Nigerian Health Budget 2016: Let The Basics Inform The Basis Of Our Bases By Abdullahi Baba Abdul
Recently, the media was preoccupied with copious analysis of how defective this year’s budget on health reared; the Nigeria Medical Association through its President and Secretary General made a paid advertorial drawing the attention of relevant government bodies and Nigerians at large to rise to the occasion by mediating a possible appropriation of the missing funds. While it is instructive to commend the NMA leadership for its responsiveness to duty, some other school of thought may have it this way; lets us do the basics to form our basis for the bases; after all as complex as the rocket science, it blossomed on the basic principles of Newton’s law of action and reaction. An American ace actor Eddy Murphy would say; “He who wants to fly must learn how to stand and walk”. In Nigeria today, the Primary Health care, a health care in which every other health care sprang from is far from what it is meant to achieve. Let us look into the Alma Ata declaration of 1978 as it defines Primary Health Care;
“An essential Health Care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community, through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development, in the spirit of self reliance and self determination”.
To this, eight areas were initially identified as key; they are, health education, immunization against childhood killer diseases, nutrition/ food supply, water and environmental sanitation, maternal and child health, provision of essential drugs, treatment of minor ailments and prevention and control of locally endemic disease, and recently the dental, mental health imperatives. This definition is simple, unambiguous that policies, strategies for program designs and implementation should speak to it. Juxtaposing this definition with the reality; It is no longer hearsay that primary health care is not accessible to individuals and families in our communities today; it is rather an Irony that despite the increase in the number of health facilities across Nigeria courtesy of the SURE-P and MDGs interventions, the facilities are built without recourse to the human resource for health need of the communities. In most cases health facilities are manned by one or two trained personnel who often cannot cope with the need of the community; in some instances the facilities are manned by non- clinically oriented health officers. Also, in the light of the community participation, communities in Nigeria are rather coerced to accepting and implementing a health intervention brought to them by donors or the government without the community active participation or input in the planning and implementation of any of the interventions; micro-planning starts and end in the comfort zones of the partners and government officials at the Federal or at best the state level; typical are Polio Immunization, breastfeeding and maternal and child health week etc; situations abound where community health practitioners and community leaders are called upon only to be given a matching order on programs they have little or no knowledge of its deliverables. Over the years, activities such as the recruitment of Consultants to facilitate or conduct facility assessment, community diagnosis, formation of village and ward health committees and recruitment of village health workers were done by the “ Ogas at the top” thereby imposing individuals who have little or no insight on the socio-cultural settings of the community they are visiting. Health Education is at its lowest ebb, one does not need to be reminded of how brief and poor the quality of time usually spent with health care providers. It is not uncommon to hear patients complain of receiving prescriptions from a health care provider even before his/her complaint are taken; Immunization program experiences vaccine out of stock while only donor/Partners supported immunization such as polio immunization interest the government officials for evaluation and action. Nutrition services are not available even in the face of overwhelming evidence of severe malnutrition in children less than five in Nigeria. It is shocking that about 50% of mortality in children less than five years are casually than casually related to malnutrition; gone are the days when sanitary inspectors were respected for their incorruptible stance and posture; now issues of water and environmental health sanitation are left to the whims and dictates of the international donors while the National Health Insurance Scheme policy of excludes contraceptive/ family planning services in its basic package in contradiction to the basic tenet of provision of maternal and child health services. Delivery kits that are believed to be available for mothers are a mere mirage; more worrisome is the fact that these kits are left in the ware houses while they rot away. The pharmacy store and drug warehouses are more of a silo for the officers in charge than an area for Pharmacovigilance and pharmacy best practices. It is at best an extension of the Private vendors and medicine sellers’ store. One would not know how bad it is until one has a cause to visit this centers as a result of minor ailment that requires as simple as a suture bite( to apposed an ulceration) or some gulp of daily shots of antibiotic (for a flu) that it will done on one that our primary health facilities are not poised to address the out of Stock syndrome that has since been identified as an impediment to making our primary health care truly basic; this is in addition to inadequate capacity to mount a viable surveillance to prevent and control our locally endemic diseases. In Nigeria, the Primary Health Care centers are orphaned; no government is ready to own it, the Local government would claim budget not trickling down, while the State government are in perpetual denial that the running of the Primary Health care is not within its purview. It is quite unfortunate that the government at the top closes its eyes, spend some of the funds meant for the PHCs without any recourse to give it a sense of parenthood; this spillover effect become evident in our secondary health facilities; that is our General Hospitals. These hospitals are exclusively run by the States government. They are meant to serve as a referral hub for the Primary Health Care centers but unfortunately they are overwhelmed with basic services such as immunization, Ante-Natal care with the States government penchant to pitch the native Doctors against their expatriate counterpart by offering them lesser wage and poor welfare packages for the same role and responsibility; regrettably this was never deemed an issue by the Job racketeers. This level of cluelessness is seen at the tertiary level; apart from the States “Specialist Hospital” that are seldom called tertiary health centers, the Federal Medical Centers and the University Teaching Hospitals are referred as Tertiary. One would wonder, what is tertiary about these centers? Is it the Antenatal clinic, the Out Patient departments, Caesarian section, repairs of Appendix and Hernia at these centers? If that is all they do, then they are more of a glorified secondary center, with due respect. About sixty years into the discovery of Lassa fever in Borno State Nigeria, nobody saw it as embarrassing to have the diagnosis of Lassa fever transverse many of the states boundaries before making it. In the same light, the diagnoses of Multi-Drug Resistant tuberculosis that has lived with us for decades were a mirage until recently with the help of nongovernmental organizations and partners such as USAID etc. It is unfortunate that why in other climes super specialties have evolved; the orders of the day are organ transplant, advance cancer therapy, non invasive surgeries and interventional procedures. The sad story is the ease at which Medical Directors of some of this badly managed “tertiary centers” get a renewal of tenure in the face of overwhelming failure in performance.
Another area that impedes so much in the development of the Primary Health Care is the government’s (at all level) penchant for free funds and support from the International organizations; the resultant negative impact is that government officials misuse appropriated government funds in anticipation of counting it gains from the performance and impact from programs and services rendered by the donor agencies. As at today, Nigerian Primary Health Care is thriving mainly on support from the nongovernmental sectors of the economy despite the yearly budget appropriation in this regards. A serious government should have been wary of such antics in order to prevent being “Penny wise, Pound foolish”. Sometimes one wonders what those barrages of agencies under the health ministry actually do!
The thieving process peaked at ad-hoc functions; where an assemblage of supposedly professionals are charged with the responsibility of bringing emergency health services and succor to its citizenry in the event of eventuality, not even the faith bias medical missions differ, not to talk of the secular- appeal jamborees like the Ëbola, Lassa and God forbid the staring Zika virus palaver at hand.
These stories go on and on; however, now that there is a new “Sheriff in town”, what is needed is identifying not just corruption free individuals but corruption fighters with impeccable records of academic, epidemics and politics to man its various health departments and agencies. We can only get it right when these basics informed the basis of our bases (Budget).
Dr Abdullahi Baba Abdul is a Public Health Practitioner,
Lives in Bauchi, Nigeria
Can be reached on,