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NIGERIA | When Politicians Are Not Talking Health

Winifred Ogbebo and Victor Okeke

Given the kind of attention accorded it and its often poor budgetary allocation, it can be said that health has not really been given a pride of place in the country. Even in this current electioneering by political parties, the situation is not any different. WINIFRED OGBEBO and VICTOR OKEKE, in this report, analyse the healthcare delivery agenda of the two prominent political parties in the country.

Barely two weeks to the presidential election in the country, none of the two major political parties has said much concerning its plan for improved healthcare delivery. Addressing journalists during a press briefing recently in Abuja, the president of the Nigerian Medical Association (NMA), Dr. Kayode Obembe, said doctors had closely watched with mixed feelings, the campaigns and documentaries by political parties listing their achievements, manifestoes and promises in the months since campaigns took off, with not a mention of health.

He said, “It is very disturbing to note that there have not been any precise and articulate pronouncements about the challenges confronting the health sector and how to tackle them.”

A health sector-focussed consulting group working to improve population health through expert research and data analytics, EpiAFRIC, evaluated the two major political parties, All Progressives Congress (APC) and the People’s Democratic Party (PDP) and made its submission.

The organization said “while the APC, in its manifesto, has a section on healthcare, it is unclear

why they have chosen the term “healthcare” rather than the broader term “health” and the PDP which has a section on health also says it will formulate a policy on “healthcare”.

Speaking on the appalling health statistics characterizing the nation’s health, Obembe said:

“Nigeria has the second highest maternal mortality ratio in the world, 454 deaths per 100,000 live births. Every day, 800 women die during pregnancy or childbirth, while 8,000 new born babies die during their first month of life.

“Life expectancy at birth is 53 years in male, 54 years in female, and (Nigeria) ranks 181 out of 198 countries of the world. Infant mortality rate is 88 deaths per 1,000 live births, and child mortality is 143 deaths per 1,000 live births, highest in Africa and 2nd highest in the world.

“The most important reason for this trend is lack of access, especially financial access to healthcare. Unfortunately, Nigeria cannot achieve Universal Health Coverage (UHC) through taxation because of poverty, 60.9 percen live in abject poverty.

“Nigeria’s healthcare expenditure per head is N67 compared with United States’ $7,000 or Switzerland’s $6000 per head,” the NMA president stated.

Within the healthcare section of its manifesto, the APC says it will: Prioritize the reduction of the infant mortality rate by 2019 to 3 percent; reduce maternal mortality by more than 70 percent; reduce HIV/AIDs infection rate by 50 percent and other infectious diseases by 75 percent; improve life expectancy by additional 10 years on average through our national healthy living programme; increase the number of physicians from 19 per 1000 population to 50 per 1000; increase national health expenditure per person per annum to about N50,000 (from less than N10,000 currently); increase the quality of all federal government-owned hospitals toward class standard within five years; invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programmes with the private sector; provide free ante-natal care for pregnant women, free health care for babies and children up to school going age and for the aged and free treatment for those afflicted with infectious diseases such as tuberculosis and HIV/AIDS; boost the local manufacture of pharmaceuticals and make non adulterated drugs readily available.

While the non-profit organization commended APC for actually publishing some measurable targets and timelines, it questioned the commitment of the party towards achieving the target.

“For instance, the reduction in maternal mortality rate in the best performing country in the world between 1990 and 2013 was in Belarus which had a reduction of 13 percent. An ambition to reduce Nigeria’s very high maternal mortality rate by 70 percent raises questions of feasibility, especially when one looks at past figures, which show an average annual reduction of 3.3 percent in Nigeria,” it said.

On reducing infant mortality to 3 percent by 2019, EpiAFRIC noted that the trend in infant mortality in Nigeria between 2010 and 2013 as well as the global trend suggested that the APC target was very ambitious.

“It is unclear where the party gets its estimate of 19 physicians per 1,000 population as the World Bank estimate of physicians per population in Nigeria as at 2010 was 0.4 per 1,000. Even if the APC’s estimates were right, their target suggests that they would facilitate the training of over three million additional doctors in Nigeria in four years, which is impossible.”

“The second section of the manifesto unfortunately has no measurable indicators, and so it is impossible for us to assess objectively,” the organisation further stated.

The PDP’s section on health says that the party shall present a comprehensive health-care policy for the country, the essential aim of which shall be: health-care for all citizens; free medical services in all institutions of learning; and free medical services to the aged and the handicapped. As its strategy, it says that PDP in government shall ensure that all Nigerians, particularly the young and the aged, shall have access to free medical services; provide free immunization to all children; progressively establish primary health centre, equipped with pharmacies, within the reach of every Nigerian, particularly the rural dwellers.

The PDP said it would progressively provide general hospitals in all local government headquarters; specialist hospitals in all state capitals; encourage research into traditional medical practices and integrate these practices into the orthodox medical system; equip and expand the teaching hospitals in the country; embark on mass training of paramedical personnel to meet the needs of our rural populace; and encourage more students to train as medical doctors among many other things.

Like APC, EpiAFRIC summarized that the PDP manifesto on health has no measurable targets or timelines, which cannot be assessed objectively. Generally speaking, both main parties promise to raise the number of medical doctors, provide free healthcare for children and the elderly, improve the quality of government/teaching hospitals, fight fake and adulterated drugs and boost the local pharmaceutical industry. In addition, the APC wants to improve maternal and child health, invest in cutting-edge technology and reduce the prevalence of infectious diseases, while the PDP aims to achieve universal healthcare, offer free medical services in all institutes of learning and free healthcare for the handicapped, improve the quality of private hospitals, promote environmental sanitation exercises, offer free family planning, increase medical personnel especially in rural areas.

Both manifestoes are not comprehensive and lack concrete details. The new, and potentially groundbreaking National Health Act signed into law in December is not mentioned by either party, nor is there any meaningful recognition of the wider determinants of health or mention of issues like tobacco control or road traffic accidents. Universal health care, which is an increasing area of global focus, only received a cursory mention in the PDP manifesto and no mention in the APC manifesto, noted EpiAFRIC.

“On the private sector, which provides a significant proportion of healthcare in Nigeria, the APC only says that it will invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programmes with the private sector; but it does not have much to say about ensuring quality. The PDP on the other hand highlights the need to regulate private hospitals, medical clinics, and pharmacies to protect Nigerians against “exploitations”, but does not examine any other ways of improving quality and does not mention driving innovation in the private health sector.”

But the time frames within which these goals will be achieved are mostly absent. In addition, the means to achieve these goals are not always explained, e.g. the APC simply states that it wants to increase the number of medical doctors. The PDP on the other hand promises to encourage students and provide special incentive for medical personnel, but it is still unclear what kinds of encouragement and incentives will be used. Neither manifesto explains how these goals will be financed.

On the whole, the non-profit organization observed that rapid analysis suggested that neither party understood or took the issue of the health of Nigerians as seriously as they should, saying, “Perhaps it is all down to a failure of communication. For instance, the PDP fails to say anything about its record on health in the last 16 years. Whatever the reason for the shoddy manifestoes on health, we will all need to keep challenging our politicians more to ensure that health does not take the back seat, especially at a time of economic difficulty”.

The NMA president, Obembe, said among issues the health community expected to be part of campaigns was the universal health coverage and per head health spending, which he noted were still lagging behind figures in countries with programmes comparable to the National Health Insurance Scheme (NHIS).

“The reason for the stagnation is clearly due to the reluctance of state governors and local government chairmen to embrace the scheme because of the counterpart funding they need to provide in order to access the fund,” said he.

The association said political authorities showed little regard for the community-based health insurance which could help poorer Nigerians get basic health cover.

“When politicians and their political parties describe themselves as grassroots-based, it leaves one to wonder then if the true meaning of that coinage is not lost on the premise of political razzmatazz,” Obembe noted.

PUBLISHED: Mar 15, 2015. By Winifred Ogbebo and Victor Okeke
Copyright © 2015 Leadership Newspaper

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