THE former Acting Executive Director of the National Primary Health Care Development Agency, Emmanuel Abanida, gave an inkling of why health care facilities in the country are in such an appalling state when he recently revealed how entrenched interests have forced the abandonment of several life-touching projects in the health sector. At a handing over ceremony recently, Abanida told his successor, Muhammed Ado, that the total cost of such projects nationwide stood at a staggering sum of N8.2 billion. He explained that the National Assembly, rather than play a role of facilitating the completion of such projects, had become the main agent of delay and encumbrance. Abanida said, "Each time we cry to the National Assembly during budget defence or budget requestwe have the mountain of (fresh) requests and additions of new health facilities (thrust on us) ... It becomes difficult for us. Even when money is available, the money comes in late at such a time when it is not possible for you to complete these projects; and so the money has to be returnedthe project becomes abandoned." According to him, many of the legislators see such projects as possible "constituency projects," with which they must be associated.Needless to say, the health sector has suffered as a result of general neglect by successive administrations. As far back as 1985, the late Nigerian maximum ruler, Sani Abacha, had described Nigerian hospitals as "mere consulting clinics." Indeed, the health sector has been one of the worst hit following a general decline that has overtaken the country in the last few decades. From a once vibrant sector, with internationally acclaimed medical experts and competing levels of facilities, some of which were once designated as centres of excellence, Nigerias health care system has witnessed a decline to the extent that minor ailments now require medical attention abroad. It is estimated that affluent Nigerians spend about N30 billion annually on medical treatments abroad. India, a hitherto struggling Third World country, has suddenly become a destination of preference for Nigerian patients. The direct consequence of neglect and poor funding of the health facilities has been the high exodus of well-trained and experienced personnel suffered by the sector, while those left behind are frustrated by lack of adequate, up-to-date facilities and conducive working environment. Research has shown that the main factor in improving the health of a population is good primary health care. But even simple eradicable diseases that have been eliminated in other parts of the world as a result of effective primary health care system are still thriving in Nigeria. For instance, while the rest of the world are dealing with the threat of poliomyelitis, a highly infectious, viral disease that affects mainly children under the age of five, evidence of new infections has been reported in Northern parts of Nigeria, especially in Kano. Nigeria is only one of four countries in the worlddown from 125 in 1988that are now referred to as polio-endemic countries. "As long as a single child remains infected, children in all countries are at risk of contracting polio," warns the World Health Organisation.Besides, as a country that is striving for recognition as an emerging market, it is difficult to achieve that set goal without a healthy and vibrant population. A well-trained but unhealthy human capital is useless to any economy, let alone a troubled one like Nigerias. The Minister of Finance, Ngozi Okonjo-Iweala, acknowledged the role of a healthy working population in an economy while unveiling her economic blueprint recently. She said, "Good health contributes to economic growth and poor health reduces workforce efficiency and output." Apart from saving lives, which is supremely important, the country could do with the foreign exchange that goes into funding treatment abroad. It is worrying that despite several attempts at reform over many years, the country still lacks a clear and coordinated approach to primary health care. The appalling state of health care facilities in the country calls for an urgent action by the Federal Government, in an interventionist capacity, to complete all abandoned primary health care facilities forthwith. While this is in progress, there is the need to strengthen the local government system to be able to play its role as the engine that drives primary health care. Health experts have advocated a "bottom-up" grass roots PHC strategy. There is no doubt that if Nigeria fails to get it right at the primary health care level, the secondary and tertiary levels can never function satisfactorily.
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