NIGERIAN NATIONAL HEALTH POLICY; PROBLEMS AND PROSPECTS

University Degree Subjects allied to Medicine

HEALTHCARE MODULE COURSEWORK

DR NISSER ALI UMAR (MPH STUDENT)

INTRODUCTION

Nigeria is situated in West Africa. It borders the Gulf of Guinea and lies between and . It is also bordered by and (1).The country has a federal government structure, 36 state governments, 750 local governments and Abuja as federal capital territory (2).

Demography of Nigeria.

Nigeria is the most populous country in Africa with the population of about 124 million and an annual growth rate of 2.8% . It’s a predominantly a young population with median age of 17.4, age dependency ration of 93 per 100 and economic dependency ration of 259 per 100 workers (3).

The life expectancy at birth has dropped over years from 53.8 years (females) and 52.6 (males) in 1991 to 48.2(females) and 46.8 (males) in 2000 and 41.3 in males and 41.8 in females by 2003 (3) for reasons which include deterioration in both structure and organization of the healthcare system, lack of skilled personnel especially in the primary health care centers, lack of financial and geographic accessibility for the majority of the populace to the limited healthcare facilities due to bad roads, political instability, unemployment to mention but few.

Nigeria is the 5th highest oil producer in the world, with a per capita GDP of 860 US dollars, relatively richer that most African countries, but due to the high level of corruption, it remains the 20th poorest country in the world with about 66% of the population living below the poverty line, and the country having one of the worst health indicators globally, the infant mortality rate was 87.2 per 1000 live births in 1990 and 105 per 1000 live births in 1999. Maternal mortality rate of 800 per 100,000 live births (4).

History of Nigerian Health Policy

At independence in 1960, Nigeria inherited a medical model of health care intended basically for the colonial administration and the Army which was also served the West African frontier force (WAFF) via the British Army medical Services and the entire colonial protectorate.

With the integration of the Army and the colonial government, treatment was extended to local Civil Servants and their relatives and eventually, to the local population living close to government stations.

Thus the colonial medical (Western) model of service developed to provide free medical care to the Army and the colonial Service officers. Medical Services was available to the local population only as incidental (8).

Simultaneously, various religious bodies and private agencies established hospitals, dispensaries and maternity centers in different parts of the country.

After the second world war (1946), the first attempt at planning a head for development of health services took place in the country. Part of that exercise produced the over all ten – year plan for development and welfare (1946-56) covering all aspects of governmental activities including health (7).

These schemes were not properly coordinated nor were they related to any overall economic targets. However, it served as the basis for subsequent health plans.

In another developmental plan between 1975 and 1980, there was a deliberate attempt to draw up a comprehensive national health policy dealing with such issues as health manpower development, the provision of comprehensive health care services based on the Basic Health Services schemes, disease control and efficient utilization of resources.

The Current health policy.

The current Nigerian National Health Policy is aimed to bring about a comprehensive health care system, ...

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These schemes were not properly coordinated nor were they related to any overall economic targets. However, it served as the basis for subsequent health plans.

The Current health policy.

The current Nigerian National Health Policy is aimed to bring about a comprehensive health care system, based on primary health care that is promotive, protective, preventive, restorative, and rehabilitative to every citizen of the country within the available resources so that individuals and communities are assured of productivity, social well- being and enjoyment of living (9).

In August 1987, the federal government launched its Primary Health Care plan (PHC), intended to affect the entire national population, its main stated objectives included accelerated health care personnel development; improved collection and monitoring of health data; ensured availability of essential drugs in all areas of the country; implementation of an Expanded Programme on Immunization (EPI); improved nutrition throughout the country; promotion of health awareness; development of a national family health program; and widespread promotion of oral rehydration therapy for treatment of diarrhea disease in infants and children (9).

Implementation of these programs was intended to take place mainly through collaboration between the Ministry of Health and participating local government councils, which received direct grants from the federal government.

Of these objectives, the EPI was the most concrete and probably made the greatest progress initially. The immunization program focused on four major childhood diseases: pertussis, diphtheria, measles, and polio, and tetanus and tuberculosis. Its aim was to increase dramatically the proportion of immunized children younger than two from about 20 percent to 50 percent initially, and to 90 percent by the end of 1990. Launched in March 1988, the program by August 1989 was said to have been established in more than 300 of 449 LGAs. Although the program was said to have made much progress, its goal of 90 percent coverage was probably excessively ambitious, especially in view of the economic strains of structural adjustment that permeated the Nigerian economy throughout the late 1980s.

The government's population control program also came partially under the PHC. By the late 1980s, the official policy was strongly to encourage women to have no more than four children, which would represent a substantial reduction from the estimated fertility rate of almost seven children per woman in 1987. No official sanctions were attached to the government's population policy, but birth control information and contraceptive supplies were available in many health facilities.

The federal government also sought to improve the availability of pharmaceutical drugs. Foreign exchange had to be released for essential drug imports, so the government attempted to encourage local drug manufacture; because raw materials for local drug manufacture had to be imported, however, costs were reduced only partially. For Nigeria both to limit its foreign exchange expenditures and simultaneously to implement massive expansion in primary health care, foreign assistance would probably be needed. Despite advances against many infectious diseases, Nigeria's population continued through the 1980s to be subject to several major diseases, some of which occurred in acute outbreaks causing hundreds or thousands of deaths, while others recurred chronically, causing large-scale infection and debilitation. Among the former were cerebrospinal meningitis, yellow fever, Lassa fever and, most recently, AIDS; the latter included malaria, guinea worm, schistosomiasis (bilharzia), and onchocerciasis (river blindness). Malnutrition and its attendant diseases also continued to be a refractory problem among infants and children in many areas, despite the nation's economic and agricultural advances as such the federal government incorporated the following objectives into nits primary health care system in line with the recommendation of the World Health Organization:

Educating the populace concerning prevailing health problems in the community and the methods of preventing and controlling them
Promotion of food supply and proper nutrition
Maternal and child care, including family planning
Immunizations against the major infectious diseases
Prevention and control of locally endemic and epidemic diseases

Nigeria is one of the few countries in the developing countries that have systematically decentralized the delivery of basic services in health and education to locally elected governments and community-based organizations.

There is a three-tier system of health care, namely: Primary Health Care, Secondary Health Care, and Tertiary Health Care.

Primary Health Care
The provision of health care at this level is largely the responsibility of Local Governments with the support of state ministries of health and within the overall national health policy. Private medical practitioners also provide health care at this level.
Secondary Health Care
This level of health care provides specialized services to patients referred from the primary health care level through out-patient and in-patient services of hospitals for general medical, surgical, pediatric patients and community health services. Secondary health care is available at the district, divisional and zonal levels of the states. Adequate supportive services such as laboratory, diagnostic, blood bank, rehabilitation and physiotherapy are also provided.
Tertiary Health Care
This level consists of highly specialized services provided by teaching hospitals and other specialist hospitals which provide care for specific diseases such as orthopedic, eye, psychiatric, maternity and pediatric cases. Care is taken to ensure an even distribution of these hospitals. Also, appropriate support services are incorporated into the development of these tertiary facilities to provide effective referral services. Similarly, selected centers are encouraged to develop special expertise in advantage modern technology to serve as a resource for evaluating and adapting these new developments in the context of local needs and opportunities.

To further the overall national health policy, governments of the Federation work closely with voluntary agencies, private practitioners and other non-governmental organizations to ensure that the services provided by these other agencies are in line with those of government.

In recent years, public revenues in Nigeria have increases substantially due to the boom in world oil price, and some of this windfall is being channeled into increased spending on primary health care. Yet, there remains a concern whether the institution of public accountability in the country will effectively allow these large spending programs to translate into improved services and outcomes. A major channel through which increased public resources are expected to impact basic health and education services in Nigeria is that of spending by local governments that are largely responsible for these services.

In addition to the constitutional provision for decentralization of primary health care to local governments, health policy in Nigeria has been guided by the Bamako initiative of encouraging and sustaining community participation in primary health care service delivery.

Problems of the health sector in the country at present.

Inadequate coverage- only about 54% of the population has access to healthcare facilities. Economic and geographic inaccessibility both limit the use of the healthcare facilities to the rural populace whereas the urban populace underutilizes the facilities mostly due to economic factors.
Inappropriate orientation of services with a disproportionately high expenditure on curative rather than on promotive and preventive health services.
Weakness in the management of services resulting in waste and inefficiency and poor coordination of inputs from various organizations resulting to more waste in human and material resources.
Minimal involvement of the community in decision making.
Lack of basic health data such as disease registers that could help in exposing the limitations of this national policy and potentially guides policy makers when modifying the policy.

Factors that limit implementation of the National health policy.

Resource limitations and leakages due to corruption- Nigeria been a third world country is constrained in terms of economic and manpower capacity and this greatly affect the implementation of the national health policy.
Lack of community participation- Although community participation has been institutionalized through the creation of Village Development Committees that are grass-roots organizations expected to work closely with local governments in monitoring and supporting primary health care services coupled with efforts from several other governmental and non-governmental organizations to improve on community participation in the provision health services, the result has not been encouraging (7).The reasons for this observation may include low level of awareness among the citizenry
Lack of inter-sectoral collaboration- every sector in the country wants to be as independent as possible whereas for a national policy to be effectively adopted there is a strong need for interdependent and collaborative commitment.
Lack of equity- there has to be equity in the distribution of the health care services and resources, which in Nigeria because of the level of social and economic inequality, equity is seldom achieved.
Lack of self reliance-for any country to be able to implement a national policy successfully, its ability to produce the required items locally is very strategic. Presently in Nigeria, most of those items have to be imported from other countries.
Other problems in implementation of the policy such as Lack of political commitment

The implication of the National health policy.

The adoption of this national health policy offers the following prospects:

The various tiers of government have responsibility for the health of the people which shall be fulfilled by the provision of adequate health and social service facilities.
The citizens shall have the rights and duty to participate individually and collectively in planning and implementation of these services.
Health care be given higher priority in the allocation of the nation resources that hitherto.
Access to health care is equitably distributed given preference to those at greater health risk and underserved communities.
Information on health be disseminated to all individual and communities to enable them have greater responsibility for there health.
Emphasis be place on preventive and promotive measures, integrated with treatment and rehabilitation in a multi-disciplinary approach.
All other sectors shall cooperate in the effort to promote the health of the population.

Reference

3- WHO Country Cooperation Strategy: Federal Republic of Nigeria 2002- 2007 p7-9

6- http://www.unicef.org/Nigeria

7- Textbook of Tropical paediatrics and Child Health by Azubuke et al First Edition P 9- 32

8- Nigerian Health Sector Reform by A.K Ukechuku First Edition Pg 5- 12

9- Nigerian National Health Policy booklet produced by the Federal Ministry of Health 2000.