INSIDE STORY: How health sector worsened during Buhari’s administration

Frustration, pain, anger, – these are emotions Nigerians are accustomed to, triggered mainly by the inability of the government to improve their lot. Former President Muhammadu Buhari, like every other politician eyeing the highest office in the nation, promised to fix the mistakes of his predecessors and improve the lives of Nigerians. After 8 years, the confidence Nigerians had in Buhari to transform the nation dwindled, amid unresolved national challenges.

Citizens who had not attained the legal voting age of 18, including those who did not have their voter’s cards and didn’t know the meaning of the popular phrase, chorused the “sai baba” slogan. Everybody wanted the change Buhari was promising. Today, the slogan only lingers on the lips of forlorn citizens as a sour reminder of failed promises.

On May 29, Buhari officially handed over to President Bola Tinubu, leaving behind a track record of successes as well as failed promises.

Before leaving office, a 90-page written account of the high points of the former administration was released. For this report, TheCable reviewed the document which listed impacts in the health sector against the promises Buhari made when he assumed office in 2015, and the All Progressives Congress (APC) next-level campaign manifesto in 2019.

SHORTENED LIFE EXPECTANCY

Two major elements affect the longevity of one’s life – health and socioeconomic factors.

Research on Nigeria’s health economics published in BioMed Central, a health journal, showed that socio-economic features such as secondary school enrolment, per capita income, unemployment rate, and the naira foreign exchange rate, all played a part in reducing the life expectancy in the country. However, the report said the indices did not have as much impact on one’s lifespan as they did in other developing countries. The main culprit behind a shortened life was health factors.

In 2015, according to the World Health Organisation (WHO), the top 10 leading causes of death for Nigerians included health-related issues. Neonatal conditions, lower respiratory infections, diarrhoeal diseases, malaria, and tuberculosis claimed the top five spots and pegged the life expectancy at 61. The former president’s goal was to improve the span by 10 years on average at the end of his first tenure.

Although by 2019, it increased to 63, the climb was far below Buhari’s aspirations. In 2021, two years into his second term, the World Bank’s most recent data shows that the Nigerian life expectancy now stands at 53, showing that the leading causes of death linger. 

INFANT AND MATERNAL MORTALITY RECORD WAS UNPRECEDENTED

During Buhari’s tenure, the former president made a commitment to prioritise the reduction of infant mortality to 3 per cent and maternal mortality by over 70 per cent by the end of his first term. The reiteration of this promise in his 2019 manifesto indicated that his ambitious goals had not been achieved. Tragically, both infant and maternal mortality rates reached unprecedented levels during both terms, setting distressing world records.

In 2015, according to the WHO, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100 000 live births, with approximately 58,000 maternal deaths during that year. The figures accounted for nearly 20% of all global maternal deaths giving a Nigerian woman 1 in 22 lifetime risk of dying during pregnancy either through childbirth or postpartum/post-abortion.  As at 2015, the lifetime risk in developed countries was 1 in 4900.

By 2020, a year into Buhari’s second tenure, the journal of global health reports said maternal deaths in Nigeria and India was responsible for 34 per cent of global maternal deaths. Factors that contributed to the surge in Nigeria included delay in making the decision to seek maternal health care; delay in locating and arriving at a medical facility; and delay in receiving skilled pregnancy care when the woman gets to the health facility. 

At the end of Buhari’s two-term tenure, WHO said Nigeria accounted for the second-highest number of maternal and child deaths globally. The UN said the COVID-19 pandemic, rising poverty, and worsening humanitarian crises intensified pressures on the stretched health system in the country, paving the way for a grim contrast from the targets set to improve mother and child safety.

BRAIN DRAIN AND WEAKENED HEALTH SYSTEMS DESPITE INCREASED FUNDING

Another promise the former president made in 2015 was to increase the number of physicians from 19 per 1000 population to 50 per 1000 and improve the quality of all federal government-run hospitals to world-class standards within five years. 

In 2022, a three-year assessment of the state of primary health care (PHC) facilities across Nigeria revealed that half of the PHCs in the country are weak.  

The assessment used indicators that cover policy design, legislation, and implementation at the state level, health workforce, health products, community experiences, budgetary allocation and release, and basic healthcare service delivery. According to the report, only 19 of the 36 states and the federal capital territory (FCT) achieved a score of 56 per cent and above in the areas of immunisation, nutrition, and maternal health.  

The results were startling, despite an increment in the basic health care provision fund (BHCPF), which according to the released 90-page written account was one of the high points of the Buhari regime. The fund is designed to deliver a guaranteed set of health services to all Nigerians, through the national network of PHCs.

“For the first time since the National Health Act was passed in 2014, the federal government in 2018 began including the 1% minimum portion of the consolidated revenue fund – amounting to 55 billion Naira in 2018 – to fund the BHCPF,” the report reads.

Currently, data reveals alarming figures for the number of health facilities per individual which stands at 17 hospitals/clinics to 100,000 people. The situation is worsened by the mass exodus of doctors and healthcare professionals which have hit an all-time high within the past eight years. The Nigerian Medical Association (NMA) had said the country may have to resort to importing doctors in the future.

However, doctors were not the only ones at the receiving end of poor health expenditure. Another promise Buhari made was to increase the annual national health expenditure per person to about N50,000 (from less than N10,000 at the time of his 2015 campaign).

However, the former president failed to fulfil both promises.  

Data from the World Bank shows that despite its vast development needs, Nigeria spends only $220 (about N101,000) per Nigerian per year, at merely 12 per cent of its GDP – one of the lowest levels of spending in the world. The health financing was even lower and worse at a time when the country was battling the COVID-19 pandemic when the average Nigerian received about $15 (around N7,000) worth of public health services a year.

‘ENDING MEDICAL TOURISM’ AT THE END OF ADMINISTRATION

The most interesting promise was, perhaps, the ban on all government officials from seeking medical care abroad – a proposal that the former president took no part of. 

Reports show that Buhari spent almost a year out of the country on foreign medical trips but was determined to make sure his successor would not do the same. A few days before the end of his two-term tenure, the former president inaugurated a 21 billion naira presidential wing of the Aso Villa medical centre. Aisha Buhari, the wife of the former president, said the new facility was built to end medical tourism for future presidents, noting that the project was inspired by her husband’s frequent health trips abroad.

BUILDING OF CANCER CENTRES

A notable achievement of the former administration was the building of cancer treatment centres across the country. 

In March 2018, the Nigeria Sovereign Investment Authority (NSIA) invested $10m to establish a cancer treatment centre at the Lagos University Teaching Hospital (LUTH), $5m each at the Aminu Kano University Teaching Hospital and the Federal Medical Centre, Umuahia.

These centres were established as modern diagnostic centres. They have all been completed and are now fully operational. 

The NSIA is now proceeding with the construction of new treatment centres to be located in Enugu and Kaduna, among several other healthcare investments. 

In 2019, a cancer treatment support programme, ‘chemotherapy access partnership’, was launched as a public-private partnership (PPP) between the federal government and a private sector coalition, to enable Nigerians to access lower-cost and high-quality medications for the treatment of several types of cancer.

In 2021, 12 additional hospitals were approved for inclusion in the programme to join the existing seven.

In conclusion, despite that few notable achievements were recorded in health, the sector largely weakened and made the news for several wrong reasons during Buhari’s administration. This is a clear indication that too many of his promises relating to healthcare were not fulfilled.