As we approach year 2015, the set date for the full implementation of the Millennium development goals (MDGs), there are concerns that the MDG initiative may suffer the fate of other laudable social economic remedial projects before it, such as vision 2010.
In this exclusive interview with Pharmanews, Pharmacist Hamidu. A. Oluyedun, a practicing hospital/administrative pharmacist based in Ibadan, Oyo State, spoke on how far we are to the attainment of the health objectives of the MDGs and what should be done on the platform of public health policy formulation and implementation, to accelerate the pace of attaining the health targets of the initiatives.
How would you describe the state of Nigerian health sector today?
A health system is an organisational frame work for the service of the health care need of a given community. The state of the health of the people is the outcomes of this complex organisational frame work of inter related elements.
The national health indices are uninspiring; Nigeria is still struggling with the poliomyelitis burden, without end in sight. Nigeria is the 4th tuberculosis burdened nation in the world.
Infant mortality and maternal mortality rates are still very high and Nigeria is ranked low, among nations with access to life saving emergency at birth.
The nation is unable to effectively curb the HIV/AIDS pandemic and the malaria burden.
There is also the increasing burden of non-communicable disease such as hypertension, cancer, diabetes among other varieties of non communicable health challenges.
The health system is facing the aforementioned challenges and many more, with a decaying health infrastructure, poorly motivated health workforce and fast declining culture of professionalism, among various cadres of health workers.
Decay at the primary health care level is a draw back on the implementation of MDG health goals. How do you see this?
Statistics have shown that about 70 per cent of the Nigerian population are resident in rural and semi urban communities.
In many of such communities, primary health centers are the only source of health care service. Also, maternal mortality, infant mortality/under five deaths, among other health challenges, occur more in the rural and semi urban communities than in the metropolis.
Therefore, the PHC is a key platform in the implementation of the MDG health goals. The PHC delivery system is fraught with political, administrative and funding constrains, to mention but a few. While 85.5 per cent of public health facilities are of the primary health care level, it is the least funded tier of the public health sector.
This all important tier of the health system is administrated by the local government administration, which is the least funded level of government, with the weakest management capacity and governance structure.
As a result, the PHC are poorly funded, ill staffed, poorly equipped and not properly supervised.
Specifically can you identify areas of challenge in the MDG implementation?
There are varying degrees of success in the implementation of the MDG health goals. However, there are visible areas of challenge and low achievement in the MDG project.
Persisting and increasing level of poverty among Nigerians is a major draw back factor, in the pursuit of the health goals of the MDG. For instance, high maternal mortality rate is reinforced by gender related poverty.
Secondly, poor sanitation and inaccessibility to safe water by majority of Nigerians, have created new frontiers of health challenges, which include the resurgence of cholera epidemic in many state of Nigeria.
Funding is crucial to public health management. Where are we missing it?
The 6.04 per cent sectoral allocation to the health sector in the 2013 budget has been described as paltry and a far cry from the 15 per cent minimum designated allocation to drive the health sector.
This allocation represents just about 41 per cent of the annual estimate needed to finance Nigeria National Strategy Health Development plan. This shows the poor level of commitment by government to pursue the health goals of the MDG to a logical conclusion.
Furthermore, over 85 per cent of health facilities in Nigeria are of the primary health care level. However, health care funding is lopsided in favour of tertiary and secondary health care institutions, to the detriment of the primary health care system.
The proposed and inconclusive health bill 2004, which is expected to compel federal and state governments to commit at least 15 per cent of their budget to the health sector, is still hanging on uncertain pendulum of bureaucracy and partisan politics.
Finally, the National Health Insurance Scheme, which is supposed to help ensure there is private sector funding for the benefit of the public health system, is ineffective.
How can we reposition pharmacy practice in Nigeria?
The pharmacy profession should reinforce existing strategies and, if need be, evolve new strategies, which will make the pharmacy profession more relevant and visible, in the eye of the public, through its mission.
The pharmacists should assert their role in the implementation of existing health polices and programmes such as the MDG, NHIS, among others.
The unique advantage of the pharmacy profession is its ability to provide first class health services, cost effectively; as well as its ability to take health care services to obscure, remote and seemingly inaccessible locations that other health practitioners cannot penetrate.
Also, in this day of lean public health budget and poverty among Nigerians, cost effective pharmacy practice is more desirable than ever to meet the health reeds of Nigerians.