In recent years, there has been a global surge in both the intensity and range of insurgencies and terrorism globally, with northern Nigeria being its most recent addition. The US Department of State reported recently that of some 15 countries surveyed for terrorism, Nigeria ranked 5th. The insurgency in Nigeria which first came to light in 2009 presents Nigeria with its gravest domestic security challenge ever. There are fears that the insurgency which has affected every facet of our national life could lead to the collapse and ultimate disintegration of the state. It has so far affected all sectors of the country, be it education, health, agriculture or the economy. Especially the North of the country has been hit hard.
Zooming in on the health sector, a sad case readily comes to mind. Yagana Goni, a 29 year old mother of 4, gave birth to her fourth child at home as usual. She however suffered post-partum hemorrhage and needed to be urgently transferred from one of the villages affected by the insurgency to the University of Maiduguri Teaching Hospital, a distance of about 120 km, to stop the bleeding. Although a commercial driver volunteered to transport her to the town after much delay, she suffered so much loss of blood that both the baby and the mother were lost.
Such is the fate of an average patient in the northern part of Nigeria, a region that has some of the worst infrastructural, health and socioeconomic indicators in the world. It is a region with a maternal mortality rate of 1,500/100,000 live births while the national average is 545/100,000, an infant mortality of 150/1000 live births while the national average is 75 / 1000 live births and a person living in that region has a life expectancy of 47 years which is 78% lower than the average national value and comparable only to that of war torn countries.
Complicating this picture further is the low level of health facilities utilization as a result of massive shortages of skilled man power like doctors, nurses and midwives, and their mass exodus to other neighboring states and countries that are considered safer. A health worker in one of the states summarized the health system in his state thus, “The health system is comatose, there are few hospitals with few drugs, inadequate and substandard technology and a lack of infrastructural support, including electricity, water and diagnostic laboratories resulting in misdiagnosis. Medical record keeping is rudimentary and diseases surveillance is very poor. We, the health workers, are so scared that the majority of us have left the state. The delivery of health care is now a personal affair and dependent on ability to pay, gradually we are becoming a state where there is no public service anymore.” Musa Babakura, a surgeon at the University of Maiduguri Teaching Hospital (UMTH) which is the only functioning University teaching hospital in the region, also described the health system as follows. “The whole healthcare system in northern Borno has collapsed and healthcare delivery is nil. The situation is a “growing health crisis”, with the sick forced to trek vast distances to receive medical attention and vaccination.”
That is why up to today northern Nigeria is one of the most entrenched reservoirs of wild poliovirus (WPV) in the world, making Nigeria the only country with ongoing transmission of all 3 sero types: WPV1, 3 and circulating vaccine-derived poliovirus type 2. By 2012, Northern Nigeria had become a reservoir for WPV reintroduction to 25 polio-free countries.
Polio is obviously on the radar of the international community, but the bad polio situation in Northern Nigeria is just an example of the general predicament in the health sector.
The very disturbing and horrendous statistics are further worsened by a weak and over stretched health system that has been affected by corruption; negative socio cultural practices; as well as poor political will, thereby maximizing the level of social and economic disconnect between the people and their leaders. The region today has the highest number of young people on drugs in the country; the highest number of child beggars; the highest number of girl-children not progressing to secondary or tertiary education; the highest number of girl-children forced into early marriages, and the highest number of employable youth out of jobs.
The Nigeria Emergency Management Authority reports that at least 470,000 people have been internally displaced from their homes while another 57,000 people have been displaced so far from that region into neighboring countries. This increasing displacement of people out of their homes has created an emergency situation in the region that is capable of spreading into other neighboring countries if nothing is done urgently.
In an interview I granted the Daily Trust newspaper, one of the major newspapers circulating in the region, I said: “The northern states need to come together and appreciate the gravity of their health care challenges and develop a comprehensive blue print for the revival of primary health care in the region. This should be backed by a very solid plan for ensuring accountability and transparency in health care expenditure in the region, because the pattern of morbidity and mortality as well as the socio-economic determinants of health and disease in the various geographical zones of the country are different. The provision of affordable and qualitative health care to the populace can be a very good tool for poverty reduction and empowerment.”
In addition, there is a need for the Federal Government of Nigeria to urgently deliver a comprehensive package of emergency medicines, vaccines and other logistics to provide much needed relief to those in need especially women and children. Also the States must devise means of retaining and motivating the available manpower remaining in the health sector by providing them extra security as well as better remuneration packages to ensure their motivation. A robust and efficient supply chain management should be in place and maintained to ensure the continuous flow of critical medicines, and other urgent logistics needed at a time like this. There is also a need for the rehabilitation of existing health facilities, vehicles and equipment to ensure prompt service delivery for those in critical need especially the vulnerable groups. Finally donor agencies need to be properly coordinated to ensure complementarity, maximization of benefit and limit waste of scarce resources. In view of the lackadaisical attitude of our government at the center, I say this is a time for more donors and donations to the north, and especially to the northeastern part of the country.
Unless, of course, nobody really cares about people like Yagana Goni.
Kurfi Abubakar (MD, MPH) is an emerging voice in global public health (2013) and works with the National Health Insurance Scheme, North West Zonal Office Kaduna, Nigeria