In recognition of immediate constraints to financial resources, health intervention should target the most vulnerable, mainly poor women and their children as well as our very senior citizens including people with disabilities. Child immunisation coverage should be 100 percent.
Public health (and economic) sabotage through marketing and sale of fake goods needs to be curbed. The burden of surveillance and eradication of fake drugs should be shared between the public and private sector. Food, beverage and drug companies have an interest to preserve the value of their brands from unscrupulous dilution. Regulation and control measures need to be strengthened, especially in public markets across the country where fake drugs are sold to vulnerable members of the public.
We account for 14 percent of maternal deaths worldwide, making Nigeria one of the 10 most dangerous countries in the world for a lady to put to bed – 40,000 women in Nigeria die in pregnancy or childbirth each year while another between 1 million and 1.6 million suffer disabilities from birth-related causes. There is much to learn from Ondo State in maternal health. The home-grown “Abiye” (meaning safe motherhood) programme is a strategy crafted and deployed to address the four delays (i.e., delay in seeking care, delay in reaching care, delay in receiving quality care and delay in getting emergency care) encountered by women that require maternal health care and follows evidential research that shows that 62 percent of all births still take place at home without intervention of skilled personnel. Furthermore, the Maternal and Child Hospital in Akure, in line with promoting research into post-partum haemorrhage, has entered into a partnership with the London School of Hygiene and Tropical Medicine.
Nigeria has the 12th highest under-5 mortality in the world in respect of which 25 percent of cases could be cured through routine immunization – every year 800,000 Nigerian children of that age group die. One of the chief causes of about 1.5 million children that go unvaccinated (immunisation coverage was estimated to be only 23 percent in 2008) in a year is that, according to the mothers, vaccines are frequently unavailable at the primary healthcare centres (PHCs) due to non- or inadequate supply. There needs to be a revamp of and rollout of the Essential Drugs (and Vaccinations) List to avoid stock-out, especially at the PHCs. It is not unusual for vaccinators to meet resistance while on duty. However, such can be overcome by addressing cultural or religious concerns, especially through intermediation of traditional rulers or leaders in the area concerned.
The National Health Insurance Scheme (NHIS) can be used to improve equitable access of healthcare facilities. Equal opportunity for all to access health facilities will help to reduce Nigeria’s disproportionate contribution of 10 percent to the global burden of maternal and infant mortality. Through private-public collaborative expansion of the Hygeia Community Health Plan (as deployed in Kwara and Lagos States), the Federal Government can significantly bridge the gaps in universal health coverage.
The Nigeria Democratic and Health Survey (DHS) should be conducted bi-annually, as against the current once every five years, to facilitate quick understanding of challenge areas and thus improve turnaround time for targeted interventions.
Dated, yet likely still relevant, statistics indicate that there is a doctor-population ratio of 0.3:1000 while there is about 1 nurse for every 1000 people. Across the core disciplines of teaching, nursing and medicine, it is worth considering emergency measures such as strongly incentivising retired (but not tired) former practitioners for deployment across the country as was the case with the establishment of the Midwives Services Scheme (MSS) launched by the National Primary Health Care Development Agency in 2009.
Whereas it is internationally recommended to have health spending per head of US$34, Nigeria records US$10 per head, of which private out-of-pocket expenditure accounts for 70 percent. The National Health Act, which was passed into law in December 2014, seeks to address funding gap as it earmarks 2 percent of consolidated federal revenue for health – a large proportion of which will be assigned for primary health care. We need to restore PHCs to ensure that they are manned only by public health nurses and not community health extension workers who have a different role to play in the health management ecosystem. The community-based approach to PHC – whereby there is a Community Health Committee (CHC) comprising a local chief, a police officer, a health professional (preferably the public health nurse) and a school principal – should be celebrated, replicated and strengthened across the country with a view to improving our national health indicators.
Health research is important, especially as it is widely recognised that international drug companies for commercial reasons are highly selective when determining health areas where to invest. It is important to strengthen at least three existing research institutions each with a key challenge in a prevailing medical area such as malaria. Of the 400 million acute attacks of malaria that occur globally, 80 percent of cases and deaths occur in Africa. In Nigeria, 50 percent of the population suffers from at least one episode of malaria each year. Malaria is a major killer of children and is a risk for 97 percent of the population. There are about 300,000 annual malaria-related deaths (compared to 215,000 for HIV/AIDS). This implies that most health challenges should be addressable at the PHC level. Environmental management will assist in control and prevention of malaria. We need to improve sanitation and access to potable water. Mr. President, you can replicate the Federal Government’s success of guinea worm eradication in other areas also requiring urgent intervention such as tuberculosis where Nigeria is responsible for 80 percent of the global burden.
Mayowa Amoo
