By Linus Aleke
The management of the Healthcare System in Nigeria is the direct opposite of how not to run healthcare system anywhere in the world, including animal kingdoms.

There are rarely any health indices that are positive in Nigeria, from in fact and maternal mortality, life expectancy, HIV prevalence, management of communicable and non-communicable diseases, as well as water and sanitation.

The healthcare system in Nigeria is deplorable, no matter how we may want to look at it. This explains why non-state actors are now working hard to ensure that the situation changes for the better.

Changing the situation for the better may be a very onerous task to achieve, but the good news is that it is doable. If all the relevant stakeholders in the sector, from the government to the civil society organisations and the media could join hands together to push for the necessary and needed reforms, increased funding, and investment in the sector, the rest would be history and Nigeria would be ones again a country to reckon with in the area of provision of the quality healthcare system.

Meanwhile, most primary healthcare centres across the federation are said, to be in bad shape, the new Health Sector Accountability Report in Nigeria posited.

The report also, revealed that Nigeria loses $1.1bn annually to capital fight, associated with medical tourism.

The report is a product of a survey carried out by BudgIT Foundation, Connected Development, and Global Integrity, with funding from Conard Hilton Foundation and Skoll Foundation.

Speaking to newsmen during the launch of the new report, the Community Engagement Manager, Connected Development, Mr. Mukhtar Halilu Modibbo said its team visited the 36 states in Nigeria but were able to get data from 34 states, adding that they also visited 783 primary healthcare centres across the country.

“There are primary healthcare centres that don’t even have lights, and there are those that have refrigerators to store COVID-19 vaccines, but the refrigerators were not functioning optimally. Some were, however, functional but there was no light to use them. The infrastructure in most primary healthcare centres is in a deplorable state, that we cannot even sit there as normal persons talk more of someone that is ill.

“There are primary healthcare centres that do not have shared toilets. Wash facilities in a primary healthcare centre should be in a good state. Most of the primary healthcare centres do not measure up to the standard of primary healthcare,” he said.

Assistant manager, BudgIT Foundation, Mr Iyanuoluwa Bolarinwa, said the study was aimed at tracking how COVID-19 funds were utilized, as well as to understand the state of healthcare across the federation.

He said, “For the past two years, we have been tracking COVID-19 funds in Nigeria through our project called COVID-19 Transparency Accountability Project (CTAP), not just in Nigeria alone but across nine African countries.

“What we have done in Nigeria in the past two years was basically to understand how COVID-19 funds were used and also, to understand the state of our healthcare system across the federation”.

On whether the COVID-19 funds were mismanaged, Bolarinwa noted, “As I speak to you, we still have not seen the audited statement of the COVID-19 funds, that was spent in Nigeria. But, have we asked for it? Yes, have we tried to get it? Yes, where is it? It is at the table of the Senate Committee reviewing the report.

“When is it going to be released for civil society members to see so, that we can understand how these funds were used? I will not categorically say that all the funds were mismanaged. But were the funds judiciously managed?

“This is the question that will be answered when we get the audited statement. When we were trying to check what was released on the platform, we saw that some things that were purchased did not meet the value of the money spent on them. The prices of those items look outrageous. Items like nose masks and other personal protective equipment.

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“What we did then, was to call the attention of the ministry of health and other MDAs that were involved in making those purchases within the period. But two years after, we are launching a report that also speaks to some of these issues I raised earlier.

“In this report, we came up with very responsible recommendations that if government at all levels attempt to implement, we would have a standard health care system that would be world-class.”

He also, said, there was a commitment by all African countries to dedicate 15 percent of their annual budget to the health sector but, after 21 years of this commitment, Nigeria has not fulfilled that obligation.

If these things are adhered to, he added, “We would have a structured and standard healthcare system.”
According to him, “We also, looked at the brain drain currently going on in the health sector. We now have a doctor to five thousand patients. Some months back, Saudi Arabian authorities came to the Sheraton Hotel in Abuja to recruit medical consultants.

“And many of them were recruited, their exit from our medical systems is seriously affecting the sector $1.1bn is been spent annually on medical tourism. If our health system is good that amount of capital fight on health alone would not happen.

What we are doing here today is a continuous effort by civil society to encourage the government towards making sure that our health system improves”.

On measures to improve the system for the better, the Assister Manger proposed, “We need to make laws that bar our public office holders from seeking medical attention abroad. If every Nigerian is compelled by legislation to seek medical attention within the country’s healthcare system, we believe that government would be compelled to fix the system.”

He further said, the taxes that are health-specific are not managed well by the authorities, lamenting that there is no transparency and accountability.

Speaking at the official launch of a report, titled “Vaccine Equity in Africa,” the CEO of BudgIT, Mr. Oluseun Onigbinde said that it is time to begin to prioritise the health sector during campaigns.

On accountability, he said, “This is the central theme of our work as BudgIT and Connected Development. That is why we are working hard to ensure health accountability. It is not just about putting more money into the healthcare system, we need to be accountable.

“A lot of budget lines around the healthcare system in Nigeria do not reflect the kind of outcome that we want to see. When you look at the social determinants of health. There are several factors around poverty, environmental challenges, etc, and there has to be an investment in things like that.

“For us, we believe in accountability. Accountability of the personnel themselves, not just money. Public officers and medical officers must be accountable in their stations. Accountability that funds committed to the health sector should be judiciously used. We feel a lot of these things will not change unless we go back to the basics. The basis is the primary healthcare system”.

He opined that over 70 percent of Nigerians spend out-of-pocket to access healthcare.

He however said that how to ensure that we invest in the primary healthcare system so that more Nigerians can have access to healthcare facilities is part of the objective of the project.

Also, the Chief Executive Officer, of Connected Development, Hamzat Lawal said, when COVID-19 hit the world, BudgIT and Connected Development partnered.

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“First, it was centred on following COVID-19 money, ensuring transparency and accountability, then we evolved into vaccine equity and vaccine distribution. How prepared are various governments and particularly, what is the state of primary healthcare centres across Africa?

“Now, we are looking at institutional accountability and strengthening systems and processes to deliver healthcare that is tied to the dividend of democracy. Today’s meeting is centred on Nigeria, where we are, and where we are supposed to be.

“One lesson we took out from my trip to over seven African countries is the best practices in Kenya. Today in Kenya, we have one stop shop data bank, where we can just click, and get information about the primary healthcare centre, know if they have the manpower if they have the vaccine if they have storage facilities and how many people have enjoyed the services in this primary healthcare centre.

“We don’t have this kind of facility in Nigeria. I also, think it is important to commend the National Primary Healthcare Development Agency”.

He said, there is a model to build a state of the art primary healthcare centres across the federation but there is no political will and needed finances around it.

“For us, we want to provide a roadmap that in the next ten years hopefully, when we have a robust primary healthcare centre that can deliver on the demands of citizens, particularly at the grassroots, and reduce pressure from secondary and tertiary healthcare centres to deliver on this critical health infrastructure.

“So, for us, we focus on Nigeria because of the population and gap. We are hoping that this roadmap will help in the next ten years to evolve good primary healthcare centres. And most importantly, prepare Nigeria and Africa for the next pandemic. COVID-19 is here and we are coming out of it, which of course, had impacted us economically, politically, health, and socially wise. But how prepared are we for the next pandemic? That is why we undertook this study and we partnered with BudgIT to do this very critical work and we hope this will inform government policies and decisions that are centred on data and accessibility for citizens and input by civil society and the media,” he concluded.