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Nigeria’s healthcare at 55: Still not good picture of health


There were no statistics or clear healthcare indices to measure the health status of Nigerians 51 years ago when the nation attained independence. This is because health services in the pre-independence era were not designed to respond to the health needs of Nigerians but were reserved mainly for the colonial officers in the urban areas to the neglect of the rural population. What was clear however was the fact that, like every other emerging young African nation, life expectancy was quite low, fertility was very high and well above 8.0 live-births per woman. There was also a high infant and maternal mortality rate while preventable communicable diseases constituted major health problems. 
However, there was a lot of hope about Nigeria’s healthcare delivery at independence.  The young nation took off with few infrastructure and facilities such as the University College Hospital which was one of the best hospitals in the world. Also, emphasis was placed on disease prevention and this was characterised by the enforcement of environmental laws through the ubiquitous sanitation officers.  The presence of the sanitation inspector (popularly called wole wole in the western region) in the neighbourhood sent fears down the spines of the inhabitants of the area. They were empowered to enter every home, open water pots and take samples to ensure that there were no mosquito larvae. The goal was the prevention of epidemics such as cholera, typhoid fever, malaria, measles and other contagious diseases. 
Indeed, Nigeria’s first Development Plan (1962-68) provided the groundwork for the increase of health facilities such as the  building of hospitals in major cities, dispensaries and maternity homes in few rural towns and villages. But these were certainly not enough to provide  access to health by a large section of the populace. Thus, by 1985, less than 30% of the population had access to modern health care. By that time, the orientation of the health services had changed and tilted  towards curative services, while severe weaknesses were evident in the management of the health services resulting in waste and inefficiency. There was minimal community involvement in health services planning. There was a dearth of health statistics for planning. Basic infrastructure and logistics support for health services provision were absent and financial allocation to the health sector was grossly inadequate.
According to the United Nations Development Programme. (UNDP), Nigeria has, since independence, consistently fallen into the group of countries with a low level of human development (HDI).  Although the country’s HDI  had risen progressively since 1960, serious slumps were recorded between 1991 and 1993.  In 1990, for example, Nigeria had a total of 13,958 health establishments, with 69 per cent of them being dispensaries that were usually staffed by non-professional health auxiliaries who could only  offer a very limited scope of health services   Maternity centres/Primary Health Care (PHC) clinics constituted 23 per cent of these, while secondary and tertiary health care facilities constituted 6 and 2 per cent respectively. 
The situation is further worsened by the  nation’s rapid population growth. At the time of Independence in 1960, Nigeria’s population was estimated at 35 million. In 2006 the populations had risen to 140 million according to the National Bureau of Statistics. In mid 2007 the US-based Population Reference Bureau puts Nigeria’s population at 144 million – an increase of over 100 million people in less than 50 years!
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Nigerian health worsened by rapid population growth Nigerian health worsened by rapid population growth

Today, availability and accessibility to quality health care services in Nigeria remain poor and below global standards. Virtually all health indices have worsened over the last decade. Apart from an incredibly low life expectancy of 49 at birth, health indices for women and children have remained so abysmal and consistently poor over the years. Indeed, statistics from the National Strategic Health Development Plan Framework (2009- 2015) adopted by the National Council on Health in 2009 show that infant mortality rate in the country stands at 75 per 1000 live birth while child mortality ratio remains 88 per 1000 live births. Under-5 mortality stands at 186 per 1000 live births and maternal mortality ratio remains 800 per 100,000 live births, contributing a disproportionate 10% of the global burden of maternal and infant mortality. In fact, it is estimated that less than half of deliveries are attended to by skilled health personnel.
The latest United Nation’s Human Development Report puts Nigeria’s HDI at 0.423 and ranked the country 142 out of 169 countries with comparable data. Nigeria did not make the very high Human Development rank, neither did it make the High Human Development rating. It was not also ranked among the countries that made it to the Medium Human Development strata. The country is also among the lowest ranking nations in the Low Human Development category, escaping from the bottom of the human development index by 27 positions.
Primary Health Care (PHC) system, the bedrock of our healthcare delivery system remains too weak to offer cost-effective services for the prevention and management of common health problems, especially at the LGA and Ward levels. In fact, a 2001 survey of public PHC facilities revealed that most public health facilities across the country are poorly equipped. According to the survey, only one-quarter of health facilities had more than 50% of the minimum equipment package and 40% had less than a quarter. Majority of the public health facilities especially PHC centres are in a state of disrepair. Although every state currently has at least one tertiary health facility, most are not functioning at optimal capacities in the provision of quality specialist care.
Nigeria’s picture of health since independence has however not been all gloom. For instance, the country joined the rest of the world to eradicate small pox in 1970. At independence she was one of the most endemic countries with guinea worm and indeed later became the world’s most endemic nation in the 90’s. Today the nation has been certified as guinea worm-free. There has also been a significant improvement in the diagnosis and treatment of non-communicable disorders (NCDs) just as its cancer management has improved remarkably.
Just last week, the nation got what could be described as a birthday present from the World Health Organisation (WHO). The country was removed from the polio-endemic countries and will now wait for two years before being fully certified as polio –free.

Fact file
● WHO 2000 health systems performance ranking – the last by WHO – ranked Nigeria 187 out of 199 countries in all five health indicators: health, health inequality, responsiveness levefilelk distribution and financing.
● Health status indicator for Nigeria are among the worst in the world. Life expectance at birth remains 49,
● As at 2010, Nigeria has the highest number of HIV-infected persons in the African continent though the country was listed among countries with “stable” incidents and significant recudtion of cases.
● Estimated infant mortality rate stands at 75 per 1000 live birth. Child motality ratio is 88 per 1000 live births; Under-5 mortality stands at 186 per 1000 live births while maternal mortalilty ratio remains 800 per 100,000 live births, conteibuting a disproportiionaate 10% of the global burden of maternal and infant mortality.
● Immunisation coverage is 23%. Only 6% of under-5s sleep unbder ITN while only 20% of children in urban areas and 14% in rural areas are appropriately treated with antimalarials at home. Less than half of deliveries are attended to by skilled health personnel.

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