Nigeria Health Watch raises a point that could apply equally to malaria in children and pregnant women: “Maybe because they do not die in aircraft crashes, in gruesome fires following oil spills or in similar tragic circumstances no voice is raised in anguish about the Nigerian children that die from vaccine preventable diseases everyday.” They note that money is not the issue, because in the case of immunization, as funding increased in the 1990s the coverage rates decreased.
Nigeria Health Watch links us to the NIGERIA PARTNERSHIP FOR HEALTH 2008 November Conference in London to learn about why the health system has not stopped the deaths from preventable childhood diseases. Prof. Adetokunbo Lucas traced the history of the Nigerian Health Services and explained how it was initially established to protect colonial personnel, and one the side some locals might have been helped. Does that mentality persist – do only the elite get proper care? Prof. Lucas suggests several things that went wrong with the health system post-independence –
- PHC concept misunderstood: Primary care alone, Cheap, poor services
- Ignoring role of communities
- Federal, State Local government roles poorly defined
- Cost-effective interventions overlooked
- Failure of implementation
Another presentation by Fola Laoye of Hygeia (a community health insurance project) observed that malaria is the most common clinical diagnosis in Nigerian clinics. Hygeia believes that it is Necessary to seek alternative sources of financing and access to health care, shifting to demand-based and output driven schemes.” Such alternative health system models are important, but can they be taken to scale?
Finally Dr Abdulsalami Nasidi showed that malaria accounts for 24% of under-five child mortality in Nigeria. Unfortunately he did not think that the Nigerian health system had made appreciable progress since the return to democracy ten years ago and casts doubt on achieving the Millenium Development Goals. Dr Nasidi concludes as follows: “Nigeria continues to face several challenges in the efforts to deliver primary health care and child survival programmes includng routine immunization and polio eradication.” His reasons for this include –
- InadequateÂ levelÂ ofÂ financing
- WeakÂ managementÂ andÂ institutionalÂ structure
- LackÂ ofÂ integrationÂ ofÂ variousÂ componentsÂ ofÂ healthÂ wellÂ being
- PoorÂ coordinationÂ ofÂ variousÂ Stakeholders
- LowÂ levelÂ accessÂ andÂ utilizationÂ ofÂ healthÂ facilities
- PoorÂ resourceÂ allocationÂ andÂ management
- LowÂ levelÂ ofÂ communityÂ efforts
- InadequateÂ monitoringÂ andÂ evaluation
From the foregoing we have the diagnosis and some prescriptions for Nigeria’s health system. What we need is the political will to make the health system work to deliver malaria and other life saving and health promoting interventions.