At a recent press briefing by a collective of health-oriented Non-Government Organisations, under the aegis of Partnership for Advocacy in Child and Family Health, fearful details about the status of the health care delivery system of Nigeria were revealed.
One came away from the encounter with the fear that the Nigerian state was waging an undeclared biological warfare, a war of attrition, against its people; that the right of Nigerians to life was being threatened through the wilful negligence of the Nigerian state!
Between 80 and 85 per cent of health issues in Nigeria affect women and children. Nigeria was declared 189th worst nation on some basic health indices. About 200 of every 1,000 Nigerian children die from malaria, pneumonia, and diarrhoea before their fifth birthday. Only five die in America.
Results of Goals 4, to reduce child mortality; 5, to improve maternal health; and 6, to combat HIV/AIDS, malaria and other diseases, of the recently rested Millennium Development Goals programme were just short of dismal for Nigeria. For example, by 2008, only 5.5 per cent of children slept under insecticide-treated mosquito net.
Though Nigeria is relatively efficient with the immunisation programme, which comes early in the life of a child, it is regrettable that donors (especially multilateral agencies), foot the bulk of the funding. The implication of inadequate funding is that about 66,000 children below age five die annually in Kaduna State alone. The Federal Government’s plan to vaccinate 41 million children against polio is laudable.
About 53 per cent of child death is due to malnutrition which also causes immune deficiency. The Nigerian Demographic Health Survey reports that about 37 per cent of Nigerian children are stunted in height, weight, and mental capacity because of malnutrition.
The feeding of children, a vulnerable group that cannot help themselves, should be a matter of priority. An underfed people will have lower mental capacity, will not achieve their full potential, will loaf about, and become a threat to national security.
The recent raids of grocery stores by hungry citizens of oil-rich Venezuela, and insurgency by Boko Haram in Nigeria, arise from the anger of the downtrodden. The ruling All Progressives Congress government must urgently implement the fulsome lunch scheme for primary school pupils nationwide. It however looks like it already kicked off in Gubio Local Government Area of Borno State.
Many poor parents can neither adequately feed themselves nor their children. Those state governors who claim that the school lunch programme is too expensive should remember that Nigerians know that food is provided free in State Houses.
Food is at the core of human survival and security. Former President Olusegun Obasanjo laments that Nigeria’s food insecurity index rose from 35 per cent of Nigerian households in February/March 2016, to 38 per cent in June/July. With the recent devaluation of the naira, it would have become even worse.
Five women die of child birth every hour in both rural and poor urban centres in Nigeria. This is because most pregnant women have little access to health facilities; are too young, especially in Northern Nigeria; do not space their pregnancies; or do not feed well. With fewer children, the food goes round, and the ravages of breastfeeding on malnourished mothers are reduced.
Family planning facilities and delivery that can reduce maternal death are inadequate. Again, the Nigerian state fails to provide counterpart funding to complement the foreign donors. And sometimes, donated family planning consumables are abandoned by callous state agents.
Because Section 33(1) of the Nigerian Constitution guarantees right of life to all, it is a constitutional responsibility for the Nigerian state to ensure that feeding and health care, both basic requirements for life, are available to all Nigerians without discrimination, always.
One rule of thumb to achieve this is to concentrate on the health issues that concern reproduction (or pregnancy), mothers, new born babies, and the adolescent children. In the long term, this strategy reduces general mortality rate. It also guarantees a healthy and productive citizenry.
World Bank President, Jim Yong Kim, says, “Today’s digital economy requires a workforce with well-developed intelligence. Failure to invest in a skilled and healthy workforce is ultimately harmful to (a) country’s future competitiveness.”
Women education, which must include enlightenment programmes on immunisation, adequate feeding, family planning, spacing of children, and general health information, must be intensified. Somebody said if you educate a woman, you educate a nation.
The menfolk, religious leaders, and traditional leaders should be recruited into the vanguard to save the Nigerian woman and child. A constructive engagement of the menfolk, who have immense authority, as husbands and policymakers, in Nigeria’s male-oriented environment is critical to health care delivery.
The federal budgetary allocation to health is tapering year after year. Most of the paltry 4.13 per cent allocated to heath in the 2016 budget went to recurrent expenditure. You don’t even want to know the figure in naira. Yet, less financially endowed African countries allocate way above 15 per cent of their budgets to health care: Burkina Faso, 15.8 per cent; Zambia, 16.4; Malawi 17.1; Botswana, 17.8; and Rwanda, 18.
But happily, Lagos State’s allocation to health care is gradually inching up-from nine per cent in 2015, to 11 per cent in 2016, moving steadily towards the 15 per cent recommended by the 2001 Lagos Declaration of the Africa Union.
The provision of the Nigerian Health Act of 2014 that at least one per cent of the Federal Government’s portion of the Consolidated Revenue Fund or Federation Account Allocation be directed at health care is observed in the breach.
Increase in budgetary allocation to health care should be accompanied by early release of funds, and the physical cash backing, to ensure programmes implementation. Unconfirmed reports attribute the release of just about 40 per cent of funds for the 2016 budget to reduced price of crude oil and pipeline vandalism by the Niger Delta militants.
Late completion of the budget proposal and submission to the legislature also contributes to the low implementation. It is therefore a welcome development that the 2017 Appropriation Bill will likely become an Act of the National Assembly before January 2017.
The dilapidated health facilities in most government hospitals compel higher budgetary allocation to capital projects than recurrent expenditures like travelling allowances, meetings, workshops, and retreats. Government policies must create an enabling environment for increased local production of drugs, equipment, and other medical consumables.
Nigerians now seek alternative herbal medicine, not out of choice, but because the private hospitals are far too expensive, relative to government hospitals that lack requisite drugs, and keep them all day on the Out Patient Department benches.
Some health experts have suggested that amoxicillin, an antibiotic, used in treating tonsillitis, bronchitis, pneumonia, gonorrhoea, and skin, urinary tract, and ear, nose and throat infections, should be a staple drug. It however makes birth control pills less effective.
Section 17(3)(d) of Nigeria’s constitution provides that “the state shall direct its policy towards ensuring that there are adequate medical and health facilities for all persons.” State actors, who as humans are also susceptible to illnesses, must address this provision with the passion it deserves. An appreciation of the nexus between health and economy better persuades the unwilling to make adequate budgetary allocation to the health sector.
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Punch
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