Baton exchange of epidemics: From cholera to meningitis

The poor health indices reeled out on this page repeatedly are pointers to the fact that much more is still being expected from the Nigerian government to turn around the health system to save the needs of the majority poor souls residing in Nigeria.

Discerning observers have wondered why year in year out we kept recycling the same old epidemics that occur about the same time each year. Repeatedly we have cholera epidemics around the country on a yearly basis; similarly, you can always tell when the next epidemic of cerebrospinal meningitis, Lassa fever etc will occur, including the likely places of ‘attack’. And yet it remained shameful that no scientific approaches are put in place to curtail these retrogressive trends.

The recent example of Cholera-CSM mass infection is even more embarrassing with regards to the recent epidemic of cholera reported in a number of states across the country, which has now passed the baton of mass infection to cerebrospinal meningitis. Between the two of them, tens of thousands cases have been recorded with tens of hundred deaths noted and still counting. One recurring offensive development here is that the recurring decimal for outbreak and quick spread of the epidemics is lack of preparation and effective policy control

And malaria remain endemic

In the same vein, malaria remain the leading killer disease (particularly in young children) and the cause of most morbidities, man-hours loss and a leading reason for school absenteeism and workplace presenteeism (that is people who came to work but nevertheless are not productive because they came in sick) in Nigeria, yet we are far from reducing or stopping this predictable but largely preventable disasters and scandalous reoccurrences.

In the tradition of this page, it is relevant here to take the discussion further by proposing certain concrete interventions that will make the essence of governance meaningful to our health needs.

In respect of the aforementioned, one area where a direct impact on the health plights of most Nigerians is to make malaria control and treatment freely accessible at no cost at all levels of healthcare. This super-endemic disease in Nigeria is noted to be responsible for between 50% – 70% of the daily health challenges of our people across all the regions in Nigeria. To this extent, a centrally-focused programme of free universal access to malaria treatment and prevention will definitely go a long way to resolve this recurrent health challenge of our people. On paper, and quite apparent, the figures for the cost of execution of the proposed free universal access to malaria treatment are clearly within the capacity of the government.

Beyond the proposition on free malaria treatment is to search through the apparatus on ground in our hospitals, including the tertiary centers under the direct purview of the federal government. Just as I had noted elsewhere, the salary packages of the government-employed health practitioners and others outside government employment are forever chasing inflationary upward trend of the macro-economy and certainly need urgent review. Of course, this alone will not make real health readily available or avert the collateral trend towards brain drain outside the country if the appropriate tools to function effectively are not put in place.

In respect of the above, one is prompted to ask: of what essence is a tertiary/secondary health institution that has non-functional or is lacking in modern diagnostic tools like the CT scans and MRI gadgets or has no effective facility to handle emergency cases in an intensive care unit among others? In some cases, ordinary inexpensive diagnostic kits and monitoring apparatus like the sphygmomanometer and glucometer, for blood pressure and blood sugar checks respectively, are scarce to come by in the in-patients’ wards of many of our tertiary centers. Hence, it is important that the government provide the light at instituting truly functioning healthcare delivery system by appropriately equipping these institutions.

And what manner of health insurance?

Another important area of the health assessment of the citizens is to really measure the impact of the National Health Insurance Scheme (NHIS) which has been in place since its enactment for more than 12 years now. To date, less than 10% of the populace have been keyed into the scheme, this is made up of mainly federal government employees, few state governments’ workers and some organised private companies’ employees. The rest of the populace is not involved and there are no signs in view that this will change dramatically.

As I had argued in the past, for the health insurance scheme, the aforementioned balance sheet scream failure and not a crawling success as the operators of the scheme and those who profiteers from it want us to believe. It should be appropriate to see to it that a major review of this scheme is done immediately. 

Free health is possible

From the point of view of a medical practitioner who have had the unfortunate experiences of seeing a number of patients dying and electing to die, simply because they cannot afford the cost of investigations and treatment in hospitals (public and private), it is necessary to have a look at what is operating elsewhere with respect to the citizens’ right to appropriate healthcare delivery. The Venezuela’s model, under President Hugo Chavez, which sees and marshaled  “Health as a fundamental human right of all citizens and residents” and as such had this provided for in the constitution is a major policy, if emulated in Nigeria, that will make appropriate healthcare delivered to vast majority of the citizens at no cost.

For those who are always quick to say that universal free health is not possible from the mindset that government cannot fund it all, or that government has no business with business (including the health business!), the recent exposés on the more than billions of dollars (equivalent in other denominations) stolen by politicians and other fraud around the oil subsidy regime etc have further shown that the funds to execute such universal access to health are there. Only that the politicians and the technocrats in charge of the commonwealth are only mindful of what they will “eat” rather than mind the citizens’ health.

On the other hand, while the agitation for more funds for health is ever relevant, it is also relevant to argue that even when conceded that very little get appropriated to the health sector than understandably desired, the so-called appropriated funds hardly get to the target layers envisaged during the budget implementation. Most of these funds get embezzled by corrupt officials and their collaborating suppliers/contractors. It is important to put adequate control measures in place and make all concerned officials accountable.

Hence, hospital administrators, like the chief medical directors etc, must be made accountable for poor service deliveries, avoidable professional misdeeds and misappropriations under their purview.

This column will continue to be relevant to the citizens’ yearning for a readily accessible healthcare system where it would be taken for granted that health will be available to all at the point of need.