Kano Healthcare Delivery: A Perennial Mirage!
By Bashir I. Bashir
POLITICS DIGEST- Public health system across nations is a conglomeration of all organized activities that prevent disease, prolong life and promote health and efficiency of its people (Goolgle.com).
An effective public health care delivery system is an essential requirement for any society to function and flourish. As such, any serious government desirous of promoting and safeguarding the health and wellbeing of its people must necessarily invest an ample share of its time, energy and available resources to provide a functional, accessible and affordable healthcare delivery system for the vast majority of its population as a deliberate policy.
As a country, Nigeria is faced with a toxic combination of several intertwined problems around its health care delivery system, ranging from inaccessibility of quality healthcare to poor hygiene, systemic corruption, malnutrition, lack of access to safe drinking water, poor health infrastructure, the pervasive incidence of fake and adulterated drugs, insufficient financial investment, and lack of adequate quality health personnel and expertise to address the medical needs of patients in a timely manner.
Likewise, monies meant for the state contributory health insurance schemes are often diverted by the governors at will, and channeled to non priority areas in the health sector or, in fact, to other projects with absolutely no direct bearing to the health sector at all. The end result of all of this is a massive exodus of the nation’s trained health care personnel to foreign lands, with an estimated 3,782 Nigerian nurses reportedly migrating to the United Kingdom in 2021 alone. In addition, Kano State has similarly lost an appreciable number of doctors and nurses to Saudi Arabia during the same year under review and the state currently has a deficit of over 11,000 health personnel required to achieve a standard patient to doctor ratio.
These, amongst many other factors, have collectively combined to create a dichotomy of sorts between the few rich ones amongst us who can conveniently afford to access premium quality health care for themselves and their immediate family from privately owned health facilities at home and abroad, and the vast majority of the citizens left at the mercy of the largely ill-equipped and nonfunctional secondary, primary and rural health care centres littering the nation’s landscape. This is essentially the general state of affairs across the country, with the severity admittedly being more prevalent in some states than in others.
The irreducible minimum requirements for any acceptable healthcare delivery system is that it must enable all citizens to access health care services, which must not only be cost-effective but must also meet certain established minimum standards of quality. Juxtaposing these essential minimum requirements with a good health care delivery system’s primary purpose of helping each person achieve the four major goals of “prevention of premature death and disability, maintenance and enhancement of quality of life, personal growth and development and a good death” will immediately suggest that the vast majority of our health care facilities in the country have fallen short in that regard.
In a recent Nigeria Tribune editorial, for instance, the newspaper quoted copiously from the US Embassy’s description of Nigeria on its website in a piece of travel information advisory meant for Americans intending to visit the country. Speaking in very unflattering terms specifically on the health sector, the embassy affirms that “Nigeria has well-trained health professionals but lacks good health facilities. It particularly notes that many medicines are unavailable, including medications for diabetes and hypertension. It says that medicine should be purchased with utmost caution because counterfeit pharmaceuticals are a common problem and distinguishing them from genuine medications may prove difficult. The expose’ also says that Nigerian hospitals often expect immediate cash payments for the health services rendered. It thumbs down the emergency health services in the country, saying that they are practically non-existent, and circumscribed by unreliable and unsafe blood supply for transfusion. It then counsels intending visitors to Nigeria to consider Europe, South Africa or the United States itself for treatments that require such services. It notes, quite sadly, that “ambulance services are not present throughout the country or are unreliable in most areas.”
As unedifying as the above sweeping uncomplimentary characterisation of our nation’s failing healthcare infrastructure might seem, it should still serve as a timely wake up call and a final effort to action on the part of the leadership, both at the national and subnational levels, to strive towards addressing the specific and general issues raised. In Kano State, for instance, with current population estimates of sixteen million (16 million) inhabitants as documented by UN reports, along with a United Nations population projections of 4,219,000 for the metro area alone, representing a 2.83% increase from 2021, the need for increased hospital space to cater for the ever growing health needs of the rising population could not be greater.
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The indices in health care delivery and outcomes in Kano State are still some of the most deplorable in the country, according to recent CESPIN reports. The state has also failed to record any significant improvement in Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) outcomes, in spite of significant investments into structures and systems for maternal and child health. For instance, Kano State had one of the highest maternal and neonatal mortality rates of 1,025 per 100,000 (MNCH2), 62 per 1,000 (2018 NDHS) in Nigeria, according to credible CESPIN studies on the subject, just as the state is also home to about a third of Nigeria’s fistula patients. In addition, only 44.7% of women aged 15 to 49 years with a live birth in the last five years attended 4 or more antenatal care visits, and 23.4% of women aged 15 to 49 years with a live birth in the last five years had delivery assisted by a skilled attendant, while 80.8% of women aged 15 to 49 years delivered at home versus 19.2% who delivered at a health facility (2018 NDHS).
With about 15% of the state’s 14.3 million inhabitants being people aged less than five years, about 1 in 6 children die before their 5th birthday, with the deaths mainly being on account of one or a combination of six major diseases. These are pneumonia, diarrhea, malaria, malnutrition, HIV/AIDS and neonatal conditions, with the first three accounting for over 50% of the under-5 mortality, while malnutrition plays a synergistic role and is associated with 50% of all deaths amongst children. The state’s nutritional indices are equally just as dismal, with about 57% of the children in Kano being stunted, even as 40.3% and 58.0% of children under-5 are underweight and stunted. Likewise, immunization coverage still lags behind the set SDG targets of 90% of all basic vaccinations despite the appreciable improvements recorded within the last ten years, with communicable diseases led by malaria and acute respiratory infections accounting for most of the post neonatal child mortality.
A study conducted by BMC Health Services and published on September 15, 2020 established that managing health systems depends on having adequate information on the supply and quality of health services available. And as nations scale up efforts for improved health coverage and response against major diseases, good data is needed to track progress and performance of the health system. Timely availability of good and accurate data is, therefore, essential for public health decision-making, but few developing countries have up-to-date data to assess and monitor service quality, or to conduct annual review of health services in the public and private sector for the population.
Kano State must, as a deliberate policy, consciously strive towards bridging the data gap as a necessary first step towards comprehensively overhauling and restructuring its entire health care delivery system to meet the ever rising quality health care demands of its teeming population. With about 70% of the population living below the poverty line, access must also be increased by adopting a simultaneous approach of a deliberate expansion and equipping of existing public health facilities, along with the establishment of new ones, where necessary, to decongest already overstretched facilities and reduce the travel time for patients desirous of accessing the most basic of health care services. This will invariably free up the larger tertiary hospitals such as the Aminu Kano Teaching Hospital, Murtala Mohammed Hospital, Abdullahi Wase Specialist Hospital and others to focus on handling and treating far more serious health cases.
In addition to striving towards eradicating or substantially tackling the perennial cases of malaria, cholera, typhoid and other similar diseases that can effectively be checked through improved hygiene practices and the provision of portable drinking water and sanitation facilities, amongst others, the state also needs to pay more serious attention to the fight against the menace of pervasive drug abuse amongst its population, along with its ravaging effects and attendant health implications on the young and active members of the society.
Mental health issues also need to be mainstreamed with a view to eradicating the existing stigma around them, such that patients can freely access the necessary care they so desperately need through both existing facilities and new psychiatric care centres to be established to meet the rising cases that are daily being thrown up on account of the rising cases of drug abuse in the state. Rehabilitation and counselling centres also need to be established across the state to provide the much needed care and support for victims of drug abuse for the purpose of reintegrating and transforming them into becoming productive members of the society once again, post-rehabilitation.
Adequate attention must also be accorded to the deployment of trained quality health care personnel to man the different levels of health care facilities across the state. The state must also wage an all-out war against the age-old phenomenon of fake and adulterated drugs with a view to effectively cleaning up the entire spectrum of the drug supply chain and ultimately eliminating such inefficacious and harmful drugs from its health care facilities and drugs stores. This can effectively be achieved via a twin-strategy of increased surveillance and stringent enforcement of extant laws around fake drugs and psychotropic substance supply to punish defaulters and serve as a deterrent to others.
In the long run, and with a strategic and forward looking approach to the provision and efficient management of an effective health care delivery system, Kano is no doubt in a prime position to take full advantage of its traditional pull factor spanning centuries to become the preferred major hub of choice for quality health care delivery in the North, Nigeria and West Africa within a reasonable timeframe. This will serve as a major source of revenue for the state and also save the nation and the sub region huge sums in foreign exchange currently being expended annually on medical tourism abroad.
Bashir I. Bashir
(January 23, 2022)
