The bane of the Nigerian health care system

The Nigerian political elite behave like a colonial or Apartheid elite.
They inhabit an island of opulence and extravagance in an ocean of
encompassing poverty and mass suffering. It is an island governed by
vicious exploitation of the system, crass contempt for the people and
total indifference to the pervading misery of the masses. Therefore, it
is not uncommon for the Minister of Education, in his mindless elitism,
and unconcealed disdain for the educational system he administers, to
have all his children studying in schools overseas. It is also not
unusual for the Minister of Health, in his utter scorn for the health
care system that he superintends, to travel to Britain, Germany or
American, just for routine medical checkups.
Without any personal stake in the institutions they administer, they are
condescendingly uninterested in the decline and decay of Nigerian
institutions. The bane of the Nigerian health care delivery system is
the refusal of the Nigerian power elite and their family members to
utilize Nigerian hospitals. The first step in improving the state of
Nigerian hospitals is in putting an end to medical tourism by our rulers
and their family members, and thus, making it imperative that they use
Nigerian hospitals.
As of 2014, overseas medical trips by high ranking government officials
cost the federal government about N250 billion ($1.25 billion).The
Jonathan administration tried to reduce medical tourism to its barest
minimum by stopping government officials from seeking medical treatment
abroad, except in cases it can be proven that the needed medical
services do not exist in the country. Nigerians had reasonably expected
that President Buhari, in consonant with his promised “change”, will
reduce medical tourism and its attendant toll on public coffers, and
corollary, improve the health services with the country.
Paradoxically, more than any other Nigerian president, Mohammadu Buhari,
glamorized medical tourism. It received a matchless boost from his
administration. Some of his medical trips were necessary, as some of his
illnesses demanded medical services not available in the country. But,
at least, one of them, to treat an ear infection, was certainly
superfluous. An ear infection is not an exceptionally grievous illness;
it could have been treated in Nigeria. That trip was disconcertingly
reminiscent of the scornful antics of earlier Nigerian administrations,
and their dramatized insensitivity to public sentiments. After more than
four years of the Buhari presidency, medical tourism continues
unhindered, and the Nigerian healthcare delivery system remains moribund
and in disarray.
In May 2019, the former Nigerian Minister for Health, Isaac Adewole,
appeared before the Nigeria senate. And the then Senate President,
Bukola Saraki, said, “The senate is concerned with the deteriorating
conditions of hospitals and health facilities across the country.” For,
“despite the annual budgetary allocation to the health sector, Nigerians
are still dying because of obsolete equipments, poor state of
infrastructure, lack of generating sets, lack of power, sometimes lack
of diesel, lack of drugs etc …” Ostensibly alarmed about the despicable
state of the healthcare delivery system in the country, the senators
questioned the minister; and the scholarly, starchy professor of
medicine answered their pointed questions. But then, despite the
supposed solemnity and appropriateness of the legislative exercise, like
most things Nigerian, it was a charade, just an exercise in hypocrisy.
The fundamental source of the problems of the Nigerian health system is
obvious, and the senators grilling the Minister for Health knew it. The
health system is suffering from neglect. Both at the state and federal
levels, the system is underfunded. At the African Union Abuja
Declaration of 2001, African leaders pledged to commit at least 15% of
their annual budgets to health. Lamentably, Nigeria has never, for once,
met this benchmark. It has never allocated more that 6% of its budget to
health care. Secondly, due to corruption, a significant percentage of
the health budget is peculated by government officials and hospital
administrators.
Health workers are not motivated because they are inadequately
remunerated, and are sometimes, not paid their salaries for many months.
And the federal government is notorious for reneging on its agreements
with health workers, especially, on remunerations and employee benefits.
Not surprisingly, strikes by medical doctors and other health workers
are prevalent in Nigeria. There is mass exodus of Nigerian doctors and
other health workers, especially, the most qualified, to different
countries of the world. In addition to reducing the quality of available
medical workers in the country, it increases the ratio of health workers
to the general population. With this alarming mix of woes, what can be
expected of Nigerian hospitals?
They are in a dreadful state. They, especially public hospitals, are
substandard and inefficiency: equipments are either unavailable or
obsolete, infrastructure dilapidated, and lacking generating sets,
power, diesel, and drugs. Unmotivated and sometimes, deliberately
operating below acceptably medical and ethical standards, the doctors
and nurses that run them are mean-spirited, bad-mannered and cold
hearted. The hospitals are overcrowded, teeming with patients suffering
and dying from variegated diseases, including readily preventable and
treatable ones. Not surprisingly, the number of unnecessary and
avoidable deaths in our hospitals boggles the mind.  Nigeria has one of
the highest pregnancy-related deaths in the world. With 2% of the
world’s population, it accounts for 11% of the world’s maternal
mortality and 12% of the world’s under-five mortality.
These problems will continue to fester until those entrusted with the
responsibility of solving them, the political elite, are forced to
experience firsthand the horrors of our hospitals. Until medical tourism
is severely curtailed, and the Nigerian ruling elite are forced to
experience firsthand the awfulness of the Nigerian health system, our
rulers will not genuinely address the troubles besetting the Nigerian
health sector.
Refreshingly, in a recent event at the Alex Ekwueme Teaching Hospital,
Abakaliki, President Buhari, speaking through a representative, demanded
an end to medical tourism because the country can no longer afford it.
Nigerians were both baffled and titillated by this demand from the
Ubermench of medical tourism. We hope that the statement was dictated by
a genuine change of heart towards medical tourism, and that Mr.
President will practice what he is beginning to preach. For “an ounce
example is worth more than a ton of precepts”.
TochukwuEzukanma writes from Lagos, Nigeria
maciln18@yahoo.com
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