HEALTH CARE IN NIGERIA
Nigeria is the most populous nation in Africa, with an estimated 112 million people. Located on the West Coast of Africa, along the Gulf of Guinea, Nigeria occupies approximately 356,670 square miles (slightly larger than twice the size of the state of California). The country is a federal republic consisting of 36 states, and 543 local governments. Nigeria’s capital city, Abuja, is located in the center of the country.
In spite of possessing Africa’s largest oil reserves, Nigeria remains one of the continent’s poorest countries. Its international debt of $30 billion dollars is roughly equal to the estimated amount of wealth stolen from the country by corrupt leaders. Nigeria is considered by some to be the most corrupt nation in Africa, if not the world.
About one-third of the population lives in poverty, and one out of every four workers is unemployed. Allegiance to family and kinship systems, as well as to the village community, is strong. Marriage often occurs at an early age, at least, for females, and childbearing also begins at an early age.
In Nigeria, families tend to live together in one village or area of a town. Mothers are the primary care givers in the family, but receive help and support from the extended family. In most families, men are dominant and make most of the decisions. Significant numbers of children do not go beyond elementary school.
Although English is the official language, there are over 250 different dialects spoken in Nigeria. The most widely spoken language is Hausa. There is no state religion. About 50% of Nigerians are Muslim and 40% are Christian. Although most people practice Islam or Christianity, many also engage in practices derived from traditional African religions.
The wealth of a nation is its health. Given the current state of health care in the country, one can only conclude that Nigeria is dirt poor, in that regard. The health care system is composed of decrepit health facilities and comatose medical institutions that have suffered from prolonged neglect and under-funding, leaving everyone open to the risk of unwarranted death. In such a circumstance, one prays not to fall sick in Nigeria, or develop any serious ailment that requires urgent care.
Healthcare in Nigeria is a national emergency. In many small, rural villages throughout the country, there are virtually no medical facilities. This is the case in the village of Akoli-Imenyi. Recently, the UN rated Nigeria very high, in terms of infant mortality and chances of women surviving during child labor. Over the decades, the average life expectancy in Nigeria has declined precipitously. Per capita heath care expenditure, as a percentage of gross domestic product, is one of the lowest in the world.
Nigeria’s teaching hospitals, famous for training some of the best medical professionals in the world, have all been reduced to glorified cottage clinics, as a result of which the best and brightest have left the country in search of better opportunities abroad. (Ironically, estimates suggest there are over 5,000 doctors of Nigerian descent practicing in the US alone. Most were trained at home.)
Primary care is largely provided through approximately 4,000 health clinics and dispensaries scattered throughout the country. As for secondary care, there were about 700 health care centers and 1,670 maternity centers; tertiary care was handled through 12 university teaching hospitals with about 6,500 beds. There is no health care facility in or around the village of Akoli-Imenyi.
As of 1999, there were an estimated 0.2 physicians and 1.7 hospital beds per 1,000 people. The lack of proper facilities, and inadequate remuneration of public sector health care workers, have also spurred the development of a limited number of privately-owned hospitals that cater to those who can afford them.
The country is in dire need of medical supplies and equipment. In 2000, only 57% of the population had access to safe drinking water, and only 63% had adequate sanitation. As of 1999, total health care expenditure was estimated at 2.8% of GDP.
Despite the receding influence of endemic diseases, health problems in Nigeria remain acute. Just under half of all deaths are thought to be among children, who are especially vulnerable to malaria, and account for 75% of registered malaria deaths.
The prevalence of child malnutrition, for children under age five, as of 1999, was 46%. Nigeria had the highest number of measles cases reported in 1995, of all African nations (95,915 cases and 12,393 deaths). In 1995, diarrhea diseases claimed 204,400 lives.
While Nigeria has a birth rate of 40.6 births per 1,000, the infant mortality rate is 98.8 deaths per 1,000 births, with a life expectancy rate of 46.7 years. As of 2000, almost 15% of all Nigerian children did not live to their fifth birthday.
Maternal mortality is the leading cause of premature death and disability among women of reproductive age in Nigeria. One in every fifteen mothers dies during childbirth. Many of the women still resort to traditional child delivery options, as hospitals are not accessible or affordable.
According to the World Bank, although men and women between the ages of 15 and 44 lose approximately the same number of years of healthy life due to disease, there is no single cause of death and disability for men that comes close to the magnitude of maternal death and disability.
Safe motherhood, comprising prenatal care, safe delivery, essential obstetric care, is not available in most of Nigeria’s rural villages and towns, such as Akoli-Imenyi. In the villages, it is common for the women to die during childbirth, due to a lack of medical facilities, and the inability to travel to the medical facilities in the urban areas.
Schistosomiasis, guinea worm, trachoma, river blindness, and yaws are other diseases of high frequency. HIV/AIDS has reached epidemic proportions in Nigeria. At the end of 2001, the number of people living with HIV/AIDS was estimated at 3.5 million (including 5.8% of the adult population), and deaths from AIDS that year were estimated at 170,000. Such statistics are heart breaking, pathetic, and scary.
Access to quality healthcare in Nigeria is either limited or non-existent, and is a staggering financial burden to families and the nation. Nigerians die of minor illnesses that could have been prevented with simple medications and healthy lifestyle.
The health crisis in Nigeria has taken an added significance because of the absence of constructive comprehensive national health policy. The federal government seems to have no constructive collaborative efforts with the state and local governments. The implications of this phenomenon are catastrophic.
Scenarios, such as the following, are the epitome of the tragedies in villages, like Akoli-Imenyi, resulting from the lack of health care in the country:
· A child in Akoli-Imenyi falls ill with fever, chills, and convulsions in a village over half-a-day’s journey away from the nearest health center. After three sleepless nights of agonizing helplessness for the family, the child succumbs. · A middle-aged artisan in a state capital falls from a height at his workplace and sustains a compound fracture of the femur. He is taken to the general hospital where the surgeon, lacking the tools for the most appropriate treatment, undertakes what he euphemistically calls “conservative management” and watches helplessly as the patient deteriorates steadily and dies. · A 19-year old female student becomes pregnant following sexual indiscretion with a married schoolteacher. She is petrified of the consequences and seeks the aid of a traditional abortionist in the backwoods of a city center. A week later she is brought into the hospital with roaring septicaemia from pelvic infection. She rapidly passes from anuria to delirium to convulsions and eventually, succumbs. · A government minister trips in his bath and injures his ankle. An x-ray in the teaching hospital shows a soft tissue swelling with no fracture. Yet, he is promptly flown out for treatment in a European country – cost to the taxpayer: $20,000. These four scenarios exemplify the cruel irony of the health care situation in Nigeria. It is unacceptable that in the 21st century, a child with a fever and convulsions dies. Or that a pregnant mother in Akioli-Imenyi, or any other village, dies in childbirth because medical attention is not available in her village and she cannot get to the nearest urban hospital miles away. Mortality from relatively minor accidents should be insignificant. A young lady with a septic abortion would not succumb, if adequate measures to confront infection and combat renal failure were available. The fourth scenario exemplifies the millions of dollars in public money spent annually on overseas treatments of minor ailments for top government functionaries is clearly indefensible, but all-to-familiar.
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