Startling statistics of Nigeria’s healthcare system, By Jerry Uwah

Nigeria has an appalling health care delivery system. Consequently, Africa’s largest economy parades the second highest maternal mortality rate in the continent. With 814 deaths per 100, 000 live births in 2015, Nigeria was second only to Chad in high maternal mortality rate.
The child mortality rate is equally horrendous. World Health Organisation (WHO) statistics suggest that 10 per cent of the world’s infant deaths in 2016 occurred in Nigeria. Nigeria’s infant mortality rate stands at 128 per 1,000 live births.
Everyone knows why Nigeria’s healthcare system has become something of a killing field. The hospitals are far-flung. In some rural communities people wade through 40 kilometres of dilapidated roads to get critically ill relatives to hospitals.
When they manage to locate the nearest hospital they wait for hours to be treated. The few public hospitals available are over-crowded, grossly under-staffed and hopelessly under-equipped.
In developed climes a doctor sees a maximum of 50 out-patients in a day. Ironically, Nigerian doctors see as many patients as they have the strength to endure. On some frenzied days a doctor might see more than 100 patients.
Primary health care centres (PHCs) are pathetic scenes. Most of them are managed only by nurses. Many of the PHCs take deliveries though they have only one nurse on duty at any given time.
There was an incident sometime last year where a nurse who was alone on duty in a PHC took delivery and the baby did not cry in time. As she struggled to resuscitate the baby, the mother went into spasm. The only nurse on duty was struggling between activating the embattled baby and writing a referral letter to send the mother to general hospital. She was just lucky to do the two together while the husband of the woman searched for a tricycle to take his wife and baby to hospital. The ambulance attached to the PHC was at the headquarters of the local government area where one of the politicians commandeered it to.
The nurses in the PHCs work with their bare hands. If they do not buy gloves with their meagre pay, they risk taking deliveries with bare hands.
With 80 per cent of Nigerians or 153 million out of a population of 192 million living below poverty line, the cost of basic treatment even in government hospitals is grossly beyond the reach of many. That probably explains the high maternal and infant mortality rates in the country. Pregnant women are at the mercy of illiterate traditional birth attendants who handle deliveries through trial and error.
Even with the poverty level in the country, pregnant women are compelled to do pregnancy scan at the cost of N2,500 before they could be registered for ante-natal care in the PHCs.
Two weeks ago a 19-year-old woman with nine months pregnancy approached a PHC for the first time to register. The nurse on duty asked her to go for pregnancy scanning and bring the result for the registration. She had no money for the scanning and that was the end of the attempt to register with government health centre. No one knows what would happen to her in the traditional birth attendant home where she would almost certainly use as an alternative.
Doctors complain that even with government’s meagre subsidy on some drugs to reduce the healthcare burden of the poor, many patients cannot get to the point of treatment because they lack the financial muscle to fund laboratory investigation into their ailments.
The mammogram scanning needed to detect breast cancer costs N12, 000 in private scanning centres. The few government hospitals that have the facility charge as high as N6, 500. When women with symptoms of breast cancer approach doctors for treatment, they are often referred to the private centres for scanning. Many who cannot afford the cost just retire home to wait for death.
In fact it has been established that the cost of diagnosis in many instances is higher than that of the actual treatment. For instance, the laboratory investigation to diagnose malaria attack might cost as high as N1, 500. However, Coartem, the new drug for three-day treatment of malaria is just N450. Many patients have died because they could not raise the money to carry out the laboratory investigation ordered by their doctors. Some years ago, a popular actor in the New Masquerade home video died because his family could not immediately raise the N130,000 needed for the series of laboratory investigations ordered by his doctors.
With the cost of diagnosis rising calamitously higher than the cost of drugs, there is need for government healthcare delivery tacticians to fashion out fresh strategy for the funding of healthcare delivery.
The way out of the quagmire is for government to shift emphasis from drug subsidy to diagnosis subsidy. All government hospitals should be equipped with advance diagnostic facilities. Diagnosis should be free while people could pay for drugs which in most cases are cheaper than the cost of investigations.
The British believe that a problem diagnosed is half solved. If government subsidises diagnoses it would drastically reduce trial by error approach by doctors and drive down the cost of healthcare delivery.

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