There is palpable anger and disappointment within the Nigeria’s health sector over the choice of the membership of the 19 member President elect Buhari Transition Committee. Many relate how serious the new government will invest in health sector with the membership of the committee and because of that they don’t want to have anything to do with the committee. When I sent out an email to national health NGOs and development partners that the health sector should engage with the committee, many were apathetic. A senior colleague retorted that “Aminu – the 19 member committee is devoid of even a single health worker or health NGO or development worker and this is an indication that the new government isn’t serious about health and may not pay attention and I will not waste my time with them.” I was very calm in replying that I also noted such gap and share same frustration but that is the more reason why the health sector mush engage the committee in order to share information that will help them make informed recommendations to the new government.
In furthering understanding why the health sector must engage, we need to review the situation. The health sector has both recorded positive and negative issues. We are happy that the signing into law of the National Health Act by the President in October 2014 to provide a framework for the management and organization of the Nigerian health system is a giant step as well as improvement in immunization coverage and drop in wild polio virus cases all over Nigeria. We have also recorded a drop in HIV prevalence and we are commended in our success in tackling of Ebola Virus Disease. Provision of midwives to primary health centers through the Midwifery Services Scheme and SURE-P have also recorded some success as well as improved access to free health for pregnant women and children under 5 years in some states through either state supported programmes or other MNCH projects aimed at saving the lives of women and children such as Saving One Million Lives Initiative.
While we are happy of the aforementioned, the below poor health status indicators are still problems that must be tackle.
- We have estimated 3.5 million people living with HIV, one of the highest numbers of infected people in the world. Nigeria also has the fourth highest Tuberculosis burden in the world according to experts. We have also witnessing the return of consultation fees, cost of drugs for HIV treatment and other laboratory services which were hitherto free.
- Incessant unrest and industrial strikes and inter-professional disputes within the health sector.
- The Federal Budget for Health has never gone beyond 7% of the annual appropriation despite the country’s endorsement of regional and international commitments of higher percentages such as Abuja declaration and Maputo Plan of Action.
- The rebasing of the country’s economy that led to her classification as a lower medium income country is negatively effecting the funding commitments of international donors (e.g. GAVI funding for Vaccines)
One study has observed that “the persistent relatively poor health indices highlight Nigeria’s inability to achieve most of the millennium development goals (MDGS) by 2015 as most of the health-related MDGs targets are off-track. They also have serious economic, political and security consequences for the country.”
It is also good to note that Nigeria has made significant progress in immunizations and these gains must be sustained. Nigeria has significantly reduced under-five mortality by 22% between 2000 and 2013, and vaccination contributed to this progress. The Routine immunization (RI) administrative coverage has increased by 38% in the last two years.
With some of these laudable achievement, there are still other many challenges as follows;
- Every year, about 800,000 Nigerian children die before their fifth birthday.
- Nigeria’s under-five mortality rate is 128 deaths per 1,000 live births. This implies that one in every eight children born in Nigeria dies before fifth birthday.
- In 2013, it was estimated that more than 800,000 children under the age of five died in Nigeria. Most of the leading causes of child deaths (such as malaria, pneumonia, diarrhea, injury, meningitis, and measles) are vaccine preventable.
The 2013 NDHS has shown that our Maternal Mortality Ratio is about 576 maternal deaths per 100,000 live births which wasn’t significantly different from the ratio reported in the 2008 NDHS of 545/100,000. It also reported contraceptive prevalence rate (CPR) for Nigeria was just 15%. While availability of Family Planning (FP) services at health facilities may have improved in the last 2-3 years, this has not been matched by improved service quality and increased demand especially at the community level where women from poor households with low education abound. The low utilization of FP services is worse in North East and North West where the utilization is less than 1% according to the 2013 NDHS figures. The Nigerian government in 2010 made commitments to release US$3 million annually for the procurement of FP commodities, and later at the London Summit in 2012 made an additional commitment of US $ 8.35 million annually over the next four years for reproductive health commodities including contraceptives. However, the government has not fulfilled the respective commitments to fund these services and of course hasn’t meet up to many other local and international commitments.
With all these in mind, whether we are happy or disappointed or indifferent, the health sector has no option than to meaningfully engage the transition committee to help them make informed decision and recommendations to the in-coming government.
1st published in Daily Trust Newspaper of 5th May 2015 by Dr Aminu Magashi Publisher Health Reporters (email@example.com)