A Lifetime of Care

World Family Doctors Day on May 19 was a moment not only to celebrate the commitment, talent and dedication of family physicians across the world, but also to recognise that access to a family doctor is not the reality of all Nigerians.

There are about 40,000 registered doctors working in clinics in the cities and rural communities across Nigeria – approximately one for every 5,000 persons in the country. The World Health Organisation (WHO) standards recommend one doctor per 1,000 people.

What haunts me the most is the millions of Nigerians who never get to see a doctor at all. These are the women who are dying every day of pregnancy complications; they are the infants dying of illnesses that are completely preventable; and they are all those suffering terrible pain and dying of injuries that can be treated.

Along with community nurses and other health care workers, family physicians are at the health care frontline – but we are far too few and often do not have the resources and support we need to ensure all Nigerians get the health care that they deserve. The first international declaration stating the importance of primary health care and outlining world governments’ roles and responsibilities for health was signed in Alma Ata in present day Kazakhstan back in 1978. Unfortunately, 41 years later, the country is still struggling to provide health care at the most basic level.

The shocking fact that on average 159 women in Nigeria die every day due to complications in pregnancy and childbirth is reason enough to say we must do more. This unfortunate statistic has been compared to an airplane carrier crashing every single day and killing every passenger on board – a dire analogy for which something must be done, and fast. There are thousands of other unnecessary deaths each day that are exacerbated by poverty and that could be prevented by affordable, accessible health care, including access to family doctors, along with safe water, sanitation and improved nutrition.

It is not hard to see the links between insufficient healthcare and the disease burden on our population. Leading causes of death in Nigeria include respiratory infections, malaria, HIV/AIDS, diarrhoeal diseases, tuberculosis, meningitis, heart disease and stroke – almost all of which are preventable or certainly treatable.

Our suboptimal health care system’s problems are obvious: it is poorly managed, understaffed and underfunded. In staffing terms, we are losing our doctors and other healthcare workers in a massive medical brain drain. The fact is that if we do not offer a stronger health system and better work prospects, Nigeria will keep losing its talented medical professionals to the British, American, Australian and Canadian health systems.

In terms of spending, Nigeria is Africa’s largest economy but ranks a shocking 187 out of 191 countries globally, with respect to health expenditure per capita. Facilities and personnel are poorly distributed in favour of secondary- and tertiary-level health facilities mostly found in urban areas, while rural areas are predominantly served by dilapidated primary health care (PHC) facilities. These funding and allocation inefficiencies have led to a shortage of PHC facilities in several states and sub-standard facilities across the country.

In short, most of the country’s poorest people have virtually no access to basic health care. It is thus unsurprising that amongst nations, Nigeria ranks seventh worst in the world in terms of basic health care, health infrastructure and preventative care.

Investing in primary care is the most efficient option we have for improving the country’s health and reducing mortality rates. Evidence clearly shows that primary care is the best route to improving access to health services, leads to better quality of care, a greater focus on illness prevention, early management of health problems and reduces overuse of specialist care. Most ‘common’ illnesses which make up over 80 per cent of patient problems can and should be managed at the inexpensive primary care level.

Evidence also shows that countries with weak health and education systems usually also have severe challenges achieving sustained economic growth, while improvements in life expectancy have been associated with annual increases in economic growth. Without a healthy populace, Nigeria cannot thrive, wasting the human potential, energy and creativity of its mostly young population.

Increased spending on primary health care with better management, accountability and transparency could make healthy lives and economic prosperity a reality for all Nigerians. Recent budgetary allocations through the Basic Health Care Provision Fund (BHCPF) are a good start but we need to aspire to committing not less than 15 per cent of national and state budgets to health and allocating a major proportion – around 60 per cent of that – to primary health care.

Effective systems must be put in place to manage primary health care services, with clear roles for family doctors and community-oriented primary care within those systems. Furthermore, each of us can make a difference by letting our elected representatives know that it is the right of every Nigerian to have access to affordable health care, with family doctors at the heart of a strengthened primary health care service.


Image: Hopkins Global Health