Nigeria: Health in a Political Space By Dr. Mike Adeyemi-Lawal (Health Advisor/Health Policy Analyst)
Health is vital for economic growth: ill health leads to disability and disability reduces human productive value which is an essential ingredient for economic growth. Health has stake in most sectors of the economy from agriculture to industrial sectors, consequently, political decisions do have strong influence on a Nation’s health outcomes. The awful performance of health system in Nigeria stemmed largely from poor political choices.
Nigeria has one of worst nutrition status indicators in the world especially among children less than five despite the potentials in agriculture, Cholera is becoming intractable and no one is looking at the water supply, drainage and waste management systems in those areas with repeated outbreaks. Lassa fever has become a household name with no particular homegrown innovation to tackle it. Our markets are not regulated; items with potential risk factors for Non-communicable diseases (NCD) and carcinogenic tendencies are flooding the shelves of local traders. This has further paved way for the rise in NCD putting the country in a double jeopardy of protracted infectious diseases and the rising Non-communicable diseases.
Health metrics are collections of health status, socioeconomic and health policy performance indicators. Health metrics are often intertwined with politics although, we cannot play politics with health interventions but there is health in politics. Health metrics are reflections of our political choices. Most Health metrics are medium to long term indicators and this implies that more often than not they transcend political office terms. Furthermore, in this part of the world where politicians think in short term, where it is not fashionable to throw up health indicators as political gimmicks during electioneering period, health is often relegated to an ‘after thought’ intervention.
Nigeria as a nation is a signatory to global health strategic innovations from World Health Organization (WHO) Alma- Ata declaration on Primary Health Care to United Nations (UN) Millennium Development Goals (now Sustainable Development Goals) and Abuja declaration of 2001 on funding and budgetary allocation to health. It is therefore pertinent for every government in power irrespective of political affiliations to move the country closer to achieving Universal Health Coverage. The blue print for achieving this should not be left for an after campaign discussion, it must be clearly stated from the get-go because sustainable growth cannot be attained with a fire brigade approach to health.
Health unlike conventional economic goods has some degree of uncertainty and no one should face undue financial risk in their attempt to access quality healthcare. To minimize deleterious outcomes from such uncertainties, the campaign for comprehensive health Insurance scheme is being championed by global health leaders. In Nigeria, low health insurance coverage has been identified as a major obstacle to achieving Universal Health Coverage, as it stands, only about 4% of the population is covered by health insurance and these are mainly civil servants.
Consequent upon this, Out of the pocket spending constitutes the largest chunk of about 70% of total health expenditures in Nigeria. This implies that Mallam Ciroma, the peasant groundnut farmer in Kebbi, Mazi Chukwuma, the shoemaker in Aba and Ogbeni Adekunle, the peasant cocoa farmer in Ijebu Ode basically depend on their daily earnings to pay for healthcare services in case of any unforeseen deterioration in their health and health of their family members. Ill health is stressful and not having means to pay for healthcare services is further depressing. Social and mass media are flooded with Nigerians soliciting for funds to offset health bills. Subjecting people to such level of ridicule is a breach of trust and a failure of governance.
Political debates should move from asking blanket questions about health to precise questions about the plan to address the high maternal mortality, low Health Insurance coverage, repeated outbreaks of infectious diseases like cholera and Lassa to name but a few. This would provide more objective and measurable benchmarks for assessing the performance of political office holders. It is important to demand more from individuals seeking political offices. Political office is a call to serve and the governed deserve the best service. Ron Barak, the Author of the Novel “The Amendment killer” succinctly captured it in the book as: “The government serves at the pleasure of the governed. Not the other way round. The governed never need the permission of the government to set or revisit the rules that apply to government” and this essentially summarized the concept of democracy as power of the people to demand accountability from the government.
The principle of health in all polices is meant to broaden our horizons when we set out blue prints for economic development. And a strong political commitment is needed to achieve health for all. Health is a human right which every government in power should consciously protect.
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