In this report, LARA ADEJORO highlights the events that shaped the health sector in 2022 as experts set the agenda for 2023
From a decline in cases of COVID-19 to reemerging disease outbreaks, signing the health insurance bill into law and a massive brain drain, the health sector has witnessed many ups and downs.
Nigeria moved from reporting over 5,000 COVID-19 cases weekly to reporting only 77 cases in two weeks as of November 20, 2022. The death toll has also fallen. Since the outbreak began in 2020 till November 20, Nigeria recorded 266,057 cases and 3,155 deaths so far.
Over 63 million of the total eligible persons targeted for COVID-19 vaccination have been fully vaccinated while over 12 million of the total eligible persons targeted for COVID-19 vaccination have been partially vaccinated so far.
Development partners, including the United States government, the United Nations Children’s Fund, and traditional and religious leaders equally commended the government’s strides in the vaccination rate.
The Ambassador of the US to Nigeria, Mary Beth Leonard, said she is confident that Nigeria has laid a firm foundation to minimise morbidity and mortality as a result of COVID-19.
“We commend the government of Nigeria for the successful launch and implementation of the S.C.A.L.E.S strategy, which resulted in the administration of over 100 million doses of COVID-19 vaccines to eligible persons in Nigeria. This is very uplifting and impressive,” she said.
Multiple disease outbreaks
However, reemerging diseases have continued to expose loopholes in the health sector as the country battles multiple disease outbreaks.
Currently, there are 604 cases of monkeypox, 1,038 cases of Lassa fever, 18,545 cases of measles, 961 cases of meningitis, 23,550 suspected cases of cholera, and 1,601 suspected cases of yellow fever. All these diseases have killed no fewer than 1,078 persons in the country in 2022.
According to the Director-General of the NCDC, Dr Ifedayo Adetifa, Nigeria recorded the highest number of cholera cases worldwide in 2021.
“This year appears to follow the same pattern. But perhaps it’s not surprising because if the circumstances that contributed to the case numbers last year have not been dealt with, then we should have the same number of cases this year. So, it tells us that the necessary interventions that needed to have been put in place were not done at the scale desired to make an impact on cholera cases,” he said.
Health insurance for all
The health sector experienced a dynamic shift in May when the President, Major General Muhammadu Buhari (retd.), signed into law the National Health Insurance Authority Bill.
“As part of our healthcare reforms, I have signed into law the recently passed National Health Insurance Authority Bill 2022, which repeals the National Health Insurance Scheme Act. We will ensure the full implementation of the new Act to provide coverage for all Nigerians,” Buhari said.
In a statement by the Senior Special Assistant to the President on Media and Publicity, Garba Shehu noted that a fund will be set up to ensure coverage of 83 million Nigerians who cannot afford to pay premiums as recommended by the Lancet Nigeria Commission.
Frail health centres
But all that could not ensure the sector was fully served. Health facilities, health centres, personnel, and medical equipment are inadequate to serve the populace.
In November, the Lagos State Commissioner for Health, Prof. Akin Abayomi, said at least 60 per cent of the primary healthcare centres in the state are not in a very desirable state.
Abayomi, who revealed this via his Instagram handle @profakinabayomi, however, said the state government had invested time to conduct a needs assessment on PHC infrastructure to provide evidence-based information for improvement.
The commissioner confirmed Lagos State has over 325 PHCs, with at least 60 per cent not in a very desirable state.
“We currently have the blueprints which will serve as the framework to transform all the PHCs. Construction will commence soon and we believe that over the next three to four years the PHCs will be transformed. #ForAGreaterLagos,” he stated.
Poor health budget
No doubt, healthcare is capital intensive but the government has failed to meet its 2001 Abuja Declaration commitment, which requires the nation to ensure that at least 15 per cent of its annual budgetary allocation goes to health.
A breakdown of the 2022 budget indicated that N724 billion (4.2 per cent) was allocated for healthcare across the 36 states of the federation and the Federal Capital Territory.
Also, of the 2023 total budget of N21.82tn, only N1.23tn (5.64 per cent) was allocated to the health sector.
Though the health sector experienced tranquillity as there was no national industrial action in the health sector in 2022, the bill for an act to amend the University Teaching Hospitals in the House of Representatives has continued to pit stakeholders in Nigeria’s health sector against each other.
The bill is uptight with disputes over competence and administrative titles.
It seeks to provide a definite tenure of office for the heads of tertiary hospitals; including students of health sciences in the training programmes of tertiary hospitals; including hospitals established post-enactment of the extant legal framework in the schedule and for other related matters; restructure the composition of the governing boards of the federal government tertiary hospitals, among others.
By implication, any health professional, including pharmacists, laboratory technicians, nurses, and others can now head teaching and tertiary hospitals as opposed to the current hierarchy that medical doctors occupy.
Brain drain
The health sector is battling its worst brain drain this year with no fewer than 10,296 Nigeria-trained doctors practising in the United Kingdom, according to the Nigerian Medical Association.
Also, the Nigerian Association of Resident Doctors has said the number of medical doctors in the country decreases daily, adding that only about 10,000 resident doctors are left.
The President of the association, Dr Emeka Orji, said about 100 resident doctors leave the country monthly to seek greener pastures.
Insecurity, poor remuneration and poor working conditions, among others, have been identified as the push factors for healthcare workers in the country.
A professor of public health at the University of Ilorin, Tanimola Akande said despite the legislative achievement the sector recorded, it still performed poorly against the benchmarks in healthcare financing.
Besides the brain drain, health infrastructure, according to him, only witnessed a face-lift in a few Teaching Hospitals but not quite significant considering the various levels of health facilities.
Expectations for 2023
“Hopefully, one looks forward to a better-funded health sector in 2023,” Akande said.
Among the developments he looks forward to, is the completion of the task before the Health Sector Reform Committee.
The don also expects the government will have the political will to implement the committee recommendations.
The NARD President noted that the government can do better with the right structures in place.
“The budget for the health sector is below six per cent and it is below the AU target,” he said.
Noting the percentage is grossly sub-optimal, Orji said the available fund will not be enough to address the challenges facing the sector currently.
With adequate funding, he said Nigeria can establish some of the hospitals the politicians visit abroad for healthcare.
“We have had interactions with many of them, and they will tell you that it is the same Nigerian doctors that attend to them over there. The difference is that those countries have invested in their healthcare sector and we need to do the same to retain our best brains,” he said.
“We are not saying that the government should ban medical tourism because it’s a free world and you can choose to seek healthcare anywhere in the world but it should not be done using taxpayers’ money.
“If there is a policy that public office holders cannot be sponsored for medical check-ups, you will see them making efforts to develop the health sector in this country,” he said.
On his part, the Chairman, Lagos State chapter of the National Association of Nigerian Nurses and Midwives, Olurotimi Awojide urged the government to improve the working conditions of healthcare workers for better healthcare.
“In other climes, you see that they have social services for their aged people and they continue to take care of them but that is not the case in Nigeria and many people want to leave the country,” he said.
He lamented the spate of insecurity in the country, and how nurses fall victim.
“During the Owo massacre, we have a nurse that lost two lower limbs and nothing is forthcoming to take care of her. It’s only those of us that are her colleagues that are making efforts to rehabilitate her,” he said.
He has expectations for the coming year, too, which include making the working environment conducive and introducing different packages that will make Nigeria attractive for healthcare workers.
