Healthcare Neglect in Nigeria Maybe a Population Control Strategy

Before anything, let us look at the statistics of healthcare in Nigeria. Various statistics  show that Nigeria has one of the worst health care delivery records in the world.

According to the World Health Organization (WHO), Nigeria is rated 187th out of 191 countries in terms of health care delivery. Nigeria has the 13th highest infant mortality rate and the 4th highest maternal death rate in the world.

WHO said one-third of more than 700 health facilities have been destroyed in the country and about 3.7 million people are in need of health assistance.

How did the country get here? The country got to this situation as a result of past and present Nigerian governments’ deliberate and consistent relegation of the healthcare sector to the bottom of National economics plans.

In 2014, Nigeria ranked 45 out of 53 African countries, in health spending. The data for health spending as a share of GDP showed that in 2014, Nigeria (at 3.7%) outperformed only Angola (3.3%) and South Sudan (2.7%), but lagged behind Ethiopia (4.9%). Nigeria’s total health expenditure is only higher than that of these countries because health spending in the country is about 75% private, and most of that is out of pockets of individuals. Of the 3.7% of GDP that Nigeria spent on health in 2014, only 0.9% of fund came from the government. On this measure, Nigeria dropped to 52nd position out of 53 countries, even below South Sudan.

Despite these horrific statistics, Nigerian government has not blinked or done anything differently.

Nigeria hosted the Heads of State of member countries of the African Union (AU) in 2001 who made the “Abuja Declaration” under which the leaders pledged to commit at least 15% of their annual budgets to improving their health sector.

In July 2013, Nigeria again hosted over 50 African Heads of State in a special summit that was tagged ‘The Abuja +12 meeting”, which reviewed the progress made on the promise of the Abuja Declaration on health funding.

Yet in the 2018 Budget proposal President Muhammadu Buhari presented on Tuesday to the National Assembly, he allocated N340.45 billion, representing 3.9 % of the N8.6 trillion expenditure plan to the health sector.

The allocation is less than the 4.16% and 4.23%  made to the health sector by the same administration in the 2017 and 2016 budgets.

Details of the budget proposal revealed that health came 12th as Power, Works and Housing got the highest capital project proposal with N555.88 billion, almost 8 times that of health.

Despite the alarming death rate in the country and after signing an agreement 16 years ago to increase healthcare spending in the country to 15%, the Nigerian government still religiously and consistently budget less and less money to the health care sector with the highest in 2012 at 5.95% of the budget.

Since the Budget is a national plan which are deliberated before passing it into law, all these may be a secret population control strategy by the government as the federal government has severally declared the nation’s growth rate as unsustainable.

Population growth rate in Nigeria is 2.6% and its population is estimated to be 450 million by 2050. The country’s Minister of State for Budget and National Planning, Mrs. Zaina Ahmed, said that the federal government has identified the high population growth rate as a risk factor, while preparing the Economic Recovery and Growth Plan (ERGP) in 2017.

Government concern over the years has not resulted to any population control policy or law of any sort: Abortion is still illegal (that may never change because Nigerians are very religious); There is no child-bearing limit; there is no national birth control campaign. Nigeria adopted such a population reduction policy in 1988. It was met with predictable scepticism and condemnation. Nigerian society is a very delicate and complex one.

Specifically, the 1988 policy seeks to reduce fertility from the present level of 6 children/family to an average of 4 children/family, suggests an optimum marriage age of 18 years for women and 24 years for men, and advocates that pregnancies be restricted to the 18-35-year range and at intervals of 2 years. This was later abandoned.

This approach will be a political suicide for any politician who dares to make such a policy today. Comparably under-funding healthcare will hurt their political aspirations less and barely affect their families who have access to foreign healthcare.

If this doesn’t explain the situation, how then do we explain a government’s indifference toward its country’s terribly alarming death rate and low life expectancy.

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Why African Countries should Learn from Cuban Healthcare System

Tanya Rosa de la Cuevas Hill is a specialist in comprehensive medicine and she runs a neighborhood clinic in Old Havana in Cuba. Along with her nurse, she looks after 334 families who live in the surrounding streets.

“Being a family doctor, I love it,” she says. “The first mission we have is to prevent illness. That’s the wonderful thing about my job. Prevention of diseases, prevention of accidents, that’s what I like best”.

Cuban healthcare system is one of the best in the world. This developing country is the world champion of Preventive Medicine and has become a world-class medical powerhouse. The country has a record unmatched in dealing with chronic and infectious diseases with amazingly limited resources. Cubans hardly die of infectious diseases because of a hugely successful vaccination program, so people live longer.

Cuban healthcare system which can be traced back to the 1960s with the creation of the Rural Medical Service which enlisted 750 doctors committed to revitalizing healthcare networks for the poor and those far from urban centers, is strongly and effectively focused on preventative, primary and community healthcare. The country also combines western medicine with traditional medicine.

Cuban healthcare system developed from more than 50 years of economic sanctions and embargo by the United State. During this period, Cuba was not allowed access to trade, technology, new research findings, modern equipment or foreign drugs. The embargo held down the economy of the country and government spending. This forced Cubans to look inward to develop a local, cheap but very effective health system using available resource.

Prevention is Better than Cure

Rather than spending money (which they don’t have) and energy fighting diseases and problems with expensive clinical services once someone is already sick, they came up with a cheaper approach by designing a mechanism for defeating the cause of disease and treating it fundamentally before it becomes complex.

They built a system that is based on cheap preventive techniques and focused on nutrition, hygiene, vaccination, traditional cultures, western, natural and alternative medicine. This is in direct contrast to western system. Western system focuses on curative medicine, uses costly diagnostic and treatment techniques as the first approach and is contemptuous of natural and alternative approaches.

Unlike western system, Cuban system is not a one-size-fits-all but rather offer locally-tailored solutions that are based on the needs of the communities served, as such Cuban medical schools remain steadily focused on primary healthcare, with family medicine required as the first residency for all physicians. Doctors are mandated to live in the community they serve.

One of the pillars of Cuban healthcare system is vaccination. Vaccination rates in Cuba are among the highest in the world. Cuba has eradicated diseases that include (with date eradicated): polio (1962), malaria (1967), neonatal tetanus (1972), diphtheria (1979), congenital rubella syndrome (1989), post-mumps meningitis (1989), measles (1993), rubella (1995) and TB meningitis (1997).

As a result of the strict economic embargo, Cuba developed its own pharmaceutical industry and now not only manufactures most of the medications in its basic pharmacopoeia, but also fuels an export industry.

Resources have been invested in developing biotechnology expertise to become competitive with advanced countries. Cuban biochemists have produced a number of new alternative medicines.

Unlike western countries Cuba invest on prevention-focused researches instead of disease-focused researches and in 2005 became the first country to eliminate the transfusion of HIV from mother to child – a huge achievement in preventive medicine.

Another aspect of Cuban health system is its health education programs. Health education is a major and mandatory part school curriculum. Children begin studying the multiple uses of medicinal plants in primary school, learning to grow and tend their own plots of aloechamomile, and mint, and later they conduct scientific studies about their uses. Radio and Television programs instruct people on how to relieve common stomach upset and headaches by pressing key points.

Cuba Healthcare System Vs Western Healthcare System

Despite limited resources and economic constrains, Cuban healthcare system is not only effective medically but economically efficient. For instance, despite spending $817 on healthcare per capita in 2014, which is less than world average ($1,059), the amount spent by the United States ($9,403), Canada ($5,719) and Europe ($4,135 ) respectively in that same year, Cuba remarkable Life-Expectancy (76-81 years) is on par with the United States and Europe and Infant Mortality rates (5 per 1000 birth) is lower than that of the U.S. and on par or lower than many developed nations.

“At the same time when New York City (roughly the same population as Cuba) had 43,000 cases of AIDS, Cuba had only 200 AIDS patients.”

Taken together, these factors together lead the World Health Organization to call Cuba’s approach a model to be repeated and mimicked by other low-income countries to create highly-effective healthcare systems despite limited resources.

African Countries Can Learn from Cuba

Currently, no African country spends up to what Cuba spends on health per capita. In 2014, Sub-Sahara Africa spent an average of $98 per capita. The highest amount spent in the continent is $570 by South Africa. With such meagre spending African countries should focus on cheaper and effective medicine. They should copy the Cuban healthcare system and modify it to fit their social and political system.

Africans societies are largely communal as such African governments should adopt community medicine and encourage the practice of family medicine. This will make it easier to merge traditional and western medicine for cheap and effective healthcare delivery. Medical students should be made to study the traditional diagnosis and treatments methods of local medicine men in their communities.

The continent will should focus more on preventive medicine, which has been proved to be cheaper than curative medicine. African government should make immunization compulsory for every child as vaccination is part of preventive medicine Cuba used to eradicate many chronic and infectious diseases.

There should be more state-sponsored awareness on immunization, good hygiene, nutrition and first aid treatments. Adopting the system may require a modification the country’s educational system and requires increased investment in literacy and health education. it should be noted that Cuba’s high literacy and education rates (99.7%) helped to promote and support the national priority on medical care especially for children.

Adopting the healthcare system will require African governments to focus on training more family doctors, and other professionals e.g. public and community healthcare professionals. They will also be required to focus more on health education and improve the use of vaccines instead of  expensive diagnostic and treatment methods which they can barely afford.

Nigerian Education System is Hindering Development

For a long time Nigerian education system has been declining. Teaching methods and curricula are obsolete and less effective. Teaching environment are unconducive for learning. Teachers are poorly trained and paid. The government now uses National Youth Service Corp member (irrespective of academic training) as teachers in Secondary schools.

Excursions, debates, science projects, craft making, music, painting, games and sports etc. are not included in public primary schools core activities anymore. Secondary school students are not properly educated due to bad education policies and infrastructure. For instance, history as a subject is not taught in primary and secondary school in Nigeria. Science and tech practical classes do not hold anymore due to lack of laboratories and workshop.

In this era when robotics, Artificial Intelligence, nanotechnology etc. are the focuses of universities, Nigerian universities prefer to teach secondary school subjects like: Use of English, Introduction to Computer Science, and Nigerian People and Culture (which are all compulsory courses). Students spend a minimum of four years learning irrelevant subjects, obsolete skills and unproductive ways of thinking, after which they graduate with little or no skill required in today’s society.

Nigerian tertiary education in sciences and engineering can only be compared to secondary education of most developed countries. Science experiments taught in practical classes are those meant for secondary school. Computer science students spend more time in school learning basic obsolete computer languages that on graduation many graduate cannot develop any system, write any program or install a software.

Education is culture, and different education systems show different societies’ cultures. Nigerian education system was not shaped by Nigerian culture like we have in Finnish, American, chinese or German education system. The Nigerian system does not reflect a Nigerian ideology or philosophy. It doesn’t reflect the people’s culture. It doesn’t fit Nigeria’s economy or economic plan.

The system is keeping Nigerians poor and unproductive. The system has already denied a generation proper education and socioeconomic empowerment as many young Nigerians have more than 16 years of formal education yet no knowledge or skill that is relevant or marketable in the Nigerian society.

Nigerian education system discourages technical and vocational education, as such it is despised by parents and parents. The government discourages technical and vocational education to the extent that they don’t build technical schools any more. In the last decades we have seen the government converting polytechnics and monotechnics to universities even when it is obvious the country lacks manpower with technical skills needed to drive industrialization.

Education in Nigeria is now all about university degrees and certificates. People go to school mainly to acquire certificates instead of knowledge because in Nigerian society, academic and professional certificates are more important than knowledge or know-how. It is common to see people piling acronyms or abbreviations of degrees, diplomas and certificates before and after their names to show they have education.

In order to acquire these certificates students spend more of their time mastering how to answer exam questions and pass exams than acquiring knowledge or education. They study their lecturer’s past questions, past marking scheme and marking pattern. They even ask for area of concentration of exam questions. They read mainly for exams and tests. It is common to hear students say, “no be the person who read pass know book, na the person wey pass exam know book,” meaning it is not the most studious person that is knowledgeable but the person with the best test grades.

Benjamin Disraeli once said, “Upon the education of the people of this country, the fate of this country depends.”

The future of Nigeria sure depends on the education of its citizens and the present education system is hindering systematic development. Nigerian education system is mainly made up of public schools as such fixing public schools is fixing most of the problems in the system.

Unfortunately, public schools are at the mercy of politicians and senior government officials, and because the children of these politicians and government officials don’t attend public schools they have no personal interest in making it work or improving it. They have never allocated more than 11% of national budget to education and most are ever willing to divert money meant for public schools to fund their children’s education in private schools or schools abroad.

Nigeria needs a working education system. But with the kind of people in leadership position, the country may not have a working system anytime soon, unless the children of those who are in government are mandated to attend public schools. Thus radical approach will drastically improve education in the country.

One of the reason why Finland has the best education system in the world today is because private schools are forbidden in the country.