By Hassan Zaggi
DR. FRANCIS OHANYIDO is the Director General, West Africa Institute of Public Health. In this interview with HEALTH REPORTERS, he x-rayed Nigeria’s health sector and warned that the precarious situation of the sector may get worst if the government fail to take the needed steps to salvage the situation.
Looking at the Nigeria’s health sector in the past four years, can you say we have moved forward or backward?
If you look at the health sector between the past four years and now, we have suffered a lot. One of the things that comes out clearly is that we were lucky that the outcome of COVID-19 in sub-Sahara Africa was not as bad as predicted. Some people may say it is due to institutional memory of the fight against Ebola and Lassa fever. However, other things played some major roles including having a younger population.
If you look at the trajectory of the response, taking COVID-19 as an example, we did not do a lot. We focused more on the procurement end of it and you know when procurement comes, accountability becomes an issue.
If you look at the human resource component of the health sector over the past four years, we have lost so many experts who have left for other countries and many are still leaving. It is not that people should not go and look for greener pasture, but we should offer them equitable opportunity in-house to have the conducive environment to work.
If you are not treating them very well, they will leave. If they feel the infrastructure is not good enough for them to work, they will leave. And all this is coming down to the issue that we have not finance our health system very well.
Our health system is still poorly accountable, it is one thing to ask for money for the health, but how about more health for the money. Transparency and accountability have been thrown into the bush. So, are we getting the right kind of health? It is going to get worst because it you don’t have the providers at the service delivery end, who is going to provide the service. It is just like we are now providing our own power source, water source, we may start becoming our own doctors and nurses for ourselves. These are the challenges. The health system is not doing too well. The health system is sick.
The 2023 election is at the corner, specifically, what will be the focus of Non-Governmental Organisations (NGOs) working in the health sector under the umbrella of Health Sector Coalition?
First and foremost, we need to agree that health is priority for Nigeria. One thing that COVID-19 has shown everybody around the world is that you must prioritise health. No economy in the world can survive if there is an onslaught of an epidemic like the type you saw in India, US and still happening in some of countries of the world.
Health is everything. Without health, there is no wealth. We need to prioritise health, we need to make sure that our health security profile is better, we need to make sure that we have better funding for the health sector.
Over the past 20 years, it is embarrassing that Nigeria hosted the Abuja Declaration for 15 per cent by the heads of African governments in 2001 and till date our own budget has not exceeded 5 per cent for health. It’s too embarrassing as a country.
We should lead the light and show the world what it means to hold such event and keep to the commitments. We have not done that. That should be a priority for anyone that will seek for any elected office in Nigeria in 2023.
We must also make sure that we have the kind of health infrastructure starting from ground to up. Obasanjo, for example, as he is now, should be able to walk out 10 minutes from his Otta farm and get a centre that can offer him treatment of uncomplicated malaria.
When we get there, we will know that our health system is working. It is unfortunate that the politicians will go to outside the country and get their treatment for all manner of ailment leaving the poorer people at the bottom of the social pyramid to die. We don’t want that kind of health system again.
That is why the Health System Coalition need to engage the political class to make them understand that we are all in this together.
A large percentage of the Nigerian population is poor. Universal Health Coverage (UHC) must become a priority. The National Health Insurance Authority (NHIA) needs to move rapidly to ensure it covers at least, 90 per cent of Nigerians.
The policy of PHC revitalization by the President Muhammadu Buhari government just died off, what do you think went wrong?
I think the PHC revalisation policy was just political. If you are genuinely interested in revalising the PHCs, you should know what the problems are. The first trouble was that governors have taken over the local governments and they are not funding them; hence, the primary health care is dying.
Primary health care should solve like 70 per cent of the disease problems people encounter daily. But you can see people go to the National Hospital with uncomplicated malaria. Why did they do that? Because the PHCs near them are not working. So, we know what the problems are.
If you are talking about revitalizing the PHCs, have you asked yourself how to make sure that the PHC system works? Have you built the trust with the communities for them to be co-owners and co-creators of that revitalized PHC? If you have not done that people will look at them somehow. If you say you want to revitalise the PHC and have not done the right things, it is political. We are not sincere about it.
Also, when you look at the funding at the federal level, 70 per cent of it goes to the tertiary while the primary health care is underserved and the primary healthcare caters for, like I said, 70 per cent of problems of health for Nigerians.
If your primary healthcare is working, your secondary level is working and you have a good referral system, even if people will go to the tertiary hospital, what they are going there for is for specialist care. If you are treated well at the primary, you don’t graduate to the secondary, even if they get to the secondary, they will not graduate to the tertiary.
Most of the things that happen at the primary healthcare are vaccine preventable.