The inadequate programs designed to address the numerous health problems in Nigeria have led to the little improvement in our health status.
Overall life expectancy at birth is 54 years; infant mortality rate is 86 per 1000 live birth while maternal mortality ratio is 840 per 100,000 live births. This is according to the World Health Statistics of 2011. Besides the continued neglect of the importance of addressing public health issues would make matters worse for poor Nigerians most of who are at the receiving end.
The major public health challenges Nigeria faces are infectious diseases, sewage disposal, health insurance, water supply, air pollution, noise pollution, environmental radiation, housing, solid waste disposal, disaster management, control of vector some diseases, doctor-population ratio, population- bed ratio, population per health facility, payment system/methods, utilisation of care, access to care, improper co-ordination of donor funds, material mortality, infant mortality, health financing, poor sanitation and hygiene, incessant doctors strike, disease surveillance, smoking of tobacco, brain drain, rapid urbanisation, non-communicable diseases, alcohol abuse, environment degradation, road traffic injuries etcetera.
Nigerians will continue to die unnecessarily from preventable conditions and disease if there are no proper programs designed to address each of these problems. The first WHO Global Status Report on non-communicable disease listed Nigeria and other developing countries as the worst hit with deaths from non-communicable diseases.
These diseases with a rising burden in Nigeria include cardiovascular disease, cancer, diabetes, chronic respiratory diseases, sickle cell disease, asthma, coronary heart disease, obesity, stroke, hypertension, road traffic injuries and mental disorders.
According to the 2011 World Health Statistics, malaria mortality rate for Nigeria is 156 per 100,000 population. Nigeria has one of the highest Tuberculosis burden in the world (311 per 100,000) resulting in the largest burden in Africa.
This is according to USAID. The proper design of programs to address the public health problems in Nigeria will no doubt go a long way in improving the health status of the people. Though there are programs designed to address some of the health issues, there is a need to solve many other health problems.
Currently, there is no program designed to tackle public health issues holistically. Some of the programs to be designed lie with health-related sectors such as the ministry of education, housing, transportation, works, water resources, science and technology, agriculture, information and environment.
The lack of coordinated efforts among these sectors affects the design of programs to address public health problems. Reduction in the number of unnecessary deaths and increased life expectancy can only be guaranteed with the pursuance, adoption and implementation of a health policy that is based on universal coverage, emergency medical services, national health insurance as well as affordable preventive care.
So many factors are responsible for the inability to design appropriate programs to address the major public health challenges Nigeria faces. Some of them include lack of political will by government and political actors, improper investment in the health sector, the inability to see the link between health and development, lack of policy to address all the health problems and weak health systems.
Design of programs to address most of the public health problems in Nigeria will greatly improve the nation’s health indices. After about seven years of revising the national health policy and with the national health act which has been watered down, there is a need for decision makers to consider a policy change.
The current national health policy have concise statements on policies of health programs such as HIV/AIDS, Malaria, Immunisation, Population, Reproductive Health, Control of Onchocersiesis, Tuberculosis and Leprosy, Blood Transfusion, Elimination of Female Genital Mutilation, Adolescent health, Food and Nutrition, Child Health, Drug & Food hygiene and safety.
The major thrusts of the health policy relate to issues such as National Health Systems and Management, National Healthcare Resource, National Health information system, partnerships for Health development, health research and National Health care laws.
This was the outcome of stakeholders submissions on what the national health policy should look like. The public’s perception of the revised national health policy is unknown. Though there has been some improvement in the health status of Nigerians but the difference is insignificant.
For instance, the achievement of the millennium development goals (MDGs) to which Nigeria, like other countries committed to achieve by 2015 remains to be seen. The issue of equity, accessibility, affordability, quality, effectiveness and efficiency which are the overall policy objectives of the revised national health policy still persist.
The primary health care on which the Nigerian health care system is based has not helped in effectively solving the numerous health problems in Nigeria. Cost effective interventions for priority public health issues such as non-communicable diseases, injuries, maternal and child health etcetera are hardly being used.
Intersectoral cooperation and collaboration between the different health-related ministries still remains a major issue. Each day there are about 1,000 new infections of HIV in Nigeria. This is according to a UNAIDS 2010 report. The World Health Statistics of 2011 also showed that the number of reported cases of malaria increased from 2,834,174 in 2008 to 4,295,689 in 2009.
Governments at all level are yet to show enough commitment towards attaining the goals of health for all Nigerians. National health systems remain weak while its management is ineffective and inefficient. There is no equitable distribution of human resources between urban and rural area. Over 70 percent of doctors are in urban areas where only 48 percent of the population live, leaving 52 percent of the population who live in the rural area at the mercy of inadequate health personnel.
The provision of good working condition for health workers still remains a challenge. Also, there is limited opportunities for career advancement and continuing education for health workers. Governments at all levels are yet to review their allocation of resources to health sector in line with internationally recommended standards. Only 1 percent of the health budget is allocated to preventive services while over 70% is allocated to curative services. Additional avenues for financing the health system such as community financing and donor/partner funds have not been fully explored and utilised.
The national health insurance scheme (NHIS) which is over six year old cover less than 10 percent of Nigerians. The construction and institutionalisation of a National health account is still in the works. There is insufficient evidence on the number of girls who die from female genital mutilation in Nigeria.
However, the National Health bill which is expected to provide a legal backing to the current health policy has been passed by the two chambers of the National assembly. It has been argued that the non-existence of health legislation in Nigeria has been the bane of non-performance of the health system.
The consequences of not designing programs to addressing the many public heath challenges Nigeria faces are increasing death toll, increased burden of diseases, further impoverishment of the people and poor standard of living among others.
The changes in the crop of leaders elected at the different level of governance necessitate a new approach in the delivery of health services to the Nigerian population.
•Aregbeshola is a graduate of Public Health at the University of Lagos, Akoka, Yaba, Lagos State.