187 out of 190, is how low the World Health Organisation ranks Nigeria’s healthcare system in the World Health Report 2000 – Health systems: Improving performance” published in February 2017.
Nigeria’s health system only ranks better than the health systems in Democratic Republic of Congo, Central African Republic and Myanmar.
Liberia and Malawi rank just above Nigeria on the quality of healthcare provided to their citizens. “WHO’s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs).”
Not surprisingly, Nigeria fared very low on all the indices.
Also the Legatum Prosperity Index, published in 2017, which ranks 149 countries on the level of prosperity ranks the Nigeria’s healthcare sector 142 out of 149 countries.
This means that the country’s healthcare system is only superior to about that of seven countries on the list, a further indication of the poor state of the Nigeria’s healthcare system. They used three main indices in arriving at their ranking; basic physical and mental health, health infrastructure and preventative care.
Healthcare spend is low in the country. N1,800 ($5) per head is what the 2018 budget provides for the health of each of Nigeria’s 198 million citizens, when the N340 billion health budget is calculated on per capita basis. This is completely dwarfed by South Africa which proposed a health budget of R205.446 billion ($17.1 billion) in 2018, representing $299 per head when compared to its population of 57 million. Yet, Nigeria is the continent’s largest economy.
Industry experts have told BusinessDay that the country has a shortage of 200,000 beds at the tertiary level.
A bed costs a minimum of N50,000 and up to N500,000 depending on the special needs required. Using the lowest cost, Nigeria requires at least N10 billion to meet up the barest minimum in number of beds required for the country’s hospitals.
“We need seasoned administrators to manage the teaching hospitals and ensure that the little money that is allocated for these training centers are adequately utilized,” said Ogbonnaya Igbowke, head, Health Thematic Group, human capital policy commission, Nigeria Economic Summit Group (NESG), expressing the view that the abysmally scarce resources should still be managed for the country to get the best healthcare delivery.
“The committee of Chief Medical Directors of all the teaching Hospitals in Nigeria must come up with a workable strategy that will ensure that the various facilities get the best infrastructure. Again they must believe in these institutions and utilize them,” said Igbokwe, who is also CEO of Heartwells Group.
For Nigeria to also measure up considerably, at least 120,000 doctors are still needed in the country, yet many of the country’s bright minds leave in droves as they seek greener pastures in Europe, North America, and other parts of the developed world.
As at yesterday, BusinessDay checks showed there were 14,916 doctors of African descent registered by the UK General Medical Council, and of these, 5,339 are Nigerians. This represents 36 percent of doctors practicing in the UK. These are individuals whose primary medical education was in the UK, but when the numbers are expanded to include Nigerians trained in other parts of the world, the figure will go up substantially. Yet, the country struggles to get adequate doctors and nurses.
Francis Faduyile, president, Nigeria Medical Association, in response to BusinessDay enquiries, decried the terribly low doctor-patient ratio in the country, saying “it is one of the reasons why we have a lot of quacks within the medical profession.”
“And a lot of Nigerians are dying at the hands of these quacks,” said Faduyile.
According to the World Health Organisation, Maternal mortality rate in Nigeria is 814, per 100,000 live births only outperforming Chad with 856, Central African Republic; 882, and Sierra Leone; 1360. War torn countries like Somalia and Democratic Republic of Cong even outperformed Nigeria.
Also, while Botswana and Mauritius have the proportion of births attended to by skilled health personnel as 100 percent, Nigeria is again down the pyramid with 35 percent, competing with countries like Eritrea, Ethiopia, South Sudan, and Chad.
The statistics get worse, for every 1,000 births in Nigeria, 108 infants (and children) die before the age of five, and again, the country sits comfortably close to the bottom of the ladder in Africa.
Data from WHO world health statistics 2017 further shows that over 72 million Nigerians are at risk of malaria, with 380.8 at risk out of every 1000 Nigerians. Whereas, malaria has ceased to be a health concern for many other countries all over. Yet, Africa’s largest economy shares the three bottom slots on the continent with Burkina Faso and Mali.
Based on global standards and in line with the country population, the country is expected to have 145 radiotherapy machines for treating cancer patients, but as at 2016, BusinessDay investigations found out the country only has eight, and out of this, only three were functional. Cancer treatment has been made worse by the poor state of health facilities, poor funding of the health sector, late diagnosis and detection, and high cost of treatment.
The eight known hospitals with radiotherapy machines in the country, as at 2016 are: Lagos University Teaching Hospital (LUTH); University of Benin Teaching Hospital, Benin; University College Hospital, Ibadan; National Hospital, Abuja; Ahmadu Bello University Teaching Hospital, Zaria; Usmanu Dan Fodiyo University Teaching Hospital, Sokoto; University of Nigeria Teaching Hospital, Enugu; and Eko Hospital, a Lagos-based private hospital.
Abia Nzelu, of the Committee Encouraging Corporate Philanthropy (CECP), says that of every five Nigerians with cancer, only one survives.
“In the specific case of blood cancer, out of every 30 Nigerians (often young adults and children), only one survives. Meanwhile, at the Tata Cancer Centre in India, the survival rate for blood cancer is 99 per cent. Future generation of Nigerians are wasting away from conditions that could be controlled medically. Sadly, Nigeria is a nation where wealth accumulates and men decay,” Nzelu said.
While a privileged few in Nigeria can afford to travel abroad for treatment, majority have to make do with the inadequate healthcare facilities. Nigerians, mainly the political class, are estimated to spend as much as US$1 billion on health tourism every year with India, Dubai, UK and the US as top destinations by Nigerians for medical care.
Nigerians who cannot afford foreign medical care from their savings or the public purse are left to take care of their healthcare needs mostly in poorly equipped public and private hospitals. Those who want better medical care use the private hospitals which are the dominant providers of healthcare in the country. Spending on healthcare is mostly an out of pocket expense and is estimated at N1.3 trillion annually, about 65 percent of the N2 trillion health spend in the country, with only about N100 billion coming from insurance. This is because health Insurance penetration is still very low with only eight million covered out of the country’s estimated population of 198 million.
There are just about 25,000 hospitals in the country, according to industry sources. This comes to an average of 7,920 Nigerians to one hospital. It is therefore not surprising that many hospitals are overfilled despite being poorly equipped and under staffed. The average doctor per head in the country stands at 1:3000 while nurse per head is 1:2000.
With such a poor healthcare system, Life expectancy in Nigeria is 52 years for men and 54 years for women, one of the lowest globally. And this is because patients easily die from diseases in Nigeria that could easily be treated in other parts of the world.
CALEB OJEWALE, ANTHONIA OBOKOH, MICHAEL ANI & CYNTHIA IKWUETOGHU
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