COVID-19: Nigeria needs a purposeful response

BY TOPE AKINYODE

There is currently no known vaccine in preventing global pandemic – Coronavirus (Covid-19). Healthcare experts say if you wash your hands regularly with soap or with alcohol-based handrub, and observe some other basic-level infection control precautions, you may wade off the demon disease; or reduce likely exposure.

Globally, death toll arising from Covid-19 continues on an alarming rise with the most developed countries actively topping the chart. However, Nigeria has only recorded its fifth death.

What exactly does healthcare look like in Nigeria? Obsolete and ill-equipped, with unavailability of essential vaccines and drugs. In 2017, Zahra and Aisha Buhari; daughter and wife of the Nigerian President both raised different alarms that the clinic which services the Aso Rock was lacking in the supply of basic drugs. Zahra alleged that the Aso Rock clinic lacks conventional Paracetamol tablets, while Aisha decried that the facility does not have a single syringe despite the huge budgetary allocation of 3 Billion it receives.

Before the pandemic, Nigeria’s healthcare was in a deplorable condition. Having an estimated population of more than 200 million people, only 72 thousand-plus Nigerians are trained medics. According to the Nigeria Medical Association (NMA), over half of Nigerian doctors practice abroad. The rough statistic is that there are 42,000 doctors to 200 million people and this, as the World Health Organization (WHO) puts it means that the physician-to-patient ratio is 4 doctors to 10,000 patients – patients have to usually wait long hours before being attended to.

Faisal, Jamil and Chowdhury (2017) projects that Nigeria’s major public health challenges are infectious diseases, maternal mortality, infant mortality, road accidents, disease surveillance, non-communicable diseases, and poor sanitation and hygiene. Talking about poor sanitation and hygiene, Nigeria is identified as the leader of open defecation worldwide. Suleiman Adamu, Minister of Water Resources in explaining the reason for the open defecation surge admitted that ‘approximately 47 million people do not have access to sanitation services in its most basic form’. To prevent a global viral disease – which potentially has no end in sight – and which is best minimized through good hygiene practices, Nigeria has a long way to go.

Citizens do not have an actionable right of healthcare per se under the 1999 Constitution of the Federal Republic of Nigeria as amended (the constitution). Although, the Constitution under Section 33 provides that citizens have a right to life, it does not envisage that ill-health could derogate from the right.

The major pronouncement on healthcare in the constitution is encapsulated under the ‘fundamental objectives and directive principle of state policy’ in Section 17 (3) (c), (d) which states that:

‘The state shall direct its policy towards ensuring that –

(c) the health, safety and welfare of all persons in employment are safeguarded and not endangered or abused;

(d) there are adequate medical and health facilities for all person’.

The courts have held that the above fundamental objectives and directive principle of state policy are ‘non-justiciable’. In law, an enactment is non-justiciable if it is non-enforceable. In Ugwu v. Ararume the Supreme Court per Hon Justice Muhammad, JSC held that:

‘An enactment is justiciable only if it can be properly pursued before a court of law or tribunal for a decision. But where a court or tribunal cannot enforce such enactment then it becomes non-justiciable’.

Notwithstanding the above, courts have also held that certain conditions could activate the fundamental objectives and directive principle of state policy to make them become full-fledged, actionable rights.

In AG Ondo State v AGF, the Supreme Court held that ‘the directive principles (or some of them) can be made justiciable by legislation’. Furthermore, in Ugwu v Ararume (sic), the Supreme Court noted that ‘the executive does not have to comply with the enactment unless and until the legislature enacts specific laws for its enforcement’.

In a move which appears to give credence to the fundamental objectives and directive principle over healthcare, the National Health Act was enacted in 2014. First proposed as bill in 2004, the bill’s enactment took a decade-long. Despite that, the Act and other sundry healthcare regulations are yet to meet up with international standards on healthcare.

Even though Cuba is regarded as poor, its healthcare outperforms many others globally. In Cuba, doctors annually visit each household; checking hearts, blood pressure, and probing into lifestyle. As at 2015, Cuba’s physician-to-patient ratio was 8 doctors to 1000 citizens; which is more than double of the physician-to-patient ration in the UK and the US. Healthcare is a fundamental human right in Cuba. Article 9 of the Cuban constitution stipulates that every sick person must be treated. Articles 43, 48, 49, and 50 of Cuba’s constitution mandates free healthcare for every citizen, safety of workers and healthcare assistance to the aged. The saying is true of Cuba that Cubans ‘live like the poor, but die like the rich’ because rather than pay hugely to cure a disease, the health system prevents it. And what more? While the entire world grapples with Covid-19, Cuba has gone a step further, it is now taking the burden of the world upon itself – and presently, Cuban doctors are in Italy – rescuing lives from coronavirus. For the records, Cuba’s most valuable and biggest export is its doctors.

The outbreak of the deadly coronavirus disease should force Nigeria to make a purposeful resolve for an improved healthcare.

Akinyode, a Lagos-based multi-disciplinary and human rights lawyer tweets @TopeAkinyode