Dear 2019 Presidential Aspirant,
A nation touted as the Giant of Africa should be ashamed of the appalling health statistics of its citizens. The United Nations’ Sustainable Development Goal 3 is to ensure healthy lives and promote wellbeing for all. Health is a globally recognised human right but a walk down the streets of your average town will show this to be a lie in Nigeria. People die in “accidents” everyday; there are obvious risks to anyone who has seen Nigeria’s roads, yet we say it is God’s will. People inhale soot that increases their risk of cancer and chronic respiratory conditions. Then they fall ill and we say it is the work of their enemies. People live in slums with no sanitation and unsanitary water, then we sigh when they die from cholera.
The health outcome of Nigerians is a window showing the whole world the priorities of her leaders. The poorest people in Nigeria’s urban centres are five times more likely to die than the urban richest. Pregnant women, as well as a lot of newborns, die from reasons that are medically avoidable. Working class youth are dying from cardiovascular diseases that people in other countries only worry about once they are senior citizens. People walk around with mental illnesses, undiagnosed and uncared for. The poor cannot access medical care. Thousands who have lost loved ones to violence will be raped in refugee camps, by those who should be providing them a safe haven.
When will enough be enough?
Health is so critical to the life and dignity of every Nigerian and I task you, dear Presidential Aspirant, to have a plan for health, not later, but right now. I am calling to you put the health and well-being of the Nigerian people at the centre of development. Through this letter, I am also giving the Nigerian people a set of health-related criteria to scrutinise you by during and after the election period. Prove to us that you plan to create an effective public health system that you will use. If it is not good enough for you, it is not good enough for any Nigerian.
We deserve a leader for who merit matters more than ethnicity, class or religion; for who value creation matters more than entourages; for who the “nobody” is valued just like the “somebody” in Nigeria. They say that a country gets the leaders it deserves. I want to give you the opportunity of a lifetime…
Here are the questions to you:
What is your plan for extending the life expectancy of citizens? Nigeria’s average life expectancy is a little over 50. The top ten causes of death in Nigeria, according to the Centers for Disease Control, are malaria, respiratory infections, HIV, diarrheal disease, road injuries, malnutrition, cancer, meningitis, stroke, and tuberculosis in that order. Many of these are preventable through investments in primary care, sanitation, and community health promotion. How will you ensure that it is not a death sentence to be born in and live in Nigeria?
What is your plan for our workforce? The rise of chronic disease outbreaks, massive emigration of the health workforce and commercial interests, such as tobacco, sabotage the health of many. The health workforce is leaving the country in droves and other countries are benefiting from the investments made in them. How can you create a Nigeria where health workers will get the remuneration and job satisfaction they deserve, so that they can provide high-quality care to meet the needs of our growing population? How will you prepare our health workforce to use new tools such as technology to fight infection and chronic diseases? Data, when used well, can be used to respond to outbreaks, can help us target areas of need, and help us monitor progress. Certainly, the giant of Africa is worthy of a system of health record keeping that is comprehensive and accessible throughout the health system, so that people can get the support they need.
How will you transform our health system to be ready to deal with the challenges today? Nigeria’s population is changing. We are dealing with infectious diseases like malaria, as well as chronic diseases like diabetes. Too many of us are walking around with hypertension and dying from heart attacks. Our health systems lack infrastructure and an orientation toward dealing with the burden of both communicable and non-communicable diseases, and preventing the cause of disease rather than just treating it. As the causes of death transform, we need not just one-off treatments but prevention, and clear plans to work with, not against or despite communities.
What is your plan for insuring ALL Nigerians? Sickness strips so many Nigerians of their dignity and pushes them into unemployment, poverty, and even taking their children out of schools. If the available insurance does not cover people outside the private and public sectors, if it does not include those in the informal economy, such as tailors, drivers, mai guards, cooks, market women, traders, etc., then it defeats the purpose of managing risk for all. Insuring all Nigerians will allow the population to get care before they fall sick and will allow them manage their risks before they develop into devastating conditions like heart attacks.
Employment, traffic, no electricity, noise from generators, and day-to-day stress in Nigeria can lead to elevated blood pressure. What is your plan to ensure that what people need to be healthy in their living environments is provided to them, instead of simply treating diseases that could have been prevented?
What will be your plan to coordinate different sectors and tiers of government around a unifying vision of health? We know that all sectors – planning, health, environment, education need to come together to drive health gains. A child living under the bridge cannot be healthy if s/he does not have housing first. It will be very difficult for an unemployed person who cannot take care of his/her family and whose housing is not secure to achieve good mental health. Employment, traffic, no electricity, noise from generators, and day-to-day stress in Nigeria can lead to elevated blood pressure. What is your plan to ensure that what people need to be healthy in their living environments is provided to them, instead of simply treating diseases that could have been prevented?
How will you deal with mental health issues? Mental health is vital. About a third of Nigerians live with a mental health condition and it is mostly poorly diagnosed or managed. These conditions can be managed with the right awareness, and comprehensive forms of care, so that people can still be functioning members of their communities and contribute to society.
What is your plan to create safe roads for all citizens, pedestrian and motorist alike? Good roads are a public health issue. Road traffic injuries are among the top ten killers of people, causing death and disability. When I say good roads, I don’t just mean the commissioning of projects, but plans to maintain them. Many Nigerians do not have cars, so this includes pedestrian signs, sidewalks, streetlights, traffic signs and accessible streets for those with disabilities. Good roads reduce death, disability and improve physical activities, which reduce the rate of chronic ailments like heart diseases.
What is your plan to work with the private sector for health? To meet the needs of the growing population, we need the private sector. This does not mean short-sighted public-private partnerships, where people run away with money, there are no results and no one is held accountable. I mean a plan with incentives to make sure that private sector partnerships are merit driven, have a comprehensive systems lens, are evidence-based, well evaluated and accountable for results, service delivery, community engagement and value creation. There are too many abandoned projects that waste money and the opportunity to save lives.
What is your plan to stem conflicts due to ethnic and religious misunderstanding? What is your plan to take care of the poor? In election season, the poor become seen as human again. But what is your plan to really count them and stop meting violence to them in the name of development?
What is your plan to take care of the marginalised and victims of violence to build an inclusive society and economy? Mr. or Madam Future President, violence is killing so many of us and leaving us with deep traumas. What is your plan to protect marginalised communities like the poor, women, slum dwellers, the disabled, sexual minorities, all of whom have their health compromised by systematic discrimination and violence? What is your plan to stem conflicts due to ethnic and religious misunderstanding? What is your plan to take care of the poor? In election season, the poor become seen as human again. But what is your plan to really count them and stop meting violence to them in the name of development? It has consequences for their health. Poverty is not a crime.
What is your plan to ensure that the average Nigerian child, whether rich or poor, in the village or city, from your tribe or another, girl or boy, can have an uninterrupted educational trajectory? Birth to age five is a critical time in the lives of children. It shapes the trajectory of their lives. Education is a predictor of health outcomes across the life trajectory. The literacy of the mother affects the health outcomes of the child. Education is also related to social mobility and the child’s future health outcomes. Yet, many of our public schools are in deplorable states and are producing equally deplorable results, not achieving their objectives or preparing students for today’s global economy.
Health is central to the development of any progressive economy, without which every other metric of development is compromised.
We deserve a leader for who merit matters more than ethnicity, class or religion; for who value creation matters more than entourages; for who the “nobody” is valued just like the “somebody” in Nigeria. They say that a country gets the leaders it deserves. I want to give you the opportunity of a lifetime – the opportunity to be a leader worthy of leading the Giant of Africa, Nigeria.
So what is your plan for the health of Nigerians, if we elect you? We are waiting for your answers.
Ebele Mọgọ is a doctor of public health, writer and impact entrepreneur. She tweets @ebyral.
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