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Editorial

Brain-Drain: Nigeria’s teeming population challenged by health sector’s man-power crisis

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Dearth of professionals in Nigeria’s critical  sectors have been growing at disturbing height. The trend has hit the  health sector so hard that the problems associated with huge deficits in man-power have worsened to a profile of deep crises, requiring urgent attention. Poor conditions of service and the lamentable apparent perpetual passive concern of the Government to the defective issues challenging the sectors have constituted grounds of dissatisfaction for health professionals. The expression of displeasure with grievances taking the form of incessant industrial actions have never changed the narratives of the disposition of the Government to the sector. Today, the profile of public health system in the Country still remains unsavoury. Strike by health professionals under the employment of the Government over the years, became a redundant feature of the sector, while the critical issues of concern remain largely unaddressed.

As more health professionals grew to develop dissatisfaction over the system, losing hope on same for the years of irresponsive disposition of the Government, the resort of many have been settled on fleeing the Country for greeener pastures. The phenomenon which has grown to be known as “brain-drain” has left Nigeria’s health sector deserted of health professionals. The profile of the upside records of Nigerian trained health professionals leaving the Country yearly have been worrisome, just as several thousands are on the look for their move out of the Country, for greener pastures.

The Nigerian Medical Association (NMA) on Monday, 04, April, 2022, disclosed that no less than 9,000 medical doctors fled the Country for greener pastures in two years. Their destination were noted to be largely the United Kingdom, United States of America and Canada. Statistics of records since the period of concern (2016 and 2018) have left the health care system with only 4.7% of specialists to manage Nigerians’ health concerns – development experts have lamented to have left negative impacts for health management in the Country. The rippling effects of the deficiencies have seen the Country losing billions to medical tourism.

In lamentation, NMA President, Professor Innocent Ujah, at the NMA’s maiden annual lecture tagged: “Brain Drain and Medical Tourism: The Twin Evil in Nigeria’s Health System,” had disclosed that over $1 billion was being spent yearly by Nigerians on medical tourism. He had decried the high emigration rate of doctors of Nigerian extraction to foreign nations, regretting a situation of health workforce crisis. The Don who had noted that human resources for health, which according to him, represented “one of the six pillars of a strong and efficient health system,” was critical to the improvement of health system, said the huge amount Nigerians were injecting into medical tourism has weakening effects on Nigeria’s economy. According to Ujah, the impacts of the ugly phenomenon on the economy, include reduction of funding and investment in the health sector, widening infrastructural deficits and the growing distrust in the Nigerian health system by the Nigerian public.

“According to the World Health Organization (WHO), sub-Saharan Africa has about 3 per cent of the world’s health workers while it accounts for 24 per cent of the global burden of disease. Nigeria has a doctor-to-population ratio of about 1: 4,000-5,000 which falls far short of the WHO recommended doctor-to-population ratio of 1:600. Nigeria is still grappling with disturbingly poor health indices. The Nigerian health sector today groans under the devastating impact of huge human capital flight which now manifests as brain drain.

“The twin monster of brain drain and medical tourism seems to have a bi-directional relationship, which implies that one will lead to the other and vice-versa. It is because of the devastating consequences of this twin evil on the health system efficiency and effectiveness and the urgent need for solutions and action that inspired the theme for this maiden NMA Annual Lecture tagged, ‘Brain Drain and Medical Tourism: The Twin evil in Nigeria’s Health System.’  The burning desire of NMA to proactively confront the many challenges of healthcare delivery in Nigeria must be sustained using evidence-based constructive engagement, high-level advocacy and understanding to achieve quality healthcare for our people so as to reduce the unacceptably high morbidity and mortality. This national discourse on brain drain and medical tourism is, therefore, inevitable at this time,” he was quoted.

The impacts of these trends are, by no small means, inimical for a nation under the stress of population explosion. The paradox of alarming dearth of health professionals in the Country, amidst population explosion is worrisome. On Monday, 1st, August, 2022, at a press briefing in Lafia, the Nasarawa State capital, during the 23rd Annual National Scientific Conference tagged, ‘Covid 19 Experience: Expanding The Role of Health System Pharmacists,’ the National Chairman of the Association of Hospital and Administrative Pharmacists of Nigeria, Olabode Ogunjemiyo, mentioned that poor service conditions were responsible for the brain-drain in the health sector. He pointed out that between January and July 2022, over 200 pharmacists had left the country to foreign lands in search of greener pastures. He was quoted, “Poor condition of service is the reason for brain drain in the health sector. Since the year began, over 200 pharmacists have left the country in search for greener pastures. And in order to check the trend, the federal and state governments need to set aside substantial resources to upgrade all our health centres and improve on our welfare packages.”

The realities before the Country is such that demand a responsive health system. The growing population, reflecting an explosive dimension, would only require that there be conscious investment in the health system for a robust architecture to cater for the demands of a population growing in such dimension. The poor commitment of the Government to the challenges of the health sector has been lamentable, apparently reflecting insensitivity to the demands from the sector pari-passu the realities of a growing population.

Commitment of huge investments to revitalise the public health system of the Country is a necessity before the Government to fulfil. The Government must live up to the expectations of developing a virile health system responsive to the demands of the Nigerian population.

As observed, large population is a source of national strength, however, in as much as such remains a potential power, it could also serve as debilitating factor. The expression of the later, finds reflection where a huge percentage of the population is saturated with unhealthy persons, who, a bad health system is unresponsive to addressing their health challenges.

To save the Country from unmanageable health crises, the Government must rise to the demands of reconfiguring the public health system of the Country. The demands for such, require nothing but an overarching concentration and deliberate commitment to the necessity of developing a responsive health system, correspondingly suitable to the realities of the growing complex population, and the challenges associated with same as health is concerned.

The troubles of the sector, which have left it unattractive and unsavoury for practitioners, must be addressed to avert the heat of looming crises which rising dearth of professionals is portending. Addressing the various issues relating to poor conditions of service, creating by the desertion for greener pastures, a vacuum brewing an alarming man-power crisis in the sector, is a necessity that must be addressed concertedly with much alacrity.

Editorial

Articulated vehicles and the scourge of avoidable deaths

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Nigerians across the country continue to die utterly preventable deaths thanks to a lack of political will on the part of its leaders. It is an ugly fate thrust upon its citizens to live in a country whose economy is built upon the blood of the ordinary people, not out of sacrifice, but nonchalance. Articulated vehicles wipe out families, dreams, and human capital in one fell swoop. Press statements from the leaders are not enough. We need the May 2024 immediacy of the Tinubu administration in this sector too.

Last week, a falling container killed a woman in the Ogudu area of Lagos. The woman was inside a car when the fully loaded 40ft Mack articulated truck fell on it, leading to her instant death, according to the Lagos State Traffic Management Authority (LASTMA).

In October 2023, a businessman identified as Akuma Kalu, was crushed to death by a 40-feet container that fell on his car along the failed portion of Etche-Ngokpala road in Etche Local Government Area of Rivers state.

In September 2023, five women died in a fatal accident that occurred in the early hours of Friday at Odumodu Junction, Nteje, Oyi Local Government Area along Awka Road, Anambra State. As usual, the container of the truck fell upon the bus carrying these people, killing them. We could go on and on. The story remains the same: tragedy upon tragedy.

Every year, the Federal Road Safety Commission, FRSC, does sensitisation with little result to show for it because the arm of the law is too short to punish offenders at the root of the problem. The constant assault on the senses has led to a desensitisation on the part of the populace. Month after month, another story of a truck that erases a family, or multiple families because its brakes fail, or its container is overturned. The combination of the death of empathy on the part of leaders and the emotional exhaustion of the citizens will lead Nigeria down the path of a dystopia.

The governors of each state have a responsibility to institute laws to protect the indigenes. This, the Federal Government must also do nationwide. The FRSC has rules and regulations for trucks. The Government needs to only enforce these rules. Enough of blaming the trucks themselves because they are not the evil entities. The lack of accountability and a weak system perpetuates the dilemma.

The political class should not wait until Nigeria happens to one of their own before acting as is usually the case. Most cases bear the mark of immediate fatality. By the time a family member experiences it, it would have already been too late. We have hope that this administration will do what it takes to restore hope to the common man. Time to act is now.

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Editorial

Renewed Hope Initiative: Beating back inequality in all spheres

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Nigeria is full of inequalities that its leaders contend with administration after administration. With every President comes a partner who shares in the vision, and does her part to alleviate the pains of the citizens. Oluremi Tinubu has etched her name in the annals of history as one of such compassionate ones.

Recently, in Abeokuta she flagged off the Renewed Hope Initiative for women in agriculture and people living with disabilities nationwide in a bid to achieve this noble goal of equity in Nigeria.

“We are supporting 20 women farmers per state with the sum of N500,000 each. To this end, a draft of N10 million per state for the South West zone will be handed over to the first ladies of Ekiti, Lagos, Ogun, Ondo, Osun, and Oyo states who are the Renewed Hope Initiative (RHI) state coordinators for onward disbursement to all beneficiaries in their respective states,” she said.

“The Renewed Hope Initiative Social Investment Programme will be empowering 100 persons with disability, small business owners in Ogun State with a sum of N100,000 each to recapitalise their existing businesses.”

In Kebbi, represented by the Wife of the Speaker, House of Representatives, Fatima Tajuddeen Abbas, in Birnin Kebbi, she said, “Agriculture plays a pivotal role in achieving sustainable development and food security. Consequently, we are introducing ‘Every Home a Garden’ competition to encourage each Nigerian woman to cultivate a garden at home to feed the family and share with neighbours, we want to see food on every table.”

We commend the forward thinking and passion for national growth required for such a herculean task. If emulated in all quarters, it will stimulate the economy at the grassroots. It is well acknowledged that the government cannot do it alone. Private individuals who are capable must rise up to contribute to national growth.

It isn’t alien to the Nigerian condition, after all. The country was able to survive the assaults of the COVID-19 pandemic thanks to the joint efforts of private individuals under the umbrella of Coalition Against COVID-19, CACOVID, a Private Sector task force in partnership with the Federal Government, the Nigeria Centre for Disease Control (NCDC). The Renewed Hope Initiative joins the tradition of programmes committed to national improvement. History will look upon it kindly.

 

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Editorial

Increasing access to community healthcare

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Recently the World Health Organisation (WHO) decried the increasing threat to the right to health of millions of people across the world. The WHO Council on the Economics of Health for All has stated that 140 countries recognise health as a human right. Unfortunately, these countries are not passing and putting into practice laws to ensure that their citizens are entitled to access health services. According to the global health agency, about 4.5 billion people, over half of the world’s population, were not fully covered by essential health services in 2021.

The WHO Regional Director for Africa, Dr. Matshidiso Moeti, in her message underscored the fact that health is not only a fundamental human right, but also central to peace and security. According to her, addressing health inequities requires intentional efforts. Considerations of vulnerable groups must be addressed. Their needs ought to be purposefully integrated into health programmes at all levels to accelerate progress toward Universal Health Coverage (UHC).

‘My health, my right,’ the global agency used the occasion to call for action to uphold the right to health amidst inaction, injustice and crises. The year’s theme, according to the organisers, was chosen to champion the right of everyone, everywhere to have access to quality health services, education, and information, as well as safe drinking water, clean air, good nutrition, quality housing, decent working and environmental conditions, and freedom from discrimination.

Moeti noted that many in the African region still need help with access to quality essential health services due largely to unfulfilled rights. She observed that this is further compounded by protracted and ongoing crises such as conflicts, climate change, food insecurity, disease outbreaks and epidemics.

Available figures show that the number of people aged 15 and over living with HIV is still high at an estimated 24.3 million in 2021 (3.4 percent of the total population) compared to 15.6 million in 2015. This underscores the continued transmission of HIV despite reductions in the incidence of people newly infected and the benefits of significantly expanded access to antiretrovirals. Moeti called on member states to uphold the progress towards fulfilling the right to health, agreed by all nations of the world in 1948 and enshrined in the WHO Constitution.

“The right to health is a universal right of all human beings, regardless of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, or another status,” Moeti stated.

Nigeria, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, has reiterated the ministry’s commitment to ensure the health and wellbeing of all Nigerians. The minister is of the view that the right to health is not just the ideal, it is a fundamental human right enshrined in the Universal Declaration of Human Rights.

For millions of Nigerians, accessing quality healthcare is a challenge. However, the federal government has mapped out some initiatives to address the challenge. These include Basic Health Care Provision Fund (BHCPF) and the Nigeria Health Sector Renewal and Investment Initiative and strategic partnerships through which the health ministry is ensuring access to health of Nigerians in remote communities across the country.

Unfortunately, the right to health for all Nigerians has not been enshrined in our laws. Therefore, we call on the federal and state lawmakers to make laws that will ensure the right to health of all Nigerians. We need laws that will ensure Universal Health Coverage for all Nigerians.

Such laws will ensure that every Nigerian has access to quality health at all times. These include having access to potable water, clean air, quality nutrition and quality housing, decent working environment and freedom from discrimination.

While the laws that will enforce the right to health of all Nigerians are being awaited, the government must improve access to health by ensuring that quality healthcare services are provided at the Primary Healthcare Centres (PHCs) across the 774 local government areas.

If the primary healthcare centres are functional, the nation’s disease burden would have been reduced by over 70 per cent. The government should provide free health services at the PHC level. For Nigeria to increase access to quality health for millions of Nigerians and ensure UHC, the health funding must be significantly increased.

Pathetically, it has become an eyesore that millions of Nigerians living at the grassroots don’t have access to quality healthcare services. This is a wakeup call to the various state Governors and their Chairpersons to reinvest in the health sector, especially the community people.

Most of the health institutions and healthcare facilities are in a dilapidated stage at the rural communities and there is no motivation for health personnel in terms of incentives, knowledge acquisition such as training and retaining of staff, the equipment in various hospitals and clinics are outdated. The federal government in partnership with international donors should reenergise in the health system for the betterment of the masses.

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