The Covid-19 virus epidemic has brought to the fore, the decay in Nigeria’s health sector. The Corona Virus epidemic started with the advanced economies of the world. This made it impossible for these countries to admit patients from other countries, because of the enormous medical challenges and the high rate of deaths in their hands as a result of the coronavirus pandemic. This reality exposed the rots in the healthcare infrastructures, alongside the obsolete medical types of equipment that abounds in most Nigerian hospitals, without overlooking the prevalence of lack of medicines too. This situation compelled the rich and those in the helm of affairs, who frequent foreign countries for their medical treatment, to seek their medical remedies In Nigeria. The Covid-19 also exposed the unfortunate situation the average Nigerian citizen is faced with, wherein little or no attention has been paid to the health of the citizens by successive governments, which happens to be the prerogative of the masses.
The Healthcare system in Nigeria is increasingly complex, and for the past few years has been facing a lot of challenges. The World Health Organization (WHO) in 2007 rolled out a framework that describes healthcare systems in terms of six core components or “building blocks”: i) service delivery; ii) healthcare workforce; iii) healthcare information systems; iv) medicines and technologies; v) financing; and vi) leadership/governance. The health care system in Nigeria has remained under recurring pressure, with the most pressing issues as:
1. Poor leadership and management challenges
Leadership challenges in healthcare revealed that one of the underlying reasons for poor leadership stems from the health managers’ unfamiliarity with leadership techniques. In many cases, it is due to managers’ disbelief in the effectiveness and necessity of learning these techniques. Other leadership and management challenges include lack of political will, corruption in healthcare systems, poor resource management/inefficiencies and poor integration of healthcare programmes. The implications of these are that poor leadership has led to increased healthcare costs, reduced efficiency and effectiveness, dissatisfaction among staff and ultimately resulting in lower patient satisfaction and poor health outcomes.
These challenges can be overcome by implementing leadership and management training as a mandatory requirement for leaders in the healthcare sector. The concept of ‘collaborative governance,’ in which non-health actors and health actors work together, is pivotal to the success of health systems and service delivery meeting changing expectations and new priorities. Appropriate leadership can create an organizational culture that is committed to quality, reducing conflicts, improving efficiency and productivity of teams, enhancing staff satisfaction, advancing healthcare system performance, and finally, meeting personal and organizational goals.
2. Inadequate human resources for health
This stems from an inadequate graduate from training institutions; a brain drain to Europe, America and Asia; and unfavourable government policies for employment into the civil services. There is also healthcare workers strikes emanating from the government inability to implement agreed policies, and programs with different healthcare organisations leading to the deprivation of healthcare services delivery to those that needed it most. Every component of the healthcare system depends on the people who manage and provide the services. Healthcare provision depends very much on the people who provide the services to clients. Yet over the years, attention and support to the healthcare workforce have not received the priority it deserves.
These have implications at all level beginning with households especially those who are poor and those who live in rural areas and who may have limited access to quality healthcare. This may be due to the lack of qualified health personnel in health facilities leading to poor health outcomes and ultimately impede the achievement of national and global health goals.
Also, healthcare systems may not be able to respond to public health emergencies such as the outbreak of diseases leading to increase mortality and morbidity in Nigeria.
The major solutions proffered to this key challenge centres on investment in capacity building/training of healthcare workers. This should be made mandatory beginning from healthcare training institutions and a regular refresher course for all healthcare workers should also be included. This may in itself address this challenge to some extent. Active recruitment and better remuneration of healthcare workers influence, to a large extent, the retention of healthcare workers.
3. Low budgetary allocation to the healthcare sector
In the last few years the budgetary allocation fall between 5% – 6% of Nigeria’s annual budgetary allocation, especially in the face of the ongoing economic downturn. The allocation to the health sector has continuously been low despite several declarations signed by African heads of state. Which among others include the Abuja Declaration of 2001 where Nigeria and 21 other African nations pledged to commit 15% of their federal budget towards increasing government funding for health needs, and the 2012 Tunis Declaration on value for money, sustainability and accountability in the health sector. Inadequate financing of healthcare by the government leaves the burden for healthcare financing on households. Many households are unable to keep up with rising healthcare costs especially in the face of the ongoing economic downturn. Others are inadequate healthcare infrastructure which led to medical tourism. According to Abubakar and colleagues, over 5000 people leave Nigeria every month for various forms of treatment abroad and about 1.2 billion US dollars are lost from the Nigerian economy to medical tourism yearly. Limited access to healthcare services is made difficult as a result of financial barriers with high rates of out-of-pocket expenditure, owing to ineffective national health insurance systems, weak healthcare systems, poor integration of healthcare programmes and professional rivalry.
The proffered solutions include increase budgetary allocation to the health sector. Budgetary allocation increase may in itself be dependent on prevailing economic situations and other underlying factors, which again accounts for the complexity of this challenge. Therefore, the government should collaborate with the private sector through public-private partnerships and encourage the private sectors to enrol their staff, their families and the communities in which they work in health insurance schemes. The government should enact legislation to compel large multinationals through corporate social responsibility schemes to give back to communities where they extract raw materials and other resources. Advocacy for political support and commitment, adequate health insurance scheme for all and upgrading of healthcare infrastructure should be intensified.
References
1. Abubakar M, Basiru S, Oluyemi J, et al. Medical tourism in Nigeria: challenges and remedies to health care system development. Int J Dev Manage Rev. 2018;13(1).
2. Oleribe OO, Momoh J, Uzochukwu BSC, Udofia D, Oladipo O, Ishola TA, Taylor-Robinson SD, Mbofana F, Adebiyi A, Barbera T, Williams R, Taylor-Robinson SD. Identifying key challenges facing healthcare systems in Africa and potential solutions. International Journal of General Medicine 2019:12 395–403
3. Figueroa, C.A., Harrison, R., Chauhan, A. et al. Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Serv Res 19, 239 (2019). https://doi.org/10.1186/ s12913 -019-4080-7
