Tuesday, July 23, 2024

ANALYSIS: Inadequate facilities, incessant strikes, other challenges before Nigeria's new health minister – Premium Times


Minister of Health and Social Welfare, Prof. Muhammad Ali Pate and Minster of State, Dr. Tunji Alausa, resume office.
Amidst cheers and optimism among key players in the health sector, Muhammad Pate on Monday officially assumed office as Nigeria’s Minister of Health and Social Welfare.
He will be assisted by another egghead and healthcare investor in the United States of America, Tunji Alausa, who is the Minister of State for Health and Social Welfare.
Mr Pate and his team face a substantial challenge in his fresh role, as Africa’s most populous nation continues to navigate the aftermath of the COVID-19 pandemic while contending with worrisome global health indices.
Mr Pate, a professor of Internal Medicine and Infectious Diseases, steps into his position with a second opportunity to significantly impact the nation’s healthcare system. When he served earlier as Nigeria’s minister of state for health, Mr Pate made a notable impression during his brief tenure.
He initiated a global coalition aimed at bolstering healthcare systems, even as he saw to the implementation of innovative programmes dedicated to addressing pressing concerns, notably the prevention of mother-to-child transmission of HIV.
Additionally, Mr Pate spearheaded a flagship initiative to rejuvenate routine vaccinations and primary healthcare and also chaired a presidential task force focused on eradicating polio while introducing new vaccines into the nation’s healthcare regimen.
Mr Pate’s past contributions while in office may have earned him recognition both far and near but the degeneration in the country’s health sector, coupled with the funding crisis may make the tasks before the new minister much more complex than he ever experienced.
Therefore, the road ahead holds numerous challenges that the new health minister must tackle early to comprehensively reshape the country’s health sector. Some of these issues are reflected in this piece.
One crucial aspect demanding the new minister’s attention is the funding of the healthcare sector.
Despite receiving its highest budget allocation ever in the 2023 fiscal year, it still fell below the commitment made by African heads of state in 2001.
This commitment, known as the ‘Abuja Declaration,’ was made under the African Union (AU), urging countries to allocate a minimum of 15 per cent of their annual budgets to the health sector.
While countries such as Rwanda and South Africa have fulfilled this commitment, Nigeria has yet to attain this goal. in the 22 years since the Abuja Declaration, Nigeria has never been close to meeting the 15 per cent target.
However, the allocation of over a trillion naira to the sector in the 2023 budget is a milestone. Still, Mr Pate needs to demand increased budget allocations by engaging governmental officials, lawmakers, and pertinent ministries on the need to invest in healthcare.
An exodus of healthcare professionals, particularly doctors, pharmacists, and nurses, to developed nations is a pressing concern in Nigeria’s health sector. Brain drain affects all sectors of the economy but the health system has, arguably, been the most affected, with Nigeria’s doctor-patient ratio worse than the recommendation by the World Health Organisation (WHO).
Hundreds of doctors leave the country every year, many of them for the United Kingdom. Statistics show that more than 5,000 Nigerian medical doctors have moved to the UK within the last eight years.
Data from the development Research and Project Centre (dRPC) shows that 233 Nigerian doctors moved to the UK in 2015, 279 in 2016, 475 in 2017, 852 in 2018, 1,347 in 2019, 833 in 2020, and 932 in 2021.
Mr Pate must confront the brain drain phenomenon in the health sector by addressing the underlying causes and creating a conducive environment for healthcare professionals to thrive domestically.

By implementing strategic measures to retain talent, offering attractive incentives, and enhancing working conditions, the minister can try to reverse this trend and safeguard the nation’s healthcare system.
A professor of Medical Microbiology, Folasade Ogunsola, said Nigerian specialists are moving to developed countries because they are not getting what they deserve in their own country.
Mrs Ogunsola, who is also the Vice-Chancellor of the University of Lagos (UNILAG), Akoka, said the poor state of government-owned hospitals is discouraging health workers from staying back.
“We need to put our hospitals in good shape at all levels so health workers have the capacity to practice their trade. We spend a lot of money on these specialists and many of them are really good but they are leaving. There has to be ways we can retain them.”
Recurring strikes by healthcare workers are a significant challenge that Mr Pate cannot ignore. Workers under different unions in the sector have gone on strikes for more than 180 days, including the recent one by the Nigerian Association of Resident Doctors (NARD).
The unions mostly involved are the Nigerian Medical Association (NMA) and the Joint Health Sector Unions (JOHESU), which often resorted to strikes to demand improvements in the working conditions, better welfare packages, increased hazard allowances, and the settlement of salary arrears of their members, among other concerns.
To address this recurring issue, Mr Pate and his team will need to adopt a proactive and holistic approach that prioritises dialogue with medical professionals. Furthermore, the minister should consider policy changes that address their key demands.
The President of NARD, Emeka Orji, said the new minister must prioritise the improvement of welfare for health workers. Mr Orji said poor welfare is one of the main reasons for the exodus of health workers.
“We want him to work on improving the welfare of health workers because this is the main cause of brain drain and other issues ravaging the sector. He needs to hasten the recruitment of health workers as many have left the country in search of greener pastures,” he said.
The UNILAG vice-chancellor also said improved welfare and good working conditions will stem industrial actions by health workers.
“It is not just about pay but the whole working condition where you feel satisfied. One of the most heartbreaking situations is when a doctor or health worker knows that if he has all the tools needed, he would have saved a life,” she said.

By focusing on open communication, conflict resolution, and collaboration, Mr Pate has the opportunity to mitigate the recurring strikes and cultivate a more stable and productive healthcare environment for both health workers and patients in the country.
Inadequate health facilities, outdated medical equipment, and the glaring disparities between urban and rural healthcare services are some of the issues that must be addressed.
The scarcity of healthcare facilities, particularly in rural and underserved areas, underscores the urgency of this challenge. These regions grapple with a dearth of health facilities, depriving residents of timely medical attention.
This also compels individuals to travel long distances to access basic healthcare, resulting in delayed interventions and compromised health outcomes.
The consequences are dire, as preventable conditions escalate into more severe medical emergencies due to the lack of accessible medical facilities. The new minister must, therefore, strategise and allocate resources to bridge this healthcare gap, ensuring that adequate facilities are established where they are most needed.
The availability of modern diagnostic tools, surgical instruments, and advanced medical technologies is also important for accurate diagnoses and treatment in health facilities.
By prioritising the expansion of healthcare facilities, modernisation of equipment, and eradication of urban-rural disparities, the minister has the opportunity to lay the groundwork for a healthcare system that truly serves its people.
Mr Orji, the NARD president, said infrastructural development and equipping health workers simultaneously is required to achieve a working health system.
The absence of sufficient data in the health sector is one aspect that can significantly impede Mr Pate’s ability to make informed decisions and formulate effective policies. Nigeria has often relied on foreign agencies to provide its data.
Without reliable data, accurately assessing health needs, allocating resources efficiently, and monitoring healthcare initiatives become challenging.
This can in turn lead to misdirected efforts, missed opportunities and reduced transparency in decision-making.
In essence, data deficiency undermines the minister’s capacity to address healthcare challenges strategically and achieve positive health outcomes for the population.
Mr Pate as the new health minister must cultivate the habit of building up-to-date data for the health sector.
The primary healthcare (PHC) system in Nigeria faces several challenges that impede the accessibility, quality, and effectiveness of healthcare services. Many PHCs lack proper infrastructure, equipment, and facilities. This hinders the delivery of quality healthcare services and affects the overall patient experience.
There is also a shortage of qualified healthcare workers, especially in rural and remote areas. This scarcity limits the availability of essential healthcare services, leading to inadequate coverage and longer wait times for patients.
Data obtained from the National Primary Health Care Development Agency (NPHCDA) indicates that only 463 (1.8 per cent) out of 25,843 PHCs in the country possess the required number of Skilled Birth Attendants (SBAs).
Health centres also struggle with limited funding and resources which leads to shortages of essential medicines, medical supplies, and equipment, hindering the provision of comprehensive care.
Addressing these challenges requires a comprehensive and coordinated approach that involves collaboration with various stakeholders, including healthcare professionals, communities, government agencies, and international partners. The new minister will play a pivotal role in driving the necessary reforms and initiatives to overcome these obstacles and revitalise the PHC system.
One such initiative is the Community-based Health Research, Innovative Training and Services Programme (CRISP) launched by the Nigerian government in May as part of efforts to bridge workforce gaps across PHCs in the country.
The Executive Director of NPHCDA, Faisal Shuaib, said CRISP aims to leverage the rural posting of resident doctors to support PHC development in partnership with Teaching Hospitals, Federal Medical Centres, State Primary Health Care Boards, Local Government Health Authorities, and communities.
Mr Shuaib said the intervention specifically focuses on increasing, retaining, and improving the quality, competency, and distribution of a committed PHC workforce, including facility outreach and community-based health workers.
“This will be achieved through effective management supervision, appropriate compensation, and the recruitment and deployment of Human Resources for Health, such as medical doctors, midwives, nurses, and Community Health Extension Workers (CHEWs), to prioritise PHC facilities nationwide,” he said.
Nigeria is one of the countries lagging behind in the pursuit of the Universal Health Coverage (UHC) by 2030 goal.
UHC aims to ensure that all individuals and communities have access to essential health services without suffering financial hardships. Nigeria, like many other countries, strives to achieve UHC to improve the health and well-being of its population.
However, several challenges including lack of access to health insurance, inequitable access, and poor healthcare infrastructure amongst others have continued to cause major setbacks in achieving this goal.
To also achieve UHC, Mr Pate must prioritise policy reforms, advocacy for increased funding, implementation of health insurance schemes, investment in healthcare infrastructure, health education campaigns, and initiatives to improve equity in access to healthcare services.
Successfully achieving UHC will not only improve health outcomes but also contribute to economic development and social well-being for the entire population.
Medical tourism has been estimated to cost Nigeria over N576 billion ($1.2 billion) yearly.
Speaking at a meeting to mark his assumption of office, Mr Pate said one of his major priorities is to reverse medical tourism.
“When you fly from Addis Ababa to New Delhi you see a lot of people going for medical tourism and it is not a thing we in the health sector should rest on our oars and regard as normal,” he said.
The UNILAG VC, Mrs Ogunsola, said if the country is to halt medical tourism, government officials must normalise patronising hospitals within the country.
“If we are to halt medical tourism, all of us in government need to use our health system, that is the only way it will help it grow and build the confidence of the people in the health care.”
She also said the health sector is extremely politicised and that it is important “we are very clear as a nation about how we want to run our healthcare system.”

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Nike Adebowale covers the health beat.  She holds a degree from Ekiti State University, Ado Ekiti. Twitter: @nikeadebowale1 

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