By Adeola Aderounmu.
A recent report in the Nigerian Guardian (23/10/2007) revealed that the Minister of Health, Prof. Adenike Grange promised free Medicare for children and pregnant women. She pointed out that some states in Nigeria are doing that already. These two related declarations are absolutely welcomed developments. To those who do not know, a pregnant woman will become sick more easily than a non-pregnant woman and that is not because she is lazy. The simplest reason is because her immunity is now compromised (not as efficient as when she wasn’t pregnant). The immune system of a pregnant woman is saddled with the protection of more than one person. A new baby on the other hand will possess an immune system that is immature and hence can be easily weighed down by different kinds of infections. It takes time before babies develop acquired immunity which coupled with the natural (inherited immunity) can confer some degree of protection against common diseases and infections. There are quite a number of factors which will affect the maturation or development of acquired immunity. When babies are overwhelmed by infections or diseases, they could succumb and give up the ghosts.
From the foregoing therefore, it would seem very appropriate to place premium emphasis on the care of these categories of people amongst us. My past experience in malaria research opened my eyes to the un-abating trend in the death of children due to malaria, respiratory diseases and other kinds of infections, many of which are preventable or curable. For so many years now, the introductory expression in any malaria research manuscripts or published papers have read something close to or exactly like this: An estimated 300-500 million cases each year cause 1.5 to 2.7 million deaths globally of which more than 90% are in children under 5 years of age in Africa (some use sub-Saharan Africa). The population of Nigeria shifts the bulk of these deaths to our doorsteps. In addition, my MSC thesis from 1999 revealed that probably up to 65% of Nigeria’s general population experience at least one attack of malaria each year. The estimated results were based on statistical analyses of data obtained from LUTH. I am also aware that we have a number of disturbing intestinal and respiratory infections with alarming statistics on the effects on babies and children. To include the effects of HIV in the list adds to the distress.
The pronouncement credited to the honorable Minister that it is possible to make free medical care available for pregnant mothers and children under five years of age is not new to us in Nigeria. Prof. Grange went further to pledge reduction of maternal mortality and reduction of diseases burden on Nigerians. The prevailing maternity mortality in Nigeria today reveals the overall deficiency that laden the successful deliverance of health services in Nigeria. If we go by the recent report on maternal mortality released jointly by the WHO, UNICEF, UNFPA (United Nation Population Fund) and the World Bank, then the statement by the honorable minister was good timing. For 2005 only in Nigeria, up to 59 000 women may have died nationwide in cases related to maternity. One of out every 18 deliveries carries the risk of death and a whooping 1 100 deaths were estimated from 100 000 live births. This is huge and alarming if the parameters used at arriving at these estimates are dependable. Nigeria was conspicuously missing from the list of countries with good death registration and good attribution of cause of death. Hence, the report on Nigeria and other countries in Group H (the last group) were simply formulated. The republic of Ireland which recorded only one maternal death from 100 000 live births in 2005 is in group A. There were 58 other countries among those who kept National records on maternal health. Sweden recorded just 3 maternal deaths per 100 000 in 2002, the United States had 11 per 100 000 in 2003 while the United Kingdom recorded 8 deaths per 100 000 in 2004. Here are figures that Nigeria’s Millennium Development Goals should be aiming at; after all human lives ought to have equal values.
The implication of our present shortcomings in the health sector is that the success of our health ministry will (like most other things in Nigeria) depends on everlasting standard procedures that will define the workings of the health department as an institution and not as a minister-dependent organ. Prof. Grange may not the Minister of Health next year or in 4 years but there ought to be procedures that will ensure that a serving or a new minister does not start all over from the scratch every New Year. Obviously, there should be room for new ideas and innovativeness but continuity to reach certain goals such as MDG on Health should be standard. When Ministers come in every other year and make the same old pronouncements (like we are starters), then one can detect that we have simply been toying not only with the health of the vulnerable groups mentioned above but also with that of the elderly and the rest of us as well.
Nigeria has actually reached that point when words must be translated into non-stop actions without delays and not just some documented events. In this country, there are a lot of scientific and medical research reports that are wasting away. Many of these reports are awashed with blueprints on eradication of medically important diseases. No one is opening the books or database. Perhaps things are just been done shabbily or half-heartedly. That would explain why despite the popularity of interventions like RBM (Roll Back Malaria) which took off in Abuja on April 25th 2000; the reports on reduction of malaria morbidity and mortality are still indicating slow progress. So much that the documented incidence of malaria in 2003 was higher than in 1990! There should be more and more of government funding for research and development. It is time we took our health issues more seriously. After surviving all these deadly childhood diseases, isn’t it appalling that life expectancy in Nigeria is still estimated to be less than 50 years? Nigeria must look inwards and purposefully too.
Let us begin to apply our medical research results with our peculiarities in mind so that we can make giant strides in the health industry. The ministry of health must enforce national objectives that will remove the obstacles hindering the eradication of polio in Nigeria. That particular problem should be given a permanent solution once and for all. Polio is one disease we must put behind us this year by taking care of the cultural and religious hindrances attached to it. The other states of the federation that have not started implementing free medical care for children and pregnant women should be ordered to do so as soon as possible. The health insurance scheme should also cater for pensioners and old people in general so that they can also have access to cost-free or subsidized health care. For everyone, the cost of receiving excellent health care should be affordable. Public and private Health institutions at various levels (Federal, states, local and community) should be upgraded and standardized forthwith in order to meet the challenges of an ever growing population and the diversities of our health problems. The continuous public health education or enlightenment of the citizenry and the significance of family planning in all of these scenarios cannot be overemphasized. The importance of health is huge: a healthy nation is a wealthy nation.
Adeola Aderounmu is a Medical Parasitologist and author of the book: The Entrapment of a Nation (http://www.bokmaskinen.se/index.php?page=2&link=2&view=1149)