Nigeria: RX for Nigeria

Source: http://allafrica.com/stories/201401060365.html?viewall=1

Nigeria narrowly missed starting 2014 in crisis after government officials met with doctors' union last week to avert full-blown strike by doctors.

The strike, earlier planned to start today, may have been averted, but issues that led the country down that road are still present.

Though some of those issues get attention, here's a to-do list for health in 2014.

Political commitment

Analysts suggest political will to improve healthcare is poor because commitment is weak. Federal, state and local governments allocate measly funds to health, and release of such funds is inadequate, they argue.

What best depicts low political commitment is the "frequent travels abroad to seek medical care" by political and public office holders, says Nigerian Medical Association.

Money, money, money

Despite calls and urgings, health spending still falls below 15% of national budget stipulated by signatories--including Nigeria--of the Abuja Declaration of African Heads of State.

Health unions complain spending for 2014 is even less than what health got last year.

Security

Demand came last year for improved security for health workers, including police posts on the premises of hospitals, after some 13 immunisation officials on vaccination duty were shot dead in Kano and doctors assaulted by police in Bama, Borno.

Deficits.

Deficiencies in equipment and infrastructure continue to be a thorny issue, despite millions of naira spent to put them right. Doctors highlighted the deficits in an ultimatum last September. In response, the federal government promises fast action in a special fund to intervene in upgrade and facilities.

Framework.

Experts think the National Health Bill might rest some of the uncertainties, but the bill itself has been beset with controversies until now. Just how health is supposed to run in Nigeria is still debatable. Nigerians know what to expect from different levels of government, but almost cannot hold any--or even health professionals--accountable.

The bill, for instance, mandates states to have individual primary healthcare boards, allowing them to access health-development funds. So far, only 27 states have a board. Both National Assembly and House of Representatives have indicated they could pass the bill this year.

The hands that work

Human resource is big issue. What Nigeria has as healthworkers is grossly inadequate for its population, and whats available is poorly distributed. For instance, it could take 80 years for the number of doctors to become adequate to the population, according to a survey of health workforce last year.

Plans to develop human resource are poor in recruitment, building capacity and defining roles, says Dr Osahon Enabulele, president of Nigerian Medical Association. Job descriptions are blunted, wages are uncompetitive, working conditions are unsatisfactory and motivation is poor, he adds.

By virtue of these alone, Nigeria continues to lose thousands of health workers in a steady annual migration to countries as the US, the UK.

At least N246.8 million could go to support nursing services and midwifery scheme this year.

Somebody save me

Universal health coverage is still in bits. The biggest group with coverage is federal civil servants. State civil services are inching toward it and A national hope is to ensure at least 30% of Nigerians get some form of health cover in the next three years, but so far only eight in 100 Nigerians have any cover.

Health minister Onyebuchi Chukwu has suggested the National Health Insurance Scheme might need to adopt "aggressive marketing" to push its products, which now include community-based insurance targeting lower income groups.

Quacks and fakes

Negligence in medicine is one thing, but dealing with quacks is another. Professional regulatory bodies talk of tightening procedures, but they also request Nigerians to make informed choices and be sharp about what health professionals they visit.

If you are in doubt, demand a second opinion, goes the mantra. In other words, you cannot anymore decide your doctor's words are final. Analysts suggest most fakes are outed when patients question decisions. After all, it is your life.

Doctors have recently called for a stop on "unbridled and indiscriminate" advertisement of herbal and medicinal products on television, radio and in newspapers as well as illegal prescriptions by persons outside licensed doctors, dentists or vets.

Their jobs are regulated by professional bodies, but recently there has been a surge in the number of regulatory agencies.

Referral system

You don't expect your doctor can work magic when you are will. How he is able to move you on to a specialist when he can't handle your situation anymore depends on the strength of the referral system.

But experts say the system is weak, as is the impact of the government on health care delivery.

Managing data

Imagine a story about health without relevance. It is almost impossible, but data about health in Nigeria leave much room for improvement, according to analysts.

The National Demographic Health Survey is the health bible for Nigeria. The last survey in 2008 is expected to give way for the 2013 version-- which is still being compiled and could suck more than N55 million in this year's budget.

A management information system for health is also in the works, alongside policies to implement e-health (costing N80m in the budget).