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Opinions of Tuesday, 4 May 2021

Columnist: Nkem Declan

Poverty and healthcare delivery in Nigeria

The impact of the present-day Nigerian economy on the health outcomes of her population is one that can be classified as potentially catastrophic. The so-called Giant of Africa (by population and natural resources) that has produced some of the best brains in healthcare, making waves in other countries, has unfortunately had a healthcare system that has suffered severe neglect.

According to the United States Agency for International Development, health indicators in Nigeria are some of the worst in Africa, and with a projected population spurt of over 440 million people by 2050, and rapid development challenges, the entire African continent stands a risk of a threatened socioeconomic enhancement.

In a 2019 “Poverty and Inequality in Nigeria” report by the National Bureau of Statistics, 40% of the total population of Nigeria, or almost 83 million people, live below the country’s poverty line of 137,430 naira ($381.75) per year. History has shown that this poverty level has since been on the increase. Poverty is a major obstacle to any population’s health. The American Academy of Physicians describes poverty as an insidious, self-perpetuating problem that affects generations of families through a group of complex mechanisms. Poverty affects education, learning abilities, risks for developing diseases, mortality and morbidity, ability to get and keep a job, and preventive health behaviours.

The traumatic effect of poverty can be deeply felt in so many areas of society, one of which is the rate of maternal and child mortalities. During my recent visit to a hospital in Nigeria, I encountered a failed attempt at resuscitating a baby born 12 hours prior, to a mother who could not afford to go to the hospital for antenatal care throughout her entire pregnancy. She was unknowingly diabetic and hypertensive, and her baby was macrosomic (very large). Due to lack of funds, she decided it was in her best interest to deliver at home. After several hours of labour, the baby, stuck in the birth canal, had aspirated an alarming amount of amniotic fluid. It was at that point that she was rushed to a nearby hospital where an emergency C-Section was carried out on her, and the baby brought out almost lifeless. A few hours later, the baby died from respiratory distress, and the woman died of post-surgical complications.

How can this be resolved?

Financial empowerment provides a better appreciation and implementation of preventive health practices, while avoiding behaviours that expose the individual to health risks. The Nigerian government has a major role to play in transforming the socio-economic standards, and consequently, the health condition of her people by expanding access to quality healthcare, providing and maintaining critical infrastructure that support healthy lifestyles, and designing poverty reduction strategies.

Considering the unavailability, and in some other cases, limited access to well-equipped healthcare facilities, it becomes crucial to adequately restructure and equip our community healthcare centres, provide well-trained personnel, making them a first point of call for preventive healthcare and the effective management of acute and chronic health conditions. A budget reappraisal must be effected towards the restructuring of our community health centres, and a revival of the already existing Community Based Health Insurance scheme which has only since covered a very limited number of households.

On a provider level, it is very important that adequate healthcare is made available to the patients, taking cognisance of their varied socio-economic circumstances, while planning and implementing a treatment plan that is attainable, effective and sustainable.

Strengthening our public health sector by ensuring that priority funding is provided to public health agencies is very crucial to improving health outcomes. This will also ensure the adequate preparedness, assessment and response to public health needs, such as the COVID 19 pandemic and periodic outbreaks of the same diseases such as malaria and typhoid fever.

It can be agreed that with over 40% of Nigeria’s population living below poverty level, there is a heightened threat to access to proper healthcare and the ability to pay for health services, out of pocket. A tangible number of Nigerians can barely afford a daily three square meal, making it near impossible to pay for healthcare services from their pockets. The government must urgently take adequate steps towards ending poverty, and scaling up effective efforts centred around available and affordable health coverage.

Despite the 10-year (1946–1956) health developmental plan, and a subsequent National Health Insurance Scheme launched by the Federal Government in 2005, healthcare delivery system in Nigeria has continued to regress speedily. The NHIS which is currently in existence, irrespective of their limited coverage, is a very brilliant and commendable initiative by the Federal Government aimed at reducing the cost of healthcare and providing efficient and equitable access to basic health services, devoid of regional bias. However, this scheme needs an improvement in the management and administration of health insurance to Nigerians who by virtue of their incomes are unable to pay for healthcare services, out of pocket.

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