DOCTOR-TO-PATIENT RATIO IN NIGERIA IS CURRENTLY ESTIMATED AT 1 TO 3500- DR DAVIES ADELOYE

The medical recent trip of President Muhammadu Buhari to the United Kingdom has raised a lot of questions in the heart of Nigerians. Olutayo Irantiola of Nigerian Reporter had an extensive chat with Dr Davies Adeloye, a Senior Lecturer at Covenant University, Nigeria. Enjoy the interview-

Describe the state of healthcare in Nigeria

The Nigerian Health System is unfortunately in a pitiable state. There are six building blocks of the Health System- leadership and governance, health service delivery, health financing, health workforce, access to essential medicines, and health information systems. With repeated strikes, poor state of health facilities, poor management of common health conditions, high rates of medical tourism, among many others, the Nigerian Health System obviously needs a complete overhaul of all these building blocks.

With the volume of doctors and in fact specialists that we have in Nigeria, should the President go for ENT treatment in UK?

Obviously No. However, unconfirmed reports reveal the President had Meniere’s disease, which is a chronic debilitating disease of the middle ear. It can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear, and often affects posture and balance. There are limited audiologists and facilities in Nigeria for electrocochleography, nystamography, etc… which are vital management options for this disease. Seeking another expert’s view, and in this case outside Nigeria, may not be unjustified.

What do we really lack on the Nigerian medical space? 

Both. Most health facilities in Nigeria are ill-equipped. Doctor-to-Patient ratio in Nigeria is currently estimated at 1 to 3500. In most cases, the health workers are on strike due to several months’ salaries owed. Recently, the health workforce has also experienced internal crises with doctors, nurses, pharmacists and other allied health professional in a protracted supremacy imbroglio.

Can you give examples of prominent people who had been wrongly diagnosed?

For legal reasons, I would be silent on this. But there are several people in Nigeria who have been wrongly diagnosed. Lack (or poor use) of equipment and poor knowledge on current standard diagnostic guidelines have been main factors.

Why is brain drain prevalent in the health sector?

Poor welfare definitely. Health professionals are well paid in several countries outside Nigeria.

Should the health sector down tools often as it happens here in Nigeria?

The answer is NO. But it is also important that government seeks to create a feasible and sustainable health system framework based on “strong” leadership and governance, to address the many issues accounting for these repeated strikes.

Tell us about the National Health Bill of 2014?

Nigeria’s National Health Bill (NHB) was signed into law by President Goodluck Jonathan on December 9, 2014. In 2006, the NHB was first presented to the National Assembly, and passed by the Senate in 2008, but only made it through the House of Representatives in May 2011. It was however not approved by the then President Goodluck Jonathan due to diverse disagreements and interests among health professionals and various stakeholders. In 2011, the Senate began another series of deliberations, and it was eventually passed in February 19, 2013. The aim of the Act is to establish a framework for the Regulation, Development and Management of a National Health System, to set standards for rendering health services in the Federation and other matters concerned therewith. The Act is set to achieve the Universal Health Coverage, eliminate quackery, and provide basic health funds needed by Nigerians. It will address provision of a package of basic healthcare services and insurance, including free medical care for children under five years, pregnant mothers, and elderly people with disabilities. It addresses provision of improved funding of health care services at the grass root so that Nigerians don’t have to travel far to access medical services. It specifically addresses vexatious issues of medical tourism plaguing the health sector, stating that that ailments that can be treated in Nigeria will no longer be referred abroad. The basic health care provision fund shall be financed from Federal Government Annual Grant of not less than 1% of its Consolidated Revenue Fund and grants by international donor partners, while the state and local governments will provide counterpart fund to support primary health care services. The challenge, as with other Bills in Nigeria, is implementation. As it’s obvious now, the national system hardly respect or carry out the provisions of this bill.

What is the mortality health statistics in the country?

Simply statistics on deaths. Find below some mortality statistics in Nigeria.

Infant Mortality Rate: 69 per 1000 livebirths

Under 5 Mortality Rate: 109 per 1000  livebirths

Maternal Mortality Ratio: 814 per 100000 livebirths

Probability of dying between 15 and 60 years: 341 per 1000 population

Life expectancy for men & women

Men: 53 years; Women: 56 years

Morbidity rate per thousand

Morbidity refers to number of people affected by a disease. So this has to be cause or disease specific. That is the prevalence/incidence of a specific disease.

What is the current state of response to emergency in the country?

Very Poor. Nigeria does not have a National Pre-hospital system or an Ambulance service. Some state and privately owned ambulance services are operational, eg. the LASAMBUS in Lagos. There is also the Flying doctors rendering helicopter services. How many people have reported benefiting from their services? Any Audit or research on these? There is no widely known central emergency call line. FRSC and Police, perhaps, have…, how useful have these been? The NEMA, FRSC, Police, Military, and Trauma centres just need to be overhauled.

Kindly let us know the prevalent terminal disease in the country?

There is poor routine health information and data collation in Nigeria. So this is quite difficult to state. However, based on the limited evidence we have, most prevalent terminal illness in Nigeria are Chronic Kidney Disease, Chronic Liver Disease, and Cancers (mainly cervical, breast, prostate and colorectal).

Is the medical facilities sufficient for 170 million Nigerian?

No

Since Prof.  Folorunsho Isaac Adewole became the Minister of Health has been a laudable project that has positively influenced the health sector in the country?

In the last NMA congress held at Sokoto, the Minister of Health announced plans to implement the National Malaria Strategic Plan 2014-2020. Malaria contributes hugely to the disease burden in Nigeria, hence, this is will have positive effects in the health sector. However, this is quite an ambitious project considering the current state of our health system, but I share the minister’s optimism, especially with what we were able to achieve during the Ebola outbreak in Nigeria. The Vision is to have a MALARIA FREE NIGERIA. The Mission is to provide equitable, comprehensive, cost effective, efficient and quality malaria control services ensuring transparency, accountability, client satisfaction, community ownership and partnership. The Goal is to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero.

What singular act of the President Muhammadu Buhari led administration will radically change the medical profession in Nigeria?

Bring experts together to work on a self-sustainable National Health Insurance Scheme (NHIS). We can learn from the NHS scheme in the UK and other insurance schemes in developed countries. From the funds generated in the NHIS and managed by credible Foreign Experts (at least for now), the Nigerian Health System may sufficiently provide free health services, pay her health workforce salaries,  address ill-equipped health facilities, and see to further clinical and public health research.