The heads of state of African Union countries on April 2001 met in Nigeria and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector. The resolution is known as the Abuja Declaration.
However, since then, the country’s budgets for health oscillate below 10 per cent to the chagrin of stakeholders in the sector.
Nigeria’s health budget for 2018 stood at N340.46bn, which was 3.96 per cent of its N8.6tn proposed national spending. A breakdown of the health budget showed Nigeria, then estimated to have a population of 186 million, allocated approximately N1, 832.62 for each citizen.
Of the total N9.45tn budgeted for 2020 by the Federal Government, N427.3bn (4.5 per cent) was allocated to health.
During his 2015 election campaign, the President, Major General Muhammadu Buhari (retd.), made many promises, several of which pertained to the health sector.
The President promised to increase the number of physicians from 19 per 1,000 population to 50 per 1,000 through deliberate medical education as epitomised by nations such as Ghana, as well as to increase national health expenditure per person per annum to about N50,000 (from the less than N10,000 then).
He also pledged to invest in cutting-edge technology such as tele-medicine in all major health centres in the country through partnership programmes with communities and the private sector and increase the quality of all Federal Government-owned hospitals to world-class standard by 2019.
But the health sector has since been fraught with continuous neglect and protests over basic entitlements, not to mention institutional and infrastructural decays.
A major criticism aimed at the current regime argues that the government hadn’t delivered on its promises assessed against the 2015 campaign promise of prohibiting government officials from embarking on medical tourism. Between 2015 and 2019, Buhari spent at least 217 days in the United Kingdom, mostly on health grounds and for meetings of Commonwealth Heads of State and Government.
In July 2019, for instance, the National Association of Resident Doctors threatened to embark on a strike over three major grievances against the Federal Government, including unpaid salary arrears, skipped salaries of N23.6bn and irregularities in the implementation of the Resident Doctors’ Act.
Amid all of these, multimillion naira offices of several, duplicated government agencies litter the Federal Capital Territory while federal teaching hospitals are in a sorry state.
This situation accounts for the reason government officials including the rich and powerful go on medical tourism.
The Petroleum Technology Development Fund Towers, a grey-cream high-rise, serving as the PTDF headquarters, is located at the Central Business District, Abuja.
A sprawling mixture of geometric shapes, the multimillion-naira structure boasts at least 10 floors. An avenue of palm trees and perfectly trimmed hedges line the driveway leading to the building.
The Fund, according to its website, existed only as a desk in the Department of Petroleum Resources until 2000, when it became a fully functional agency of government.
“PTDF is a special purpose fund to train and make available skilled, competent and qualified local manpower for the oil and gas industry,” the website indicates.
Talking about lavish office complexes, anti-corruption agencies may be not among the ones anyone would expect to have such.
However, the headquarters of the Independent and Corrupt Practices and Other Offences Commission, located in Central Area, Garki, Abuja, has an ironically extravagant design.
An origami-style canopy forms the mouth of the majestic building, an unconventional structure with deep blue window panes that seem to go on endlessly.
Like its anti-corruption war, the Economic and Financial Crimes Commission’s new head office also has imposing and intimidating structure.
Situated at Jabi, Abuja, the 10-storey building wears a grey and red exterior. The N24bn facility, which looms large over an equally impressive concrete lot, was inaugurated in 2018 amid pomp and circumstance.
Hospitals get better attention abroad
Governments in advanced countries pay quality attention to healthcare. Some of the hospitals in these countries are either government, private or charity-run.
One of them is Johns Hopkins Hospital regarded as one of the world’s greatest hospitals and medical institutions. It’s a teaching hospital and biomedical research facility of the Johns Hopkins School of Medicine, in Baltimore, Maryland, United States.
Founded about 131 years ago by city merchant, banker/financier, civic leader and philanthropist Johns Hopkins (1795–1873), the Johns Hopkins Hospital and its school of medicine are considered to be the founding institutions of modern American medicine and the birthplace of numerous famous medical traditions, including rounds, residents and house staff.
Among the numerous achievements of the hospital is the formation of many medical specialties such as neurosurgery, cardiac surgery, and child psychiatry.
The hospital occupies approximately 20 of the 60 buildings on the Johns Hopkins Medical Campus. The complex is said to have over 80 entrances and receives 80,000 visitors weekly. It also houses over 1,000 beds and has a staff of over 1,700 doctors with over 30,000 total employees.
Another hospital that ranks among the world’s biggest is the Cleveland Clinic in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, the hospital runs a 170-acre campus in Cleveland, as well as 11 regional hospitals and 19 family health centres in northeast Ohio, and hospitals in Florida and Nevada.
Outside the US, the hospital also has a facility in Abu Dhabi, United Arab Emirates and a sports medicine clinic in Toronto, Canada, as well as a campus in London, which is scheduled to open in 2021.
Cleveland Clinic, consistently ranked as one of the best hospitals in the US, had an operating revenue of $8.4bn in 2017, recording 7.6 million patient visits and 229,132 admissions.
As of 2019, the hospital had over 60,000 employees, including 11,800 nurses and over 3,953 physicians and scientists in 140 specialties.
When the United Kingdom Prime Minister Boris Johnson was infected with the coronavirus on March 27, he was admitted to the St Thomas’ Hospital on April 5.
According to findings, the hospital is a large National Health Service teaching hospital in Central London, England. Originally located in Southwark, but based in Lambeth since 1871, the hospital has provided health care freely or under charitable auspices since the 12th century.
It is one of London’s most famous hospitals and a prominent London landmark, largely due to its location on the opposite bank of the River Thames to the Houses of Parliament.
As of January, the St Thomas’ Hospital, and three other hospital trusts in the UK, were put on standby to receive suspected COVID-19 patients.
In fact, there are better-equipped private hospitals than government-owned ones in Nigeria. This explains why many citizens would rather seek medical attention in private facilities.
For instance, one of such private hospitals is St Nicholas Hospital located on Lagos Island. Founded about 52 years ago a gynaecologist and obstetrician, Moses Majekodunmi, also an ex-Minister of Health in the First Republic, the hospital has facilities at different locations in the country. It has recorded laudable feats renal transplant in Nigeria.
A struggling healthcare system
However, the COVID-19 pandemic has further exposed the crisis in the Nigerian health sector even as medical workers battle to curtail spread and treat the infected.
The President, Commonwealth Medical Association, Dr. Osahon Enabulele, in an interview with Sunday PUNCH, said every well-meaning, patriotic Nigerian with a conscious and progressive mind would have realised that the advocacy on the need for government at all levels to prioritise the health of the people and investments in the health sector had become glaring with the challenge of COVID-19.
According to him, people now understand what it means to say health is wealth.
Enabulele said, “I do not, therefore, think that anybody needs any other lesson, apart from the learning point from the current challenge of COVID-19, to know that, going forward, health has to be top priority in terms of investment decisions of government at all levels, and even decisions of all of us as Nigerians.
“Pre-eminently, this is a time to begin to ask ourselves how we have done in terms of our investments in the health sector. It is clear that, going from North to South and East to West, there has not been much attention paid to the health sector and the health system in general.
“I expect that, going forward, there will now be top priority given to health in terms of maximum attention and investment, not only the health infrastructure in terms of the equipment and facilities but also the health workforce, which is important in driving any health system.”
The CMA president stated that there was no reason health, consistently, would be behind several other sectors, adding that, going forward, health should be number one.
He queried the remuneration packages for health workers, saying the reward system was unacceptable.
“Currently, what is the incentive even now that we are battling COVID-19 in terms of hazard allowance? They have a miserable hazard allowance of N5, 000 monthly paid to health workers in Nigeria and that has been since 2009.
“It is something that needs to be quickly rejigged in terms of all the elements that will make for a functioning, effective and sustainable health system. I expect that our leaders at various levels will now begin to put allocations to the health sector as top priority.
“There is no reason, year in, year out, the health budget in our nation, for instance, and all levels of governance cannot meet up with the 15 per cent agreed on in 2001 at the Africa Heads of Government meeting that was hosted by Nigeria,” he added.
Enabulele noted that in the United Kingdom and other countries, unlike Nigeria, where there was little or no external conflict, health was given a top priority.
“In the UK, for instance, the health budget is, more often than not, higher than even the budget for Defence because of the way they value their health. The statistics are all there. The National Health Service, for instance, has one of the most profound budgets anywhere in the world,” he said.
The Executive Director of the Centre for Open Leadership and Anti-corruption, Debo Adeniran, also said a lot of wasteful spending by the Federal Government had deprived the health sector of basic amenities.
Adeniran urged the government to redirect its attention on health care facilities, provide incentives for frontline health workers and ensure provision of essential equipment and facilities, especially in tertiary health institutions like the University College Hospital, Ibadan and Lagos University Teaching Hospital, among others.
He said, “If you get to the National Assembly, the old complex is still useable, but they abandoned it. They built another one and it’s still the one they want to renovate with a huge amount of money.
“That is the area of wastage that we should look at. The National Assembly do not empathise with ordinary Nigerian people by spending so much money in acquiring unearned comfort for themselves by ordering 2020 Toyota Camry.
“That is ostentation that we shouldn’t afford. We should talk about the amounts of money being wasted on government officials who travel abroad for nothing, just because they want to get estacode, they waste the scarce foreign reserves and foreign exchange.”
A former member of the House of Representatives in the Second Republic, Dr. Junaid Mohammed, also decried the state of the health sector.
Mohammed, who is also a medical doctor, stated that government expenditure profile indicated a lack of priorities.
He said, “But this is not unusual because virtually everything we have been doing in this country, for as long time as I’ve been politically conscious, has never been on any serious priority. If an individual, family, clan or the society lacks any serious priority, you can see that the lack of priority is reflected in the way they go about spending or disbursing their resources.
“And at the end of the day, when challenges are being faced, you find that that lack of priority shows itself and the non-performance of what has been done is the case. In the health sector, in particular, and to a certain extent education, there is already a road map to follow.
“The World Health Organisation has, over the years, given indication as to what percentage of national budget must be spent, not only in the particular area of health delivery system, but it also indicates what sub-sectors of the health delivery system must be spent.”
The former lawmaker said, as far as the WHO is concerned, the emphasis should be on primary health care, preventing diseases threatening lives of children, including diarrhoea, malaria, and typhoid, among others.
He added, “We ought to take a reasonable chunk of our own budget so that, at least, our children will grow up better. If they grow up in better health, they will be in a position to resist some of the illnesses, which are the common scourge of our existence.
“Cuba has one of the best medical services in the world. They have a life expectancy rate, which, in fact, is at par with advanced countries like Canada, the United States, Scandinavian countries like Sweden, Norway and Denmark, as well as New Zealand.
“It shows that it is not the amount of money that you spend, per se, but how carefully you spend and how sincere the elite who are managing the health system have been in disbursing these resources. If we don’t do that, then you don’t complain about anything.”
On his part, a former governor of Kaduna State, Balarabe Musa, told our correspondent that he was not optimistic that the current regime could do any better in the health sector after the end of the pandemic.
According to him, one cannot expect anything hopeful from the regime because of the alleged level of incompetence and inability to control the situation.
Musa said, “Things have been allowed to reach this level that we have lost control. We only wait for the worst. The level of incompetence in every respect is clear that you can’t really hope for anything.
“I know, as religious people, we hope God will correct the situation but we have to stand up before God can help us. Are we, Nigerians, standing? We are not. We can’t rely on God because we are not faithful to God.”
The Chairman, Presidential Advisory Committee against Corruption, Prof. Itse Sagay (SAN), noted that there was a fundamental problem with the health care system. He, however, argued that the problem predated the current regime.
Sagay said, “It is not something limited to the present government. It’s a long-standing problem which has been going on throughout the military era, through the beginning of democracy in 2000 and so on. It’s not a new thing.
“The attempt to try and hang it on the current government is just a vicious political gambit which obviously would fail on any rational observation. It’s nothing new about our poor health architecture.
“Everybody agrees, I agree too that something needs to be done. But it is not something that can be done because of this coronavirus. I think that’s ridiculous. We can’t establish a viable health system within three to six months. That is another misconception.”
According to him, the discourse should be geared towards a long-term plan to progressively establish what people are asking for, so nobody will need to leave the country to seek medical attention.
The constitutional lawyer said, though the current regime needed to take action, the blame should be passed on all generations of politicians, starting from the Second Republic.
He said, “I think this government in power should start a plan, but the whole country should put hands together and not start a blame game, which is meaningless in the circumstance. So, we have a poor health system in this country — totally inadequate.”
Speaking on banning foreign medical trips, Sagay argued that some factors should be considered.
He stated, “One, supposing somebody has his own money, you cannot stop him because that would be in breach of his human rights. You can say you won’t sponsor him with government money because government has a right to how it wants to use its money for the betterment of the nation.
“But if a person has his own money, you can’t ban him from going abroad. That is totally against his human right and the human right, number one, is right to life.
“Two, what we should also ask ourselves is, do we now first build a viable health system before banning those who are being sponsored abroad or do we put the ban in now to say, ‘damn it, if anything happens to such public official while the ban is on, well, too bad’?”
He said, most importantly, one should consider a situation as in the past, where a head of state, vice president or governor was seriously ill and the country allegedly did not have the facilities.
“Do we say he should die here because we have a principle that no medical tourism for health purposes? Do we allow such to happen to a major person whose death will shake the nation?
“It is a complex thing and I think our people, particularly public observers, tend to talk without thinking of the consequence of what they are doing.
“In conclusion, I think we must put hands together and vigorously transform our health system. But until we do that, I don’t think I would like to put any embargo on any of going abroad,” he said.