Fixing the healthcare in Nigeria


By Ola Orekunrin

Nigeria’s healthcare system has currently bagged the reputation of one of the five worst healthcare in the world. However, the problem is beyond whatever reputation and identity we have on the global scene. The real issue lies in the number of preventable deaths we are unable to manage daily. It is a very depressing fact that the standing mortality rate especially in childbirth and pregnant women is very high. Ironically, this can be reduced drastically if the appropriate measures are put in place.
In these years that I have served (and I’m still serving) actively as a physician, I have observed and carefully analysed Nigeria’s healthcare system. I have seen that Nigeria and even Africa’s healthcare challenges are more economic than clinical. Nonetheless, revamping our health sector will involve organizational restructuring, upgraded financing, task shifting and a re-prioritization of public and primary healthcare services. I see hope however and a great possibility that Nigeria’s healthcare sector can get the advancement it so requires. Change is usually rapid and achieved even better when systems are at their lowest; this is where we are right now. It is imperative that all and sundry become involved in the advancement of Nigeria’s healthcare as it boils down to the well being of our families and our abilities to live happy and healthy lives, eventually.
One of the turning points can be drawn from the success of Dangote’s Cement Company. Dangote’s Obajana factory is one of the most advanced and largest cement factories in Africa. Part of its huge success lies on how Dangote has been able to effectively manage the factors that influence a reduction in the average cost of production while increasing the volume of output. The most important lesson from Dangote’s Cement Company’s system is the massive network of small distributors in various communities across Nigeria. This improves availability and eases the process of accessing cement products to local communities; only large orders make their way to the factory. The Chinese Cement Industry is not structured this way. They own various factories which are located very far from source of raw materials. Unfortunately, the quality of cement is usually very poor and the profit margin is low. Accessing cement from the Chinese Cement Industry is very tedious especially for individuals in rural communities who have to go long distances to reach the factories. This is exactly how the Nigerian healthcare system is. Our health sector is plagued with more hospitals and less primary healthcare centers. This might seem an awesome feat especially as building hospitals have become a common and first-to-go project. This is not to say that hospitals are irrelevant. Our hospitals are so congested that they cannot deliver primary care with ease and hence, many medical conditions receive inefficient attention.
Primary care is the initial point of contact between a patient and the healthcare system that provides individuals with access to the information and resources they need for optimal health outcomes.  Dangote’s cement distributors are like primary care providers. A re-organisation of Nigeria’s healthcare system to incorporate more efficient primary healthcare centers will make it easier for individuals of various communities to access care for common ailments such as uncomplicated malaria, constipation et cetera. This way, hospitals will become decongested and if specialized, will handle conditions that need advanced treatments such as heart surgeries. The Costa Rican healthcare sector is a typical model of an effective primary healthcare system.
Restructuring our health system is ultimately essential but without adequate financing, we may never create the health system that works. Nigeria’s current economic status quo is already burdened with debts but there are ways around it. As it stands, only 3.7% of Nigeria’s Gross Domestic Product is available as the allocated budget for the health sector. This is grossly insufficient. Collecting new tax, strengthening tax administration, donor funding, and possibly, an exercising of Nigeria’s power of seigniorage (having the Central Bank of Nigeria print money to lend the government) are avenues for providing funds to power the healthcare system of a new Nigeria. Micron insurance for health is also a means even though most Nigerians are yet to see its importance.
All hands must be on deck as we revamp the Nigerian healthcare system via prioritization of primary healthcare services, innovative approaches like telemedicine, remote support for paraclinical healthcare and staff, institution of robust systems to manage patients’ journey to accessing primary care, task shifting and adequate financing.
Now that you have experienced my perspective on the problems and challenges in the healthcare system, do you agreed with my suggestion or disagreed? I hope we can agreed on some fundamentals that guide my ideas and suggestions. First, we need to allocate our resources wisely, by that I meant federal government can sink huge amount into the healthcare system for ultimate benefit to Nigerians.  As you can see from my comments, the write up dictates a reorganization that emphasizes a modern decentralised funded and supported primary healthcare system along with improved public health infrastructure.
Funding is always a challenge but what is more important than health of our citizens? Good health is required for success in all levels of life and a successful citizenry is required to move our nation forward to grow our economy, and improve opportunities for all. These, I might add, will dramatically increase revenue available to invest in the public good. Furthermore, we need to think a little ‘ outside the box ‘ hospitals, specialists and gender all practitioners are certainly integral to our healthcare system but of the routine care can be done less specialized and less expensive workers. In the same way, we need to get the proper balance between primary health facilities and large hospitals. When funds are limited, they must be strategically invested by providing better medical care for greater number of Nigerians.
Finally, along with innovation approaches, we need to ‘go backs to the basics’ easy improvement to our public health system such as education, sanitation, water that will pay huge dividends for our population. There is nothing new or complicated about these improvement. We have the knowledge and workers who can implement them now.

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