The health care sector in Nigeria has seen an increasing and deliberate neglect in the past 10 years. The British Council report on Nigeria highlighted the demise of universal access to health care in Nigeria.

In 2003 the life expectancy in Nigeria was 52.1 years old, by 2012 life expectancy has gone down to 47 years old, one of the lowest in West Africa. With the increase of private health care, increasing poverty and gender inequalities, Nigerians are finding it difficult to access free universal health care at the point of need.

An average Nigerian lives on less than $2 a day. The burden of poverty and pollution has created a disease burden generation with high demand for adequate health care.

Nigeria is one of the many developing countries and emerging markets that has failed to attain the set goals for the millennium development goals.  Based on the last global HIV surveillance report released in 2012 and the report from National AIDS Control Agency, the HIV epidemic in Nigeria is the second in the world after South Africa.

Nigeria is on the top five countries with the highest level of High Blood pressure in the world. A child born in Nigeria in 1993 will have 60% chances of reaching age five, in 2013 a child born in Nigeria will have less than 30% of reaching age five.

The northern Nigeria still accounts for the second highest numbers of missiles and polio after Pakistan.

Various governments in Nigeria have come up with different policy documents to address this “epidemic”. In 2005, the administration released the “National Policy on Public Private Partnership for Health in Nigeria Federal Ministry of Health”. According to this document the core of it will be to:

 

A central aspect of these health sector reforms is to mobilize and harness all resources – across both public and private sectors – for the benefit of the population. Accordingly, it is desirable to develop a national public private partnership (PPP) policy in health.”-

 

The policy is to create a process of allowing private health care provider into the health sector. Though this idea has been tried in many part of the world and of most recent the United Kingdom where the policy is facing stiff oppositions from many stakeholders including doctors and nurses.

A private sector run health care is built on the basis of the ability to pay for health care at the point of access. The National Bureau of Statistics said 60.9% of Nigerians in 2010 were living in "absolute poverty" - this figure had risen from 54.7% in 2004. This means that in essence almost 60% of Nigerians will not have access to health care at the point of need.

The inequality in health is not just wealth based. The British council reports above also highlight the gender. Women are more likely to die from preventable disease compared to the men.

The disparity in education and access to good living standard has also compounded the challenges women faced on daily basis. This means in effect that a pregnancy in Nigeria could mean a death sentence. About half of under-five deaths occur in only five countries: India, Nigeria, and Democratic Republic of the Congo, Pakistan and China. India (24percent)and Nigeria (11percent) together account for more than a third of all under-five deaths globally.

Nigeria as a country spends less than 5% of its gross domestic product (GDP) on health, and annual per capita health spending is less than US$ 35 per person as proposed by Commission on Macroeconomics and Health. Almost 4% of Individual household spend more than half of their annual income on health. Therefore healthcare cost is an added burden on already burdened families and households. 

In its bid to make healthcare affordable and accessible, the government came up with a “framework based on the principles of the Four Ones: one health policy, one national plan, one budget, and one monitoring and evaluation framework”. The key principles of which is built on:

Leadership and governance: The determination to increase access to universal health care demands a sense of leadership from not just the government but also from civil societies, private sectors and individual citizens. This is a very important strand to attaining the millennium development goals. There is need to increase demand for more government investment in health care and more accountability from the key stakeholders in the health sectors.

Health service delivery: The health service delivery in Nigeria is at a very sick state. In 2000, the World Health Organization (WHO) ranked Nigeria overall health care service 187th position among 191 Member States. Since 2000, Nigeria has sunk deeper in world ranking. The need to have trusted healthcare delivery service should not be compromised by the lack of ability to pay. It is the responsibility of government to provide healthcare for the people most indeed of it. The civil societies have the responsibility to hold the government to account on their promise to deliver universal health care free at the point of use for the most vulnerable in the society. The Nigerian health service can only deliver at the point of care if the government decides; to increase healthcare budget, invest in training and retraining of healthcare professionals. There is also the need to have a non-discriminatory approach to health care delivery. The national assembly with the government should take a leadership role in setting a proactive example in promoting an health service that is devoid of sentiments based on religion or tribe.

Human resource for health: Since the mid 90s, Nigeria has experienced a continuous decline in professional healthcare personnel. The 90 saw a mass exodus of Nigerian doctors, nurses and midwives to Middle East, Europe and America. For the health care in Nigeria to be competitive there need to be a huge investment in science and technology. The various medical schools in Nigeria should be well equipped and well resourced that the “traditional” lecturer strikes will not affect the level of degree. Salaries of healthcare professionals should be attractive as well and sustainable to attract promising individuals. Innovative health care delivery should be informed by good knowledge of medicines based on science and technology. The working of health care professionals should be informed by guidelines has clinical trials as its basis.

Financing for health: The government present financing of health care in Nigeria is appalling. There need to be a shift away from international donor funded health care services. The government needs to make a bold step in making proactive financial commitment to healthcare. The present financial situations in America and Europe have put a big constraint on global healthcare funding. Internationally funded healthcare is not sustainable and based on this, there should be a fiscal policy of the government to allocate up to 10%-12% of the annual budget to healthcare and health related projects including training and upgrading of hospitals and medical schools. The financing of healthcare in Nigeria should be at par with the financing of education and securities

Community participation and ownership: There is need for a health system that is community driven. The best healthcare services in the world are built around the community ownership of such services. The civil societies have a role to play in monitoring and evaluation of healthcare set goals and indicators. The Key stakeholders should not just be the government and health professionals, but also the people that use the system. Patient should have a say in the delivery of healthcare through out the process from planning to implementation. Nigerian healthcare service should be driven by the principle of “Nothing about us without us”. Community feedback should inform healthcare delivery. Healthcare policy including funding should be designed around the community demands rather than the other way round.

Research for health: The best healthcares in the world are informed by research and development. Nigeria with the rich resources at its disposal in terms of human and natural should be a leading force in global research and development. This can only be achieved through political leadership and will power. The present state of Nigerian healthcare is way below expectations.

All the listed approach is achievable only if there is a vertical responsibility from not just the government but also the people. Nigeria has failed to achieve the millennium development goal and we are approaching the end of the goal come 2015. The discussion on what should follow should be backed up with not just word but with political desire to put healthcare as part of the fundamental human rights.