In the face of enormous challenges facing the health sector, the Nigeria Medical Association (NMA) recently marked ‘the Physicians’, a week when doctors appraise the medical profession and Nigeria’s health care system, among other things. The week enabled doctors in the country to offer humanitarian services and, as part of its corporate social responsibility, the association specifically charged its members to focus on strengthening health care services in medical clinics established in the various camps set up for displaced flood victims. At present, a good number of Nigerians have been rendered homeless by floods, with stories emanating from the camps that several pregnant women had delivered babies while in camp. As such, NMA deems it necessary to offer such women and other displaced persons adequate health care services.
The theme of this year’s week is: “Prescription Rights – Its Abuse and Implications for the Health of Nigerians,” while subthemes include: “Medical Tourism and Investment in Nigeria’s Healthcare System; Role of NMA and other stakeholders and Ageing and “Health – the Role of Doctors.”
While other subthemes are of paramount importance, the subtheme on ageing and health has come at an apt time, owing to the fact that elderly persons and also a larger percentage of Nigerians are being faced with high level of poverty and neglect by the government. At present, 70 per cent of Nigerians are living below the poverty line, with about 60 million unemployed persons in the country. Government at the local level, which is supposed to cater for majority of Nigerians, has collapsed and as such there are no facilities, infrastructures or social amenities to cater for rural dwellers. There is no social security system in the country, while there are no homes for the elderly in the country and pension is not being paid as and when due. This state of affairs has resulted in the untimely death of many elder citizens and, as such, the focus of the NMA on ageing and health is a welcome development.
While speaking at the flag off of the physicians’ week, the President of NMA, Dr. Osahon Enabulele, said, “It is the progressive, universal decline in functional reserve in organisms over time and that the populations worldwide are ageing, with the number of older adults expected to increase to 974 million by 2030. Currently, about 59 per cent of older adults live in the developing countries, which also have the largest absolute number and largest percentage increase of older adults.”
The global age distribution of populations is rapidly changing, due to long term declines in fertility rates and worldwide improvements in mortality rates. This demographic transition/transformation is accompanied by an epidemiological transition in which non-communicable diseases are becoming major causes of death and contributors to disease burden and disability.
In Nigeria, though the life expectancy at birth is put at 47.3 for males and 48.3 for females, the population of older adults aged 60 and above is on the increase. The population of this age group of Nigerians currently put at 7.6 million is predicted to increase to 27.7 million by 2050.
According to Enabulele “it is imperative that short, medium and long term plans be instituted to adequately cater for this age group of Nigerians and that anything short of this may lead to catastrophic consequences on health care expenditure, as well as the mortality and morbidity indices of Nigeria.” This is due to the fact that chronic and non-communicable diseases, which afflict most elderly people are major contributors to mortality and morbidity and cause increased utilization of health care facilities and resources.
In Nigeria, not much emphasis has been devoted to the care of the aged in terms of medical, psychosocial and functional needs, while there is a dearth of trained medical personnel dedicated to the care of the elderly.
It is against this backdrop that the association recommended that government at all levels to institute and enforce a policy of free medical care for elderly people. In addition, committed efforts should be made to address the socio-economic and functional needs of the elderly, particularly the prompt payment of pensions.
According to the NMA leader, the association shall partner with relevant government agencies and ministries to intensify the promotion of lifestyle medicine/health promotion campaigns to empower elderly people to live healthier lives. The association also recommended that government should also provide for the health promotional needs of elderly people in Nigeria and to create district and neighbourhood recreation/sports centres for them.
Dr. Enabulele called for training of more doctors in geriatric medicine and that geriatric comprehensive assessment is made a standard practice in all hospitals. The association appealed to government at all levels, corporate and non-governmental organisations and private entrepreneurs to massively invest in hospice care rather that old peoples’ homes. NMA also called on the National Postgraduate College of Nigeria to give greater emphasis to geriatric care and establish subspecialties of geriatric medicine domiciled in the departments of family medicine and internal medicine.
On the controversial issue of prescription rights, which has set it up against the pharmaceutical association, the doctors association called for prescription and enforcement of sanctions for violators of the framework guiding the prescription of drugs and medicines in Nigeria. According to the president, one of the problems plaguing Nigeria’s health care system is the gross abuse of prescription rights facilitated by factors such as poor regulatory and legal framework, poverty and out of pocket financing of health care, poor governance, high level of illiteracy and a weak health system.
The need for a collaborative effort between doctors and other professionals within the health sector was clamoured for by the doctors. For the patients to enjoy uninterrupted services, everyone must be ready to serve and render such service willingly and satisfactory.
The need to have unfiltered service base on approved practices was also echoed by the conference, which must be implemented by the relevance authorities.