Despite its importance, health is not highly invisible on the political agenda in Nigeria.
Politicians hardly mention it, people rarely make a fuss when they feel let down by our hospitals, the press pays occasional lip service; the health professions would rather squabble over whether the next minister should be a doctor, pharmacist, nurse or chemist, and government sends all its senior officials to Germany and Saudi Arabia for treatment.
Yet we suffer in our ignorance. We stay glued to CNN and watch as health and health care is one of the defining issues in the American elections. We ally ourselves to either the conservative party’s republican stand or the slightly more socialistic ideals of the democrats. Yet, in our almost 50 years of independence we have not given much strategic thought to how we can best deliver health and health care to 140 million Nigerians. Our health policies and strategies have not changed significantly since colonial times.
When politicians are asked about health; they reel out statistics about the new hospitals they have built. No one has bothered to ask…since when did the responsibility of “building” move from the Ministry of Works to the Ministry of Health.
How many lives has the “hospital building” saved?
Until the National Programme of Immunisation (NPI); a body that still exists legally was suddenly scrapped and became an appendage of the National Primary Healthcare Development Agency (NPHCDA), what did NPHCDA do? It built health centres! Has anyone challenged the government on how many of the Primary Health care centres promised and built since 1999 when Nigeria returned to democratic governance is actually providing primary health care?
How many of these centres would you take your child and have him treated for malaria?
To how many primary health care centres can you go for your antenatal visits?
What has been the strategy of our government at different levels to provide for our health?
Our last government spent most of the capital expenditure on health equipping 6 tertiary hospitals in the country with what they regarded as state-of-the-art diagnostic facilities. No one bothered to do the strategic thinking that would have shown that this would only be accessible to less than 1% of the population, that we neither had the electricity nor the technical expertise to use these…and even if we did. Even if the brand new multi-million dollar MRI machine did reveal that you had an anterior lesion at C2, posterior lesion at C2-C3 with swelling at C2-C3. What do you think can be done about it in any of our Teaching Hospitals?
Of what benefit is a diagnosis to your health? That is the questions Nigerians should learn to ask.
So what is the opportunity cost of that MRI machine? 1 million doses of the measles vaccine? Maybe 100,000 antenatal visits for pregnant women? maybe providing life-saving antiretroviral drugs for 10,000 Nigerians for life? Any Nigerian will tell you why these are not viable options to our politicians. There is no large infrastructure contact to be awarded!
It is not an issue being mentioned in the press. Health is not necessarily a topic that sells newspapers. Being complex, technical and dry, except when one is personally affected, it has a daunting problem in attracting media attention – Most journalists and their editors run and hide from health. Unlike politics and sports, which any journalist can easily write about, health is a bit more difficult. It requires some in-depth understanding of the issues, a luxury that most of our journalists probably cannot afford. But they need to. As Paul Collier said in his TED Talk, relating to his book “The Bottom Billion”, unless we have a critically enlightened population, politicians will continue getting away with gestures. See below:
How do we address such a complex problem, one that is not even appreciated yet? When people die in accidents in Nigeria it inevitably hits the headlines, but no one lifts a finger about the death of a child from measles, a disease preventable with a vaccine that costs less than a bottle of coke. We accept the lackadaisical attitudes of physicians in public hospitals as inevitable. Something will have to give sometime.
Who will convene this national conversation?
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead
Just published in the WHO Bulletin:
Nigeria still searching for right formula
Bull World Health Organ. 2008 Sep;86(9):663-5.
“Despite several attempts at reform over the past 30 years, Nigeria still lacks a clear and coordinated approach to primary health care. Michael Reid reports.”
Readers might be interested in the following items (among others) on the Malaria Matters Blog as relates to Nigeria’s health system:
Involving the private sector in Uganda, Nigeria
Health systems and high burdens
Malaria in pregnancy services need strengthening in Nigeria
Sundays Editorial in the Guardian “The State Of Health Care Services”