Nigeria: A Sick Giant, By Dele Agekameh
In 2011, Toyin Saraki, the wife of the Senate president, Bukola Saraki, stood before a crowd at a TEDx event in London and told the story of how, in 1991, she faced a hellish ordeal during the birth of her first child in Nigeria. The baby was a twin; but complications occasioned by the lack of an effective health system back then led to the loss of one half of the twins. She further told of how she sourced advanced baby formula and other items from around the globe to ensure the survival of the remaining twin.
Mrs. Saraki had a satellite phone by her bedside that allowed her go to extremes for her remaining child. Not even the combined wealth of her family, the Ojoras of Lagos, and her husband’s family, the Sarakis of Kwara, could prevent the loss of the other child in a Nigerian hospital. Mrs. Saraki never thought about having another baby in Nigeria after that ordeal. Although she has since gone on to make remarkable strides in helping to reduce child mortality and maternal death, the truth is that many Nigerian women still have worse ordeals in Nigerian hospitals today and the country has the fourth worst maternal mortality rate in the world.
Our healthcare system in Nigeria is still very much below par, even by African standards. This was part of the areas of emphasis of Bill Gates, the billionaire philanthropist and tech tycoon, in a speech he made during his recent visit to Nigeria. Gates stressed the need to get education and healthcare right if Nigeria ever wants to truly become the global economic power that it desires to be. He pointed out the country’s poor investment in human capital, which is largely measurable by the quality of education and healthcare available to the people. He reminded a crowd of national leaders that while the average life expectancy for upper middle-income countries is 75 years and the average for low-income countries is 62 years, average life expectancy in Nigeria is only 53 years.
The Bill and Melinda Gates Foundation has made vast investments in healthcare in Nigeria since 2006. Mr. Gates has particularly been on the frontline of the fight to eradicate polio, which is still a concern in Nigeria, as part of a very small number of countries who are yet to be declared polio-free by the World Health Organisation (WHO). One in three Nigerian children is chronically malnourished despite many programmes and donor-assisted projects in healthcare across the country. Many ‘landmark’ projects in different states quickly lose steam and are allowed to slide into the same mediocre level of healthcare that is the norm in most parts of the country.
For Nigerians like Mrs. Saraki and international partners like Mr. Gates who have committed so much effort and resources, the persisting mediocrity must be a deep and personal concern. If the crusaders and financiers of the healthcare system sleep with heavy spirits, one wonders about the plight of the victims who live through the helplessness of a decrepit health system. The frustration of slow improvement must also be compounded by inadequate commitment and investment into the health sector by the government.
In 2016, South Africa dedicated 12 percent of its budget to health, while Botswana, Zambia, and Burkina Faso all committed over 15 percent, with Rwanda going as high as 18 percent. In the same year, Nigeria allocated only 4.1 percent of its budget to the health sector. This poor commitment continues to occur, even though Nigeria’s overall budget has grown by 92 percent from N4.49 trillion in 2015 to N8.621 trillion in 2018.
Contrary to the WHO recommended yearly minimum budgetary allocation of 13 percent into the health sector and the African Union minimum of 15 percent, which was adopted in Abuja in 2001, the country has not allocated more than 5.95 percent of its budget to the health sector since 2001. The self-proclaimed giant of Africa has been continually dwarfed by its contemporaries and countries with lesser means.
In 2016, South Africa dedicated 12 percent of its budget to health, while Botswana, Zambia, and Burkina Faso all committed over 15 percent, with Rwanda going as high as 18 percent. In the same year, Nigeria allocated only 4.1 percent of its budget to the health sector. This poor commitment continues to occur, even though Nigeria’s overall budget has grown by 92 percent from N4.49 trillion in 2015 to N8.621 trillion in 2018. The estimate of health expenditure for 2018 represents only 3.9 percent of the total budget, which shows a decline in health spending. It is perhaps figures like this that spurred Mr. Gates’ advice to the country’s leaders that the true development of the country depends on the decisions they make, especially in investing in the Nigerian people.
Healthcare is a major area of focus in governance in developed countries, and a party that fails in this aspect is almost certain of losing the vote of the people in the next elections. The National Health Service (NHS) in the United Kingdom, for instance, is a mammoth organisation that will run on an estimated figure of £126 billion in 2018. Yet, there are complaints about inadequate funding for this organisation that will cater for less than 67 million people in 2018. This gives one some insight into the amount of investment needed to run a robust healthcare system. Nigeria is currently nowhere in this vicinity, with a growing population of more than 180 million people.
While very expensive modern private hospitals are popping up in places like Lagos and Abuja, many are still not good enough for the elite, who have had a taste of good and efficient healthcare in other places. It is a hot material for comedians now to state that the difference between the rich and the poor is that the former prefer to die outside the country. The recent officially certified emergency flight of Alex Ekwueme, the late former vice president of the country, to his death outside the shores of the country is an ironic confirmation of this very expensive joke.
Politically-inspired statistics being thrown around also adds to the lack of consciousness about the weight of our healthcare problem and, as a result, a reduction of investment into the health sector. The recognition as the largest economy in Africa, translates into almost nothing at a personal level for the average Nigerian.
In the middle of all this, the population continues to explode unchecked. Most of the boom occurs in the poorest areas of the country, where access to education and primary healthcare or any government presence is the lowest. It seems there is a direct link between lack of education and the astronomic increase in population, and a further link between this increase to the greater inadequacy of lean resources. The under-development of the country is a conundrum of poor decision-making by the ruling elite because of greed or incompetence and equally poor decisions made by the lowly masses because of ignorance, compounded by a lack of education.
Politically-inspired statistics being thrown around also adds to the lack of consciousness about the weight of our healthcare problem and, as a result, a reduction of investment into the health sector. The recognition as the largest economy in Africa, translates into almost nothing at a personal level for the average Nigerian. Irresponsible politicians concentrate on this to divert crucially needed funds for healthcare and education into areas that will boost or maintain this superficial size of the economy. It is a tragedy, one that Mr. Gates has now pointed out in no subtle manner.
Our best hands in the health sector are fleeing the country in droves because the safety of their own lives is not guaranteed, as the Ebola outbreak proved. Furthermore, as experts in the field, they understand better the danger of just being a resident of this country. We need to take greater responsibility for our own healthcare. Government must commit to the health sector like never before and desist from concentrating on maintaining unsustainable infrastructural development without commensurate human development.
The population surge also needs to be contained. Rash measures like bans and the like are not advisable, but the populace must be educated about maintaining and managing our resources by keeping our numbers reasonable. There is no merit in Nigeria being Africa’s most populous country without being able to feed her young and vulnerable or guarantee a good life for the people. The ultra-politicisation of Nigerian life and the Nigerian experience is having devastating effects on healthcare that may become almost irreversible if things continue the way they are going. The quality of life is the ultimate rubric of success, but as a country, Nigeria is pitiably unsuccessful. Therefore, the time has come for a reappraisal of our priorities.
