SIR: In the build-up to the now-historic 2015 general elections, President Muhammadu Buhari, who was running against the then-incumbent president, promised to end medical tourism for government officials. Contrary to that promise, Buhari has gone to the United Kingdom on a sixth trip since assuming power.
The sixth trip coincided with a general strike by a doctors’ union in the country. The National Association of Resident Doctors (NARD) downed tools to protest poor remuneration and unfavourable conditions of service. The Nigerian healthcare system has been in a state of disrepair for decades, leading to the late General Sani Abacha, a former head of state, quipping in 1984 that Nigeria’s hospitals are mere consulting clinics.
Health care facilities across the country are neglected, and the poor bear the brunt by having no choice but to patronise the decrepit, ill-equipped and underfunded healthcare centres. What is not recognised is that the government’s negligence violates a fundamental right to accessible health care.
In a half-hearted bid to make healthcare available to all and sundry, former president, Dr. Goodluck Jonathan in 2014, enacted Nigeria’s National Health Act (NHAct) which prescribes a legal structure for the regulation, development, and management of Nigeria’s health system. With inclusive Universal Health Coverage, everybody can get quality health services whenever they need them, without suffering costing an arm. Sadly, the laudable act has been abandoned.
The Basic Health Care Fund (BHCPF), an offshoot of NHAct, is meant to substantially increase revenue allocated to improving Primary Health Care, with a sustainable mechanism of removing financial barriers to accessing primary healthcare. BHCPF comes from not less than one per cent Consolidated Revenue Fund (CRF) and contributions from donor grants.
If put in place, the BHCPF will increase access to healthcare for the poor. Sadly, the 2018 Health access quality index rated Nigeria in the lowest rung of health indicators. Nigeria is ranked 187 out of 195 countries, despite the government earmarking N55 billion for BHCPF in 2018.
In 2021, only 4.526 per cent (N592.166 billion) of the proposed N13.082 trillion of the budget has been allocated to the health sector, the bulk of which goes into recurrent expenditure. This proposal means that most of the money would go into the system’s administration and not improve it. Especially when Nigeria battles Covid-19 pandemic, this is a far cry from the 15% of annual budget set by African Union countries.
Besides, Section 3(4) of the NHAct, appears ambiguous. It states that: “… all Nigerians shall be entitled to a guaranteed minimum package of services.” The federal government should spell out the minimum package in clear terms. If the NHAct is fully implemented and operationalised, it promises to protect Nigerians’ right to health.
The government can also leverage on Public-Private Partnerships (PPPs), a long-term contract with risk-sharing to expand access to quality healthcare delivery, especially in remote areas.
For instance, the PPP between the Abbott Fund and the Government of Tanzania greatly assisted in modernising facilities, training staff, improving hospital, patient management, and HIV/AIDS testing and treatment at over 90 hospitals and rural health clinics across Tanzania. So far, Abbott Fund has invested more than US$50 million.
In Nigeria, the feat can be replicated. A coalition of public and private partners can collaborate on primary health facilities, medicine, diagnostic centres, treatment, research, among others.