country, all the Draconian laws, we want to engage the government to get them out.

And what will make doctors is to effectively put in place appropriate equipment that they will not be under any pressure. For example, we are going to have a push for Health Bank that it will be a single digit loan, just like we have Bank of Industry and Bank of Agriculture, we should also have Health Bank where we have an of period of moratorium that you have to work before you start paying. So these are things we want to do, not minding that we must make sure that those of our colleagues in the public services are well paid appropriately and adequately, and as you have known, brain drain is a major issue affecting the health profession.

Lastly, we want to also see how within the health sector we can have the harmony that we suppose to have, we want to engage our sister's professionals, the pharmacists, nurses, so that we can sit down and agree on how to move forward. The guilty contest game we have been into, we need to stop it and it will benefit us.

Source: Pharmatimes