As we approach the new date for the presidential elections, we decided to use the additional time provided by the postponement to scrutinize the two leading party manifestoes on health in a bit more detail. While there are other parties also in the race, we have chosen for convenience to focus on the manifestoes of the two front-runner parties – the People’s Democratic Party (PDP) and the All Progressives Congress (APC).
The APC in its manifesto has a section on healthcare. It is unclear why they have chosen the term “healthcare” rather than the broader term “health”, but the PDP which has a section on health also says it will formulate a policy on “healthcare”.
Within the healthcare section of its manifesto, the APC says that it will:
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Prioritize the reduction of the infant mortality rate by 2019 to 3%; reduce maternal mortality by more than 70%; reduce HIV/AIDs infection rate by 50% and other infectious diseases by 75%; improve life expectancy by additional 10 years on average through our national healthy living program;
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Increase the number of physicians from 19 per 1000 population to 50 per 1000; increase national health expenditure per person per annum to about N50,000 (from less than N10,000 currently);
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Increase the quality of all federal government owned hospitals to world class standard within five years;
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Invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programs with the private sector;
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Provide free ante-natal care for pregnant women, free health care for babies and children up to school going age and for the aged and free treatment for those afflicted with infectious diseases such as tuberculosis and HIV/AIDS;
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Boost the local manufacture of pharmaceuticals and make non adulterated drugs readily available.
First, we must commend the APC for actually publishing some measurable targets and timelines. However there are many questions raised by these commitments.
For instance, the reduction in maternal mortality rate in the best performing country in the world between 1990 and 2013 was in Belarus which had a reduction of 13 per cent. An ambition to reduce Nigeria’s very high maternal mortality rate by 70 per cent raises questions of feasibility, especially when one looks at the numbers in the table below, which show an average annual reduction of 3.3% in Nigeria.
The ambition to improve average life expectancy by 10 years is perhaps more attainable, given that between 1990 and 2013, Liberia saw a 20-year increase (from 42 years in 1990 to 62 years in 2012) and three other African countries a 19-year increase (Ethiopia from 45 to 64 years, Maldives from 58 to 77 years and Rwanda from 48 to 65 years as stated here). Nigeria has also seen an increase in life expectancy of 6.7 years in that period (see table below).
On reducing infant mortality to 3 per cent by 2019, the table below shows the trends in infant mortality in Nigeria between 2010 and 2013, suggesting that the APC target is very ambitious, looking at global trends.
It is unclear where the party gets its estimate of 19 physicians per 1,000 population as the World Bank estimate of physicians per population in Nigeria as at 2010 was 0.4 per 1,000. Even if the APC estimate were right, their target suggests that they would facilitate the training of over three million additional doctors in Nigeria in 4 years, which is impossible.
The second section of the manifesto unfortunately has no measurable indicators, and so it is impossible for us to assess objectively.
The PDP section on health says that:
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The party shall present a comprehensive health-care policy for the country, the essential aim of which shall be:
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Health-care for all citizens;
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Free medical services in all institutions of learning; and
- Free medical services to the aged and the handicapped.
As its strategy, it says that:
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PDP in government shall:
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Ensure that all Nigerians, particularly the young and the aged, shall have access to free medical services;
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Provide free immunization to all children;
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Progressively establish primary health centre, equipped with pharmacies, within the reach of every Nigeria, particularly the rural dwellers.
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Progressively provide General Hospitals in all Local Government headquarters; specialist hospitals in all State Capitals.
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Encourage research into traditional medical, practices and integrate these practices into the orthodox medical system.
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Equip and expand the teaching Hospitals in the country;
- Embark on mass training of paramedical personnel to meet the needs of our ruralpopulace;
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Encourage more students to train as medical doctors;
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Provide special incentives for medical practitioners and other medical Personnel with particular emphasis in those located in remote areas;
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Stimulate the local production of medical drugs and other supplies;
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Encourage family planning by providing family planning services and materials free of charge;
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Regulate private hospitals, medical clinics, and pharmacies to protect Nigerians against exploitations; and
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Make and enforce stringent laws against the manufacturing and sale of fake and adulterated drugs; and promote a healthy physical environment by intensifying the present periodic environmental sanitation exercises
As the PDP manifesto on health has no measurable targets or timelines, we are also unable to assess it objectively.
Generally speaking, both main parties promise to raise the number of medical doctors, provide free healthcare for children and the elderly, improve the quality of government/teaching hospitals, fight fake and adulterated drugs and boost the local pharmaceutical industry. In addition, the APC wants to improve maternal and child health, invest in cutting-edge technology and reduce the prevalence of infectious diseases, while the PDP aims to achieve universal healthcare, offer free medical services in all institutes of learning and free healthcare for the handicapped, improve the quality of private hospitals, promote environmental sanitation exercises, offer free family planning, increase medical personnel especially in rural areas, integrate traditional medical practices and increase the number of general hospitals, specialist hospitals and primary health centres.
Both manifestoes are not comprehensive and lack concrete details. Topical issues such as ambulance services, non-communicable diseases, security of medical personnel, health sector strikes and many more are not even mentioned. The new, and potentially groundbreaking National Health Act signed into law in December is not mentioned by either party; nor is there any meaningful recognition of the wider determinants of health or mention of issues like tobacco control or road traffic accidents. Universal health care, which is an increasing area of global focus, only receives a cursory mention in the PDP manifesto and no mention in the APC manifesto.
On the private sector, which provides a significant proportion of healthcare in Nigeria, the APC only says that it will invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programs with the private sector; but it does not have much to say about ensuring quality. The PDP on the other hand highlights the need to regulate private hospitals, medical clinics, and pharmacies to protect Nigerians against “exploitations”;but does not examine any other ways of improving quality and does not mention driving innovation in the private health sector.
Time frames within which these goals will be achieved are mostly absent. In addition, the means to achieve these goals are not always explained, e.g. the APC simply states that it wants to increase the number of medical doctors. The PDP on the other hand promises to encourage students and provide special incentive for medical personnel, but it is still unclear what kinds of encouragement and incentives will be used. Neither manifesto explains how these goals will be financed.
Both manifestoes are also silent on how they will ensure that the progress made on polio is sustained, how the lessons learned from the Ebola outbreak will be applied and how the coverage of the National Health Insurance Scheme will be improved.
On the whole, our rapid analysis suggests that neither party understands or takes the issue of the health of Nigerians as seriously as they should. Perhaps it is all down to a failure of communication, as for instance the PDP fails to say anything about its record on health in the last sixteen years. Whatever the reason for the shoddy manifestoes on health, we will all need to keep challenging our politicians more to ensure that health does not take the back seat, especially at a time of economic difficulty.