The Challenges of Healthcare Delivery in the 21st Century Nigeria

Information about The Challenges of Healthcare Delivery in the 21st Century Nigeria

Published on August 3, 2014

Author: gbolaadebisi1

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LECTURE: LECTURE THE CHALLENGES OF HEALTHCARE DELIVERY IN THE 21 ST CENTURY IN NIGERIA BY GBOLA ADEBISI Principal Consultant, Genius Associates Healthcare Delivery Systems: Healthcare Delivery Systems An organized plan of health services.   The system or program by which health care is made available to the Population and financed by government, private enterprise, or both.   The elements of a health care system embrace the following:   Personal health care services for individuals and families, available at hospitals, clinics, neighborhood centers, and similar agencies, in physicians‘ offices, and in the clients' own homes;  (2) The public health services needed to maintain a healthy environment, such as control of water and food supplies, regulation of drugs, and safety Regulations intended to protect a given population;   (3) Teaching and research activities related to the prevention, detection, And treatment of disease; and   (4) Third party (health insurance) coverage of system services. “Nigeria’s Heath Status: Two Steps Forward, and One Back — The Enigma of Success in Retreat”: “Nigeria’s Heath Status: Two Steps Forward, and One Back — The Enigma of Success in Retreat” 1. “A child falls ill with fever, chills and convulsions in a village over half-a-day’s journeyaway from the nearest health centre. After three sleepless nights of agonizing helplessness for the family, it succumbs. 2. A middle aged artisan in a State capital falls from a height at his workplace and sustains a compound fracture of the femur. He is taken to the general hospital where the surgeon, lacking the tools for the most appropriate treatment, undertakes what he euphemistically calls “conservative management” and watches helplessly as the patients deteriorates steadily and dies. 3. A 19-year old Polytechnic female student becomes pregnant following sexual indiscretion with a married schoolteacher. She is petrified of the consequences and seeks the aide of a Traditional abortionist in the backwoods of a city centre. A week later she is brought into the hospital with roaring septicaemia from pelvic infection. She rapidly passes from anuria to delirium to convulsions and eventually succumbs. 4. A Government Minister trips in his bath and injures his ankle. Clinical and radiologic examination in the Teaching Hospital show a soft tissue swelling with no fracture. Yet he is promptly flown out for treatment in a European country – cost to the tax-payer: 20,000 Dollars” “Nigeria’s Heath Status: Two Steps Forward, and One Back — The Enigma of Success in Retreat”: “Nigeria’s Heath Status: Two Steps Forward, and One Back — The Enigma of Success in Retreat” These four scenarios exemplify the cruel irony of our health care situation in Nigeria. The child with a fever and convulsions, probably malaria, need not die from it. Similarly, with good occupational health education the frequency of industrial accidents should be a great deal lower than it is today, and the mortality from relatively minor accidents should be insignificant. The young lady with the septic abortion, even if reckless, need not succumb had there been adequate measures to confront overwhelming infection and combat acute renal failure in a hospital setting. Her indiscretion may even have been averted with adequate and timely sex education of her “at risk” vintage. The fourth scenario, in which well over two million naira of public money is spent for overseas treatment of a minor ailment in a top government functionary, is clearly indefensible but all-to familiar even today…” Emeritus Professor of Medicine, University of Ibadan, Nigeria, Professor O.O. Akinkugbe , in his address entitled, “Nigeria’s Heath Status: Two Steps Forward, and One Back — The Enigma of Success in Retreat” The Nigerian Health System : The Nigerian Health System Three tiers: Primary (PHC) – Local Governments – first point of contact – preventive, curative Secondary (SHC) – State governments – referral, specialized services – out/in patient – surgery, gynaecology, obstetrics and community health  And Tertiary (THC) – Federal government – apex – teaching and specialist hospitals Reality Check: Reality Check Many secondary and tertiary health facilities are crowded with patients that have simple ailments that can be managed at the primary health centres which typically have many idle health care workers. However, there are some services that should be provided at all levels of care such as immunization, antenatal care and family planning. Reality Check: Reality Check “t he health status indicators for Nigeria are among the worst in the world and that on the average, health status of the population has declined, compared with the indicators of a decade earlier” . Life expectancy has continued to drop - 47years in th 2008 Nigerian Demographic Health Survey (NDHS) report, 6 years lower than the 53years average for the least developed countries (LDC) Maternal Mortality Ratio MMR) - 545 per 100, 000 live births, one of the highest rates in the world. Equivalent to 4 maternal deaths/hour, 90/day, and 2,800/month, totaling about 34,000 deaths annually. 1 one out of every 7 to 8 children dies before the first birthday and 1 out of 6 before the 5 th birthday. HIV and TB: HIV and TB The 2008 sero-prevalence survey reported an adult HIV/AIDS prevalence of 4.6%, so Nigeria has about 3.5 million people living with HIV, one of the highest numbers of infected people in the world. Nigeria has the fourth highest TB burden in the world. Where you live and your worth matter: Where you live and your worth matter Nigeria also has huge disparities in health status between geopolitical regions and income groups. Infants and children under 5 years are more likely to die in the northern region of the country than in the southern region and under-5 mortality rate is 87 per 1,000 among the wealthiest population and 219 per 1,000 amongst the poorest Issues Militating Against Good Healthcare for our People: Issues Militating Against Good Healthcare for our People Weak primary health care system Financing of Healthcare is skewed in favour of tertiary care Human resource (HR) for health challenges - brain drain even when numbers are inadequate Financing Healthcare – need to move away from Out Of Pocket (OOP). No where near the Abuja 2000 declaration of 15% of budget for health Weak and unclear government structures – Local government chairmen share monthly allocation rather than spend on health Provider focused rather than client focused health system Poor drug and medical commodities management Weak information management Immunization is Critical to Good health: Immunization is Critical to Good health Health Insurance: Health Insurance Created in 1999 by Obasanjo – Legislatively the NHIS covers government employees, employees in the organized private sector the informal sector Also covers Children under 5 Permanently disabled persons Prison inmates But in reality, it presently covers Less than 10% of the population HMOs feeding fat on capitation from government and large corporations Private doctors make cheap, easy money from capitation for other services providers NHIS is a huge government department steeped in corruption Nigeria Health Status: Nigeria Health Status The 2000 WHO report on the performance of health care systems rank the country 187 out of 191. The  life expectancy  is low and about 20% of children die before the age of 5. Traffic congestion  in Lagos,  environmental pollution  and  noise pollution  are major health issues. Maternal Mortality Rate 2010 840/100,000 births 2008 608.3/100,000 births 1990 473.4/100,000 births The under 5 mortality rate, per 1,000 births is 143 The neonatal mortality as a % of under 5's mortality is 28. Population growth has been rapid: Population growth has been rapid Source: UN, World Population Prospects, 2008 Nigeria’s population is set to soar: Nigeria’s population is set to soar Source: UN, World Population Prospects, 2008 Nigeria’s fertility rate has started to fall: Nigeria’s fertility rate has started to fall Source: UN, World Population Prospects, 2008 The infant mortality rate has fallen, but not steadily: The infant mortality rate has fallen, but not steadily Source: UN, World Population Prospects, 2008 Life expectancy has risen, but not steadily: Life expectancy has risen, but not steadily Source: UN, World Population Prospects, 2008 Crude birth and death rates are falling: Crude birth and death rates are falling Source: UN, World Population Prospects, 2008 Nigeria’s education and health spending: Nigeria’s education and health spending Source: Mason et al. 2010. Population and economic progress in Nigeria. Background paper for the NGN project.   Actual ($) % of spending Education, Public 142 7.33 Education, Private 922 47.63       Health, public 39 2.01 Health, private 833 43.04       Total 1,936 100 Total Public 181 9.33 Total Private 1,755 90.67 Per capita spending ( 2004 $s)   Nigeria’s human capital investment compared to other countries: Nigeria’s human capital investment compared to other countries Source: Nigeria: The Next Generation Task Force secretariat, 2010. Low health spending reflected in low level of maternal health: Low health spending reflected in low level of maternal health Source: Nigeria 2008 demographic and health survey: key findings. Low health spending reflected in high levels of child mortality: Low health spending reflected in high levels of child mortality Source: Nigeria 2008 demographic and health survey: key findings. Low health spending reflected in low level of children vaccination coverage: Low health spending reflected in low level of children vaccination coverage Source: Nigeria 2008 demographic and health survey: key findings. Low health spending reflected in high level of unmet need for family planning: Low health spending reflected in high level of unmet need for family planning Source: Unpublished background memo for the NGN project. Unmet need in the context of current fertility: Unmet need in the context of current fertility Source: Nigeria 2008 demographic and health survey: key findings. Conclusions and Take Aways: Conclusions and Take Aways

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