Tropical Health Matters

Earlier this month the New York Times expressed the concerns of many in and out of Nigeria when it said “That the president of Africa’s second-wealthiest country and its biggest oil exporter had to travel abroad for minor treatment speaks volumes about the state of services in Nigeria. The average Nigerian lives on less than $2 a day and has no reliable access to electricity, clean water or adequate health care.”

Nigerians were excited about the election of Barack Obama in the US, but what of their own leaders? Low expectations were visible when the New York Times quoted a accountant in Lagos: “’What can we do? We just have to fold our arms and accept what our leaders do.’ Patrons near him nodded in resignation.” Are people also just folding their arms and watching efforts to control malaria in the country?

What can be done in this environment? The Siemens company is now in court for extensive bribery activities.  The New York Times also reports that Siemens “made $12.7 million in payments to senior officials
in Nigeria for government contracts,” and explained that, “Siemens bribed wherever executives felt the money was needed, paying off officials not only in countries known for government corruption, like Nigeria …”

Ironically and fortunately, and unlike other countries such as Uganda, Nigeria has not been implicated in corruption over the management of its Global Fund monies. Nigeria did almost lose its first GFATM malaria grants because of slow progress toward its self-selected performance indicators and did lose a GFATM HIV grant basically for just not spending the money in a timely fashion to achieve goals. Because of slow performance in its Rounds 2 and 4 malaria grants, Nigeria was unable to secure approval for its GFATM malaria proposals for Rounds 5-7.  Finally Round 8 was approved in principle, but hangs in limbo for actual funding. These experiences speak to broader health systems inefficiencies.

Being Africa’s most populous country, Nigeria faces both opportunities and challenges. The vast supply of highly qualified human resources is the opportunity – the challenge is a system that may not enable these human resources to apply their knowledge and skills to solve common health problems.

A major system challenge is the 3-tiered health system wherein Federal, State and Local Governments each have constitutionally designated health care responsibilities.  The Federal is best organized to meet policy and procurement challenges, but it is at the State and more especially the Local Government levels where actual malaria program implementation happens. The Private Sector and NGOs also play a major role, too. These non-governmental partners are involved in a national coordinating forum, but such mechanisms are rare at the State level and below.

Local Governments (LGs) that have the prime responsibility for primary health care delivery, which includes malaria services, have the weakest infrastructure, and these number 774.  Formerly the National Primary Health Care Development Agency provided technical assistance to Local Governments, but in recent years its focus has narrowed to selected wards at the level below the LG.  Until the LG health system is strengthened, it is unlikely that Nigeria can defeat malaria.

With advocates like Nigeria Health Watch things might change: “But times have changed. Nigerians will no longer be taken on wild goose chases about … “who awarded which local government what contract to build primary health care centres” … or “… which health committee colluded with which company to equip teaching hospitals with MRI scanners“…. We expect health to be measure in health terms …. and not by buildings or by machines.”