A few weeks ago, a domestic worker in my home—let’s call her Mama Musa—narrated the experience of giving birth to her first child to me. When she arrived the only functional primary healthcare centre (PHC) in her village in labour, she was given a bed and told to wait because there was no doctor available to attend to her. After a few hours, a nurse arrived and told her she needed to start praying. Fear gripped her as she started to remember the faces of the women in her rural community in Plateau State who never survived childbirth. After much ferocious prayer, and without a doctor, she was able to give birth to her first son. She is still one of the lucky ones: she had a PHC she could access, and a skilled attendant present at her birth. Considering that 1 out of every 5 PHCs across the country are dysfunctional, and that the costs of private healthcare are out of reach for the average Nigerian, the process of creating life often become a series of negotiations with death for Nigerian women.
Each year, 58,000 women die in Nigeria due to pregnancy and childbirth related causes, making Nigeria the second largest contributor to maternal mortality in the world. Many of these deaths could be prevented, but Nigeria’s coverage and quality of health care services are abysmal. It’s not just women who are being failed: the 2,300 under-five year olds who die daily, the billions of naira Nigerians spend on medical tourism every year, and the outbreaks of diseases like Lassa Fever are just a few of many examples that Nigeria’s healthcare system is failing us all. Scandalous health statistics and stories are so ubiquitous in Nigeria that it is hard to not become desensitized to them—but none of this is normal.
Nigeria can do better. Indeed, if Nigeria is to retain the ‘Giant of Africa’ title, Nigeria must do better where healthcare investments are concerned. Despite being shaken by genocide in the 90s, Rwanda was able to achieve the highest average annual reduction in both under-five and maternal mortality in the world between 2000-2015. By 2012, Tanzania had fulfilled its 2001 Abuja Declaration commitment to allocate at least 15% of the budget to improve the health sector. Four additional countries reached this target by 2014: Gambia, Malawi, Swaziland and Ethiopia. Meanwhile, Nigeria’s budgetary allocation to the entire health sector last year was 5.2%. In fact, when WHO calculated government spending as a share of GDP in 2014, South Sudan spent more on health than Nigeria. Yes, South Sudan.
Improved health investments aren’t just good for Nigeria’s ego—it’s good for her economy. Because Mama Musa survived childbirth, she has been able to support her family since her husband’s death. She has a farm in Plateau state managed by her two sons, and sends money to them to boost the business through her earnings in Abuja. But the case for improved healthcare investments in Nigeria is not just anecdotal: empirical evidence confirms the economic gains associated with increased healthcare investments, when coupled with good policies and good governance. For example, a study published by the WHO, World Bank, USAID and others in 2011 notes that increasing life expectancy by just one year can increase a country’s GDP by 4%. Studies have also shown that an investment of $1 in reducing stunting among children yields $11 in economic benefits. Healthy and productive citizens are the most essential component of Nigeria’s Economic Growth and Recovery Plan.
The National Health Act (NHAct) of 2014 provides a clear plan for improving healthcare investments and achieving universal health coverage in Nigeria. The Act mandates at least 1% of Nigeria’s Consolidated Revenue Fund (total federal revenue) is to be transferred to the Basic Health Care Provision Fund (BHCPF). This investment would provide Nigerians citizens with a basic minimum package of health services. This package would have meant Mama Musa and her peers had access to maternal, newborn, immunization, emergency and routine care at a minimum standard when she had her children. Today, it would mean she does not have to worry about investing all her earnings in private healthcare whenever she or her children get sick.
Unfortunately, the BHCPF has not been operationalized since the law passed, meaning that millions of lives have been lost, and that millions more hang in the balance. In 2015, the Ministry of Health noted that if effectively implemented, the NHAct of 2014 is cumulatively capable of saving 3,131,510 lives of mothers, newborns and children under age 5 by 2022.
With budget deliberations currently underway, ONE and its partners are calling for just 1% of Nigeria’s total federal revenue to be allocated to the BHCPF this year. By implementing this law and taking additional steps to ensure transparency and accountability in Nigeria’s health system, the Government of Nigeria has the ability to Make Naija Stronger. Over the past few weeks, key members of the National Assembly have demonstrated unprecedented commitment to include this 1% statutory transfer in the 2018 Appropriations Bill. The National Assembly cannot accomplish this on their own, however, as the President must assent to the bill before it becomes law. And so, all roads lead to Aso Villa. Mr. President: will the change continue with you?
Blessing Omakwu-Soremekun, Esq. is the Policy and Advocacy Manager at ONE, an international campaigning and advocacy organization working to end extreme poverty and preventable disease
This article was first published in the Daily Trust Newspaper on the 19th of April 2018