A sick population cannot be productive, and in Nigeria, poverty for many people implies they cannot afford to fall sick, or it could cost them their life. If an individual can afford to get treatment, it may perhaps even be understandable if they become ill, but not in Nigeria where 93 million people are estimated to live in extreme poverty.
Nigeria bears a disproportionately high share of the global disease burden, according to the World Health Organisation (WHO).
One hundred million malaria cases are recorded in Nigeria every year, out of which an estimated 300,000 deaths are recorded.
Even though most of the world has eliminated malaria, it remains a leading cause of death in Nigeria, and poverty is not far fetched from this phenomenon.
With 152 million Nigerians living on less than N720 ($2) a day, paying for healthcare, however basic, has become a luxury.
For instance, in Ikorodu, a suburb of Lagos, to treat malaria costs about N6,000. The malaria MPwider test costs about N2,000 while drugs and consultation cost about N4,000.
To treat typhoid, another ‘common ailment’, costs about N8,000. Treating both malaria and typhoid when the doctor identifies the twin ailments would cost about N15,000, excluding hospital admission which could drive health costs up to about N25,000.
Joseph Alaka (not real name) ran a buoyant fishing business before the pangs of diabetes and kidney complications drove him into bankruptcy in 2012. Before this time, he would supply fish to market women, restaurants and hoteliers. A lot was well with him until his health challenge began to require N75,000 weekly for dialysis – a treatment that filters and purifies the blood using a machine.
From his company complex to his properties that could be made liquid, he continued to sell to raise funds for his treatment. To keep his six children in school, Alaka has had to carve an event centre out of the idle land around his home. Events are not regular and when they do come, he makes about N40,000 as rent.
Alaka is currently in India with the hope of getting a long-term cure and the funding of his trip is from the rest of his real estate properties and donations from family and friends.
“Healthcare in Nigeria is largely privately funded, and there are out-of-pocket costs associated with diagnosis, treatment, and survival,” said Larne Yusuf, a Lagos-based medical practitioner. “This has worsened the level of poverty because too many Nigerians have died due to lack of funds for medical treatment.”
The almost non-existent and equally weak health insurance in Nigeria has seen out-of-pocket payments for healthcare become the norm, driving many people into poverty. Fifteen years after the inception of the National Health Insurance Scheme (NHIS), it has only managed to enrol about 4 percent of Nigerians, roughly 8 million of the 201 million population.
The scheme continues to be bogged down with policy somersaults, ineffective operational guidelines, corruption, inefficiency and bureaucratic bottleneck in the registration process.
Regrettably, the quality of care received under the scheme is also questionable with accusing fingers pointed at major stakeholders including the NHIS, Health Management Organisations (HMOs) and the hospitals.
Umar Sanda, former president, Healthcare Providers Association of Nigeria (HCPAN), said the fear of paying out of pocket has hindered so many Nigerians from having access to quality healthcare.
“Mandatory health insurance in Nigeria as we have been advocating will help people reduce the huge amount of spending (for healthcare), and enable them to access care in the hospitals without the panic of payment,” Sanda said.
The indirect cost of illness in Nigeria has been estimated at $879 billion, more than double the country’s GDP, and accounting for about 36 percent (more than one third) of the $2.42 trillion total productivity loss across the WHO African region. This was contained in an exhaustive report on ‘The indirect cost of illness in Africa’, produced by the World Health Organisation.
The report also noted approximately 50.9 percent of loss in Lower-Middle-Income Countries (LMICs) was borne by Nigeria, which in 2018 had a paltry health budget of N340 billion ($946 million).
Nigeria’s health expenditure as a percentage of the Gross Domestic Product (GDP) averaged 3.4 percent between 2007 and 2016, compared with South Africa (6.5 percent) and Kenya (4.5 percent), according to data sourced from the World Bank.
It gets worse, according to the WHO, as Nigeria has one of the lowest doctor to population ratio in Africa.
A poll citing the Medical and Dental Council of Nigeria (MDCN) reported that there are about 72,000 nationally-registered Nigerian doctors, with only 35,000 practising in-country.
Factoring this figure with national population estimates, there is a deficit of over 260,000 doctors in Nigeria and a minimum of 10,605 new doctors need to be recruited annually to meet global targets.
In the pharmaceutical aspect of healthcare, the cost of drugs also makes it difficult for many people to get treatment. Seventy percent of drugs used in Nigeria are imported, implying the already financially challenged Nigerians have to pay a premium for most medicines.
“In Nigeria we import most of our raw materials, it is only water that we do not import,” said Moji Adeyeye, director general, National Agency for Food and Drug Administration and Control (NAFDAC), in an interview last year. She explained that in order to achieve Universal Health Coverage in Nigeria, the costs of medicines have to be considered.
“We need to start manufacturing up to 80 percent locally because that is the way we can ensure easy access to medicines, and how they can become affordable,” said Adeyeye.
Looking at China’s economic success in the last four decades, lifting millions of people out of poverty did not happen without an improved healthcare system. As of 2017, China’s per capita GDP was $8,826. Its life expectancy is 75, and its infant mortality rate is now nine per 1,000 live births.
“All hands should be on deck in the pursuit of universal health coverage for Nigeria as this is the only veritable means of securing the health asset of our populace and ensure a healthy and highly productive workforce for nation building and achievement of individual prosperity,” Tunde Ladele, chairman, Health and Managed Care Association of Nigeria (HMCAN), said.
CALEB OJEWALE, ANTHONIA OBOKOH & TEMITAYO AYETOTO
