Problems of Nigeria Health Sector and Possible Solutions

It is a well-known fact that one of the many ways Foreign Exchange earnings leave Nigeria is medical tourism. In fact, a 2013 Business Day report revealed that 47% (18,000) of Nigerians, who visited India that year, did so for medical reasons and expended up to N41.6 billion and also you need not be told that almost 60% if not more of health services are provided by the private sector.

It is also not surprising that Nigeria ranked really low in the recently released global healthcare ranking is not surprising.

The results of the World Health Organization’s analysis of the world’s health systems among 191 member states are in, and Nigeria ranked 187 only ahead of the Democratic Republic of the Congo, Central African Republic, and Myanmar.

Using performance indicators including overall level of health, distribution of health in populations, responsiveness and distribution of finance, France ranked 1, followed by Italy, San Marino, Andorra, and Malta, respectively. This clearly shows that there is much to be done in the sector.

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Healthcare services in Nigeria have been and are still very poor and not properly managed. One of the limitations to the full achievement of a universal healthcare delivery system include

• The limited coverage of Nigerians under Social Health Insurance (NHIS)
• Primary health care
• Long queues
• lack of medications and Unavailability of Modern Equipment
• inexperienced doctors lack adequate medical personnel
• Inadequate funding
• Management
• Corruption in healthcare
• Poorly trained nurses
• No Medical facilities
• No compassion and medical errors
• Ineffective waste management

Nigerians Social Health Insurance

One of the limitations to the full achievement of a universal healthcare delivery system in Nigeria is the limited coverage of NHIS. It was established under Act 35 of the 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost through various prepayment systems.

Unfortunately, 11 years after its establishment only a handful of Nigerians are under the scheme and majorly comprises of civil servants but it was created to all Nigerians including children under 5 years, prison inmates, and disabled people.

By its structure, its aims are to provide social health insurance in Nigeria on a contributory basis where health care services of contributors and their dependents are made from a common pool of fixed regular amounts made by the contributors.

But an investigation revealed that Nigerians are still paying out-of-pocket for medical services even with the gloomy economic situation in the country, it is so sad that many Nigerians cannot afford to go to hospitals.

They rather patronize quacks and roadside drug vendors. Even in some states where healthcare is free for the elderly, pregnant women and children under-five, many complain of not having enough money for transport and other logistics.

Also, they have been accusation that some Health Maintenance Organizations (HMOs) do not pay the hospital thereby frustrating the scheme. Many Nigerians have not keyed into this scheme.

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Primary Health Care

Our primary health care system is faced with many challenges, and there is very urgent need to improve the quality of service delivery and also expand it to many other communities who still lack the presence of any health facility till date.

Many primary health care centers, clinics or posts in the country are just mere dilapidated structures without the presence of any staff or manned by inadequate manpower and unskilled personnel.

They lack drugs and equipment and have a poor referral system. Some of them are located so far away from some communities that the people cannot afford to go there and most of them resort to traditional medicine practitioners or private hospitals.

1. Long Queues

Only a few Nigerians can afford to pay the expensive money needed in a private hospital so most prefer going to the general hospital which is relatively free.

The situation, however, forces the ailing into choosing between the general hospital and private hospital this make them endure long agonizing wait and the indignity of being reduced to just another number. You see examples of very sick patients having to queue and not getting quick access to doctors.

2. Lack of Medications and Unavailability of Modern Equipment

Most of these primary health care centers do not have medications and these lead to many deaths in the country.  There is also unavailability of modern equipment in the hospital which is one of the biggest challenge and also one of the reasons many Nigerians travel out of the country to seek better medical treatment some of the modern equipment includes cars, surgeon rooms, x-ray rooms, etc.

3. Inexperienced Doctors and Lack of Adequate Medical Personnel

most of these doctors are not properly trained, they are ill-equipped to give a correct diagnosis and we have plenty examples of patients being given medication different from what they are suffering from which has led to deaths or permanent disability.

Also the number of doctors in Nigeria, even at a general level has been insufficient for the population because the number of doctors produced in the entire Colleges of Medicine across the country is less than 3,000.

This shortage of medical personnel leads to overworking of the few available. Among this personnel, most of them are based in the big cities like Lagos, Port Harcourt, Abuja thereby reducing the number of those available in other states.

4. Inadequate funding

There is lack of funding. In some rural areas, there is no electricity in the health centers, how will doctors function in such environment?

In the 2017 national budget of N7.298 trillion presented to the National Assembly by President Muhammadu Buhari for approval, only a meager 4.17 percent was allocated to the health sector, which is arguably one of the most critical sectors that drive other sectors of a country.

The WHO’s analysis shows that with only about 25 percent of the supposed allocation only given to healthcare for 2017 in Nigeria, it means on the average, about 75 percent of healthcare services for each Nigerian will be funded from out-of-pocket, with the majority of Nigerians obviously unable to afford it.

5. Management and Corruption

lack of appropriate planning, execution, transparency, accountability and poor corporate governance, and monitoring mechanism contribute to the problem of the health sector. Corruption is one of the major problems of many sectors in Nigeria.

Primary health centers are set up in places that are not really needed all because of political reasons and those that really need such are left to suffer.

Salaries are not correctly paid and not paid on time. Substandard drugs are supplied to hospitals and sometimes drugs meant for health facilities are diverted to benefit a certain class of people, all these and more are one of the issues facing the health sector.

6. Poorly Trained Nurses

Nurses are very important in every hospital; they stay with patients 80% of the time. Nurses also need to be properly trained to provide assistant in situations where the doctors are not available. And also attitudes of some nurses in hospitals is nothing to write home about.  Also, their salaries are really low.

 7. No Compassion and Medical Errors

Doctors and nurses are known to lack compassion and empathy. People looking for help will suffer when it comes to a doctor-patient relationship.  In Nigeria hospitals, nurses don’t only insult their patients, they go ahead to embarrass patients’ visitor.

They make you feel unwanted harshly, character trait widely different from what they were taught in nursing school. They are very quick to insult women on labor and mock them at any slight opportunity. After birthing, they hardly assist to take care of the infant.

The increase in medical errors has also contributed to the high number of preventable death in the country, experts have said. Medical errors are also a very big Heath challenge in Nigeria, medical errors have a lot of dimensions.

The first type is what is called misdiagnosis. That is when people are given the wrong diagnosis and that means the chances of treating the person is zero means the wrong treatment is given for a wrong disease.

The second one is when doctors diagnose right but the wrong drugs and medications are administered to the patient. While The third is when you get the diagnosis right, get the right drugs to administer but you administer the drugs improperly, probably due to insufficient training or exposure. So these three are very important in terms of how people eventually die in hospitals.

This happens a lot in hospital but we won’t hear of it because most of them are not popular in the society so they go unnoticed, about 30% of deaths are due to medical errors.

8. Ineffective Waste Management

Hygiene is one other thing facing the sector. when you visit most hospitals, the smell is so horrible and you can see waste lying about, the toilets and bathrooms are also very dirty. How do you expect to get good medical attention in a dirty environment?

Most of the problems listed are just a few out of the many problems facing the health sector. You might wonder that how do we solve these issues.

The NHIS should be made available to all citizens of the country to make health care facilities available to everybody at a cheap rate.

Medical doctors, nurses and other specialist need to be properly equipped in schools to prepare them for the job. They need to get more theoretical practice so that they can handle any issue. And also there should be continuous training for the medical specialist to make them properly equipped at all times.

To solve most of these problems, federal government need to pump enough funds into the sector. If there are enough funds, facilities would be upgraded, medications would be available and salaries would be correctly paid and on time, this is a form of motivation for the doctors and specialist.

Corruption is a major issue. They should be a regulatory agency set up to regulate and monitor the activities of all hospitals. Corrupt practices need to be curtailed.

Doctors need to adhere to the Hippocratic law and save lives first rather than asking for money.

One very important means of addressing the health challenges in Nigeria is to ensure that we have a functional and effective primary health care system because most Nigerians live in the rural areas.

Facilities Maintenances should be introduced to help in making sure that healthcare assets fulfill their lifecycle, maintenance cost is tracked to continuously ascertain the profitability of the asset, equipment failure is predicted and prevented to improve productivity, and downtimes are minimized to reduce the total cost of maintenance.

healthcare facilities should implement a sustainable process that properly separates regulated from non-regulated medical waste at all times. This process will include a regular collection, handling, storage, transportation and processing of waste.

Creation of a conducive environment which can significantly reduce the transmission and spread of microorganism infections in healthcare facilities.

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