As the year 2023 ends in less than 24 hours, PUNCH Healthwise reflects on major events that negatively and positively shaped the Nigerian health sector and the way forward. ANGELA ONWUZOO reports
A cursory look at prominent events that dominated the Nigerian health sector in 2023 showed that it was confronted with multifaceted challenges that further exposed its weakness and ailing nature.
Major events that shaped the sector in 2023 ranged from the outbreak of diphtheria, anthrax disease, and dengue fever, to health workers’ migration to foreign countries, poor funding, exit of a major global pharmaceutical company from Nigeria, and soaring prices of essential drugs.
All of these showed that the country is far from achieving Universal Health Coverage and any of the Sustainable Development Goals pegged for 2030.
2023 has been a very difficult year for many Nigerians, especially patients and their relatives due to the economic hardship in the country occasioned by the removal of fuel subsidy, which plunged many into untold hardship and poverty.
Regrettably, prior to the removal in June by President Bola Tinubu, many Nigerians had in February battled depression with some losing their lives due to the scarcity of naira notes caused by the implementation of the naira redesign policy of the Central Bank of Nigeria.
Available evidence shows that the outgoing year was plagued by so many depressing situations that severely impacted the physical and mental health of Nigerians as well as their general well-being.
This is even as statistics showed that the challenges will continue in the New Year if the government fails to prioritise the health sector and the health of Nigerians.
Though few achievements were recorded in the sector, such as the integration of the Human Papillomavirus vaccine into the routine immunisation system, the setbacks, however, far outweigh the achievements.
Brain drain
Many stakeholders in the sector in 2023 raised the alarm over the Japa syndrome (mass exit of medical doctors) and the inadequate number of health workers in the country, describing it as worrisome.
No fewer than 10,296 Nigeria-trained doctors are presently practising in the United Kingdom, according to the Nigerian Medical Association.
Even though the patient-to-doctor ratio in Nigeria is among the lowest in the world, experts say Nigeria has a horrible ratio of one doctor to 8,000 patients, which is against the World Health Organisation’s recommendation of one doctor to 600 patients.
The Coordinating Minister of Health and Social Welfare, Professor Ali Pate said the country still needs about 400,000 health workers to cater to the healthcare needs of Nigerians effectively.
But stakeholders say it will take Nigeria 20 years at the minimum, to produce 400,000 health workers needed to fill in the gap and cater to the health needs of Nigeria’s 220 million population.
The senior health professionals said it would be impossible to produce sufficient personnel to effectively meet the country’s increasing healthcare needs with the current burden of brain drain.
A past President of the NMA, Professor Mike Ogirima, said the massive migration of Nigerian health workers to foreign countries, mostly in search of greener pastures, has taken its toll on the few doctors left in the system.
Ogirima, who is also the Provost, College of Health Sciences, Federal University, Lokoja, Kogi State, said for now, the country only produces an average of 3000 doctors annually, lamenting that Nigeria was faced with a huge doctors deficit.
“We currently have about 45,000 doctors practising in Nigeria. Many of them have left the country. If it takes 10 years to get that number of doctors, it will take another 10 years to produce other health workers.
“So, it will take us nothing less than 15 to 20 years to produce 400,000 health workers. If we are deficient and need 10 years to catch up, know that the world will not wait for us and the population is not waiting either”, he said.
Two weeks ago, the Nigerian Association of Resident Doctors disclosed to PUNCH Healthwise in an exclusive interview that no fewer than 1,417 of its members are planning to leave for the United Kingdom and the United States before the end of 2023.
NARD also revealed that over 900 of its members left for Europe between January and September 2023, expressing concern over Nigeria’s poor health sector and the rate of doctors’ exodus.
Though the United Kingdom had in April placed Nigeria on the red list of countries that should not be actively targeted for recruitment by health and social care employers, many Nigerian health workers remain unwavering in their decision to relocate and practice abroad due to poor remuneration, poor working environment and lack of facilities at home.
The WHO in 2023, listed 55 countries, including Nigeria as countries facing the most pressing health workforce challenges that make achieving the Universal Health Coverage unattainable.
A 2017 survey carried out by the Nigerian Polling organisation in partnership with Nigeria Health Watch revealed that about 88 per cent of medical doctors in Nigeria were seeking work opportunities abroad at the time.
Diphtheria outbreak
The year under review began in January with an outbreak of diphtheria, a vaccine-preventable disease in three states which later spread to 19 states and the Federal Capital Territory, claiming many lives.
Health experts blamed the resurgence of the bacterial infection and the associated high-case fatality on a combination of low vaccination among children, who are considered most vulnerable to the disease, and the absence of diphtheria antitoxin during the early stage of the outbreak.
The Nigeria Centre for Disease Control in October said diphtheria killed over 600 in 19 states and the Federal Capital Territory, with over 14,000 suspected cases recorded so far.
The NCDC on January 20 placed Nigerians on alert over the disease following reported cases in Lagos, Kano, Osun, and Yobe states.
Its Director General, Dr Ifedayo Adetifa explained that Diphtheria is a serious bacterial infection caused by the bacterium called Corynebacterium species that affects the nose, throat, and sometimes, skin of an individual.
He noted that diphtheria spreads easily between people through direct contact with infected people droplets from coughing or sneezing, and contact with contaminated clothing and objects.
Adetifa said, “People most at risk of contracting diphtheria are Children and adults who have not received any or a single dose of the pentavalent vaccine (a diphtheria toxoid-containing vaccine); people who live in a crowded environment; people who live in areas with poor sanitation, healthcare workers and others who are exposed to suspected or confirmed cases of diphtheria.
“Diphtheria spreads easily through direct contact with an infected person, droplets from coughing or sneezing, and contact with contaminated clothing and objects.
“The onset of signs and symptoms usually starts after two to 10 days of exposure to the bacteria. Symptoms of diphtheria include fever, runny nose, sore throat, cough, red eyes (conjunctivitis), and neck swelling.
“In severe cases, a thick grey or white patch appears on the tonsils and/or at the back of the throat associated with difficulty in breathing.”
According to him, 73 per cent of the reported diphtheria cases occur in children aged one to 14 years, while 80 per cent of those affected have not received any vaccination.
FG confirms first anthrax case in Nigeria
The Federal Government on July 17 confirmed the first case of anthrax in Nigeria, stating that the disease was detected in a farm in Niger State.
The FG had earlier alerted the general public to the outbreak of anthrax disease in some neighbouring countries within the West African sub-region and advised Nigerians to desist from consuming hides, otherwise known as ponmo, at the moment.
It specifically stated that the disease was widespread in northern Ghana, bordering Burkina Faso and Togo, and promised to keep Nigerians updated on developments on the disease.
Anthrax is caused by the spore-forming bacterium – Bacillus anthracis, which primarily affects animals such as cattle, sheep, and goats.
It can also infect humans who come into direct contact with infected animals or contaminated animal products, such as meat, wool or hides.
Anthrax infection may occur through the inhalation of spores, while cutaneous anthrax can result from contact with contaminated materials or through open wounds.
Exit of GSK
In August, British multinational drugmaker and biotechnology company, GlaxoSmithKline, announced its exit from Nigeria after 51 years of operation.
Since its exit, the prices of drugs produced by the company have reportedly skyrocketed, becoming scarce.
Pharmacists said GSK’s departure was a minus for the pharmaceutical industry because most pharmacies in Nigeria have one thing or the other to do with GSK, so shutting its operations was not a good signal for the pharmaceutical industry in Nigeria.
A past president of the Pharmaceutical Society of Nigeria, Olumide Akintayo, told PUNCH Healthwise that imported medicines, which formed 70 per cent of the most consumed medicines, recorded a 200 -300 per cent increase.
He disclosed that the prices of life-saving medicines for persons with renal challenges or cancer rose by about 300 per cent.
The pharmacist further noted that locally produced drugs were also affected since most of the raw materials were imported.
Akintayo also attributed the sharp rise in drug prices to the depreciation of the naira to the dollar.
Besides the GSK’s exit, soaring prices of essential drugs in the year under review were compounded by the downward trend of the naira, which it had consistently maintained since the Central Bank of Nigeria, in June, allowed a free float of the national currency against the dollar and other global currencies.
The declining naira value had led to manufacturers struggling to get raw materials, thus affecting production costs and jobs.
New leadership
A new leadership in the health sector was also a major event in the under review. President Bola Tinubu on August 17 appointed Professor Ali Pate, as the Coordinating Minister of Health and Social Welfare.
The appointment of the accomplished global health leader and a professor of Internal Medicine and Infectious Diseases sparked excitement in the sector.
Pate’s passion for the sector is unquenchable, which was evident when he gave up his role as Chief Executive Officer of GAVI, the vaccine alliance, to serve his country.
Stakeholders in the sector who applauded his appointment said the professor will not be learning the ropes from the start, as he previously served as Minister of State for Health from 2012 to 2014.
Assisting him in this crucial position is Dr Tunji Alausa, who took on the role of Minister of State for Health and Social Welfare.
They succeeded Dr Osagie Ehanire, who served as the minister from 2019 to 2023, and Dr Olorunnimbe Mamora, the former Minister of State for Health.
Pate upon assumption of office on August 21, assured that he would work toward ending medical tourism in Nigeria.
The minister said there was a gap in health outcomes that needed to be improved upon.
“When you fly from Addis Ababa to New Delhi, you see a lot of people going for medical tourism and it is not a thing we in the health sector should rest on our oars and regard as normal.
“We should do something about it and improve our health outcomes.
“It is important that we deal with the issues of governance to improve the governance of health.
“The Federal Government, states and local governments and other stakeholders will work together, including those who may be differently abled in the construct of health policy and implementation,’’ he said.
Doctors’ strike
The health sector also witnessed health workers’ strikes which have become part of Nigeria’s healthcare system, and usually take a heavy toll on helpless patients who struggle to pay for healthcare out-of-pocket.
The National Association of Resident Doctors on August 11 ended a three-week strike to press for a pay rise after the removal of fuel subsidy.
Resident doctors are medical school graduates training as specialists.
They are pivotal to frontline healthcare in Nigeria as they dominate the emergency wards in hospitals.
NARD said the decision to end the strike followed “a very fruitful meeting” with lawmakers, led by the president of the Senate, Godswill Akpabio.
“From our interaction with the President of the Senate and the practical demonstration he did before us today, we are very confident that there will be light at the end of the tunnel,” the then-NARD president, Dr Emeka Orji said.
The doctors were also demanding the immediate payment of the 2023 Medical Residency Training Fund, tangible steps on the “upward review” of the Consolidated Medical Salary Structure, and payment of all salary arrears owed its members since 2015.
The health sector is also likely to begin the New Year with a strike as members of the Medical and Dental Consultants Association of Nigeria have threatened to go on strike if their demands are not met by January 28, 2024.
The association made this known in a statement made available recently to PUNCH Healthwise and signed by the association’s president, Prof Aminu Mohammad, and Secretary General, Dr Alhaji Daiyabu.
According to the statement, MDCAN, during its emergency National Executive Council meeting held earlier in the month, deliberated on the correct payment of emoluments of Clinical Medical Lecturers with a Consolidated Medical Salary Structure, the increase in the retirement age to 70 years, the whereabouts of a kidnapped professor and improvement in the country’s security situation, among others.
Dengue fever outbreak
The NCDC on December 16 confirmed the outbreak of dengue fever in Sokoto State.
The NCDC, in a statement posted on its website, noted that the outbreak was detected in November 2023.
The statement signed by the NCDC Director General, Dr Ifedayo Adetifa disclosed that so far, 71 suspected cases, 13 confirmed cases, and zero deaths have been reported in the state from three Local Government Areas; Sokoto South (60 cases), Wamako (three cases) and Dange Shuni (one case).
The NCDC noted that the majority of the suspected cases reported fall between the age range of 21- 40 years.
Dengue fever is a viral infection caused by the dengue virus and transmitted to humans through the bite of an infected mosquito. Human-to-human transmission of the virus has not been established.
The virus is found in tropical and sub-tropical climates, mostly in urban and semi-urban areas worldwide.
Most people with dengue have mild or no symptoms and will get better in one to two weeks.
In rare instances, dengue can be severe and lead to death. If symptoms occur, they usually begin four to 10 days after infection and last for two to seven days.
The symptoms of the fever may include high fever (40°C/104°F), severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands, and rash.
Individuals infected for the second time are at greater risk of severe dengue illness.
Mental health bill
Despite worrisome events that bedevilled the health sector in 2023, there was some cheering news that excited Nigerians.
The former President, Major General Muhammadu Buhari (retd.) on January 6, signed the harmonised Mental Health Bill into law.
The Bill, which was harmonised by the Senate and House of Representatives in 2021, replaced the Lunacy Act of 1958.
The President, Association of Psychiatrists of Nigeria, Professor Taiwo Obindo, who confirmed the signing, described it as a great relief to the mental health care and practice in the country.
“A final culmination to over two decades of several efforts by the Association of Psychiatrists of Nigeria now has an Act/Law on Mental Health governance and we are now part of the global space with best global practice”, he said.
With the new law, the Lunacy Act of 1958, which practitioners condemn as outdated and inhumane, will cease to be effective.
The establishment of the Department of Mental Health Services in the Federal Ministry of Health and a Mental Health Fund are some of the provisions of the National Mental Health Bill.
Introduction of HPV vaccine
The Federal Government, on October 24, introduced the HPV vaccine into the routine immunisation system to prevent cervical cancer among girls aged nine to 14 years, and this was seen as a significant achievement.
HPV vaccines are meant to prevent infection by certain types of human Papillomavirus, a common sexually transmitted infection that can cause a range of conditions in men and women, such as cervical cancer.
The vaccination targets 7.7 million girls, which is the largest number in a single round of HPV vaccination in the African region.
The girls are expected to receive a single dose of the vaccine, which is highly efficacious in preventing infection with HPV types 16 and 18, known to cause at least 70 per cent of cervical cancers.
NAFDAC approves malaria vaccine
On April 18, the National Agency for Food and Drug Administration and Control approved the R21 malaria vaccine manufactured by the Serum Institute of India.
The Director General of NAFDAC, Professor Mojisola Adeyeye, said this makes Nigeria the second country, after Ghana, to approve the new malaria vaccine developed at the University of Oxford.
According to her, the vaccine was indicated for the prevention of clinical malaria in children from five to 36 months of age.
Nigeria records first minimally invasive heart surgery
It is also interesting to note that Nigeria’s first-ever minimally invasive open heart surgeries were carried out by a private hospital in Lagos in 2023.
The operations were coronary artery bypass grafting (CABG) – Off-Pump, and Mitral valve replacement both done without big cuts on the chests of the patients.
The successful surgeries carried out by Tristate Healthcare Systems in Lekki, put Nigeria on the list of the few countries in the developing world with the capacity to perform complex surgical procedures.
The surgeries were done on four different patients while their hearts were beating.
