Towards improving Nigeria’s health sector

Everyday, one in every five children die from vaccine-preventable diseases. This amounts to over 2,000 kids daily. That means every day, including today, 2,300 Nigerian kids will die! And that amounts to over 750,000 kids every year in Nigeria.  This is what it means: the number of under-5 children that die in Nigeria annually because […]

Everyday, one in every five children die from vaccine-preventable diseases. This amounts to over 2,000 kids daily. That means every day, including today, 2,300 Nigerian kids will die! And that amounts to over 750,000 kids every year in Nigeria. 

This is what it means: the number of under-5 children that die in Nigeria annually because of vaccine-preventable diseases is about 40% of the entire population of The Gambia.

The figures are high and appalling, but the implications are even more so. Each kid stands for someone’s hope, joy and more – all of that shattered because of a disease that could have been prevented by a timely shot of vaccines. That little bundle of flesh being buried and covered with sand could have been tomorrow’s president, professor, inventor, engineer or more. That body, now reduced to a statistical figure, could be someone’s father or mother. Yes, the figures are high and appalling, but the implications are even more so.

Vaccination leads to immunisation. When a child gets the right vaccines, in the right measure and at the right time, she develops immunity, that is, she is immunised against a wide range of diseases that cause death. The World Health Organisation (WHO) lists 25 such diseases that can be prevented by vaccination. They include poliomyelitis, measles, cholera and yellow fever. Put simply, if a child completes her immunisation, she can no longer be a victim of these diseases. Vaccinations are the railings that will prevent 2,300 kids falling to their death everyday.

But why aren’t we building strong railings?

If vaccination offers such a relief from our grief, why are our children not all fully vaccinated? Reports show that many Nigerian children are not vaccinated. A study showed that 58% of Nigerian children are not born in the hospitals, meaning that these are not likely to be enrolled in the immunisation programme. These ones have no railings to lean on at all.

Another report shows that among those born in the hospitals, only 30% complete their vaccination schedule. A recent newspaper report tried to find out why parents do not return to the clinics as and when due to complete the vaccination of their children. It discovered that, first, some parents forget; second some other parents do not have money to pay for transportation to the hospital.

Third, many clinics are not well equipped. Some don’t have the vaccines or the facilities for storing them. In others, health workers do not have the basics such as gloves. In yet others, hospitals do not have means of transporting the vaccines from where they are deposited.

Protecting children against killer diseases

The failure of Nigeria to vaccinate all her children, that is, to stop the death of 2,300 kids every 24 hours, should not be taken in isolation. How long do Nigerians live? If you are 53 years or above, you should worry because you are now on “injury time”. Life expectancy for Nigerians is short: just 52 years. All our neighbours live longer – including Niger (61 years) and Chad (53 years). Life expectancy in Ghana is 62 years while the average Chinese will live up to 76 years.

In Nigeria, just as life expectancy is short, maternal mortality is incredibly high: everyday, 145 women of childbearing age die due to pregnancy related causes. That is, in 145 homes where families and friends are looking forward to welcoming a new-born, there will be, instead of celebrations, mourning and commiserations. This happens in 145 homes everyday. In the whole world, Nigeria is the second highest when it comes to the death of children and mothers. In fact, Nigeria is performing poorly on most health indicators. 

The health sector in Nigeria is not in a healthy state. Physical facilities are grossly inadequate: many have to travel many kilometres to reach a clinic. That is the main reason that 58% of children are born out of the hospital and only 35% of births are attended by trained health workers. Where health facilities are found, they are ill-equipped. The basic tools, regimen, antigens, and kits are not available or not functioning.

Could things have been different?

To expect the health sector to perform better than it is currently performing is to try to expect the skunk to emit perfume. The sector is currently grossly under-funded. Things could not just have been better.

Budget allocation to the health sector in Nigeria is likely one of the lowest in Africa. In 2001, many heads of states met in Abuja and declared that at least 15% of their annual budget would be devoted to health. Between then and now, Nigeria has not even once kept to that declaration. The closest Nigeria ever got to the Abuja Declaration was in 2012 when it allocated roughly 6% of the annual budget to health. In 2016, the portion of the budget allocated to health dropped to 4.1%; in 2017, it is 4.2%.

A closer analysis would show that there is not a wide difference between the 2016 and 2017 allocation – 4.1% and 4.2% respectively. Given the fact that much of the tools and resources in the health sector are foreign-exchange affected, and given how low the naira has fallen recently, the 2016 allocation actually amounted to far more US dollars than the 2017 allocation. The sad implication of this is that the performance of the health sector in 2017 will be expectedly poorer than it was in 2016.

The progressive decline calls for worry. The 2017 budget should be revisited and the percentage allocated to health should be moved up to at least 10%. Underfunding is the major reason that Nigeria is failing to reach the benchmark on vaccination, that family planning services are ignored, that the hospitals are not within the reach of the rural people, that the hospitals are in a deplorable state, and that staff morale is low. Unless underfunding is drastically redressed, things would not be different.

It is important to invest in the economy, agriculture, education and infrastructure. However, without a healthy workforce and a healthy citizenry, all the investments in these sectors would be a waste. Therefore, a direct investment in health is an indirect investment in all the other sectors.