It is common knowledge that the literacy rate among Nigerians still falls below the expected standard, worse still is health literacy. Health literacy connotes the ability to comprehend information on health related issues and apply the knowledge in making decisions about one’s health care needs. Going by this definition, a seemingly literate person can still become illiterate, when confronted with health information which may overwhelm such an individual. Even in advanced climes such as US, about 40 per cent of the population has limited health literacy. The fallout of health literacy is evident in the inability to locate health care providers and services, divulge information on health history, self-management of chronic diseases, as well as irrational use of medicines.
Health information can be quite daunting, and if not properly understood, it puts the individual in poorer health, leading to more hospital visits, increased health care spending, reduced productivity, increased morbidity and mortality, amongst several factors. The prevailing limited health literacy in the Nigerian society is also central to patient safety, medication errors, including lack of appreciation for the role of health care service providers and patronage of quacks. The most vulnerable group are the adult population (many of who grapple with chronic age-related illness), children (especially those with illiterate parents), people living in rural areas, illiterates.
A professional’s level of communication and the patient’s level of comprehension are often at variance. In the words of a senior friend, health care professionals suffer from information congestion and often find it extremely difficult to disseminate information to patients in basic, easy to understand language. Dr Rudd, a Harvard medical scholar, in his call to improve health literacy, enjoined health professionals to:
- Adjust expectations and demands from the patients.
- Consider the literacy environment.
- Improve their oral and written communication skills.
- Develop materials and tools that will aid easy understanding of health information.
The re-emergence of the middle class in the Nigerian society has brought along with it the many attendant culture and practices. This will eventually increase the health care spending. It is often said that a healthy lifestyle starts with eating right. The rapid expansion of the fast food industry in Nigeria is a cause for serious concern. The fat and salt content of most of the meals, which are mostly of Western origin, have not been analysed, and most likely may be well above the daily recommendation. In the near future, we should expect a surge in hypertension, diabetes, infertility, cancer, tuberculosis and other chronic diseases.
Unfortunately, the government does not project to increase its budgetary spending on health, to tally with licenses given to fast food franchises, brewery companies, cement companies and other industries whose activities have a debilitating effect on the citizenry. Rather, what we see is shrinking health care spending, which is well below the WHO recommendation. Individuals are therefore saddled with the burden of taking care of their health care expenses. Failure of the government to envisage and plan for the emerging health burden will put more pressure on the already overstretched facilities.
Several studies have documented that an individual with limited health literacy will incur health related expenses that are four times higher than that of a more literate counterpart. In societies where health expenditure is not reimbursed, the fraction of the disposable income that is available for each illness or hospital visit recedes towards zero, making it extremely difficult for such an individual to seek or pay for quality health care services. This does not encourage professionalism to thrive and it is one of the loopholes being exploited by quacks, causing more damage to the health of the citizenry. Curbing health illiteracy may therefore offer a solution to stem the tide of exodus of health care workers to other countries, where active measures are in place.
Improving the health literacy will reduce the incessant strikes among health care providers in the health sector. Many Nigerians, albeit unknowingly, engage in practices that will increase the number of visits to the already overstretched existing health facilities across the nation. This results in additional demand on the health care provider, who is not remunerated accordingly, and will eventually protest, by embarking on strike action to demand a better package.
On the part of the government, the lack of health literacy and the attendant burden among government officials makes it difficult for them to comprehend the situation in the health sector and seek ways to ameliorate the burden on the health care providers.
Unlike in other climes, where health education materials are generated by government and aid agencies for distribution to patients in hospitals and other health care facilities in Nigeria, the one on one contact is still heavily relied on for information dissemination. However, with a shortfall of 144,000 health workers as at December 2012, as reported by Prof. Boluwaji Fajemilehin, this method cannot make any significant impact. The burden on the available health workers is huge, with a doctor to patient ratio of 1:3500, and it makes it impossible to give adequate health education to the patient during the shortened consultation time.
Nigerian health sector is still grappling with many issues, such as paucity of funds, incessant strikes and proliferation of quacks. The constant battle for supremacy amongst some health care professionals has equally served as a distraction to any co-ordinated effort to promote health literacy, leaving the patients (to whom all took an oath to protect) impoverished. Ironically, by not taking any active, highly impactful measure to propagate health literacy, the stage is being set for increased hospital visits, which revert back to the health workers.
All healthcare providers should see it as a point of duty to help educate the teeming populace on health care information. We cannot make any significant improvement towards the actualisation of the MDG goals, or any other projected goals on health, without first educating the populace on health related issues. A healthy nation is a wealthy nation.
Correspondence: firstname.lastname@example.org. Olaide promotes health literacy via www.naijahealthcenter.com