Introduction
Policy development in the health care system has been an issue in Nigeria, which is a developing country. Policy makers and other important stakeholders in the health care system of Nigeria have been grappling with many issues that relate to the delivery of healthcare services to the population. Uneke, Ezeoha, Ndukwe, Oyibo, and Onwe (2010) note that, “capacity constraints at the individual and organizational level, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs” are major issues that cripple health care system in Nigeria (p. 110). Since the delivery of healthcare services is dependent on the nature of the health care system, ineffectiveness of the system reflects the poor state of health care in Nigeria. Moreover, Osazuwa-Peters (2011) notes that social determinants of health in Nigeria are environment, cultural beliefs, and inaccessibility of healthcare services. The existence of these determinants of health explains why there are geographic and ethnic disparities in incidences of infectious diseases like polio. Therefore, the research paper analyzes the state of health in Nigeria with a view of identifying social determinants of health, health issues, current solutions, and development of health policy.
Rationale for Selecting Nigeria
Nigeria is a developing country, which has many health issues for its health care system is still in formative stages. Owing to its economic conditions, the healthcare services are not only unaffordable, but also inaccessible. Since the population of Nigeria is about 150 million, it is difficult for the government to provide affordable and accessible healthcare services. Statistics show that over 50% of the population in Nigeria lives in rural areas, where healthcare services are inaccessible. In a bid to improve accessibility of healthcare services in rural areas, the health care system established over 20, 000 primary healthcare centers. Osazuwa-Peters (2011) highlights that primary health care centers are in a state of decay because lack of enough resources put their infrastructure in poor conditions, which impede the delivery of healthcare services. Evidently, the state of the healthcare system in Nigeria reflects that of developing countries, which require appropriate policy development to enhance accessibility and affordability of healthcare services.
As a public issue, the shortage of human resources affects the delivery of healthcare services in Nigeria. According to World Health Organization (2014), Nigeria is one of the 57 countries that face human resource for health crisis since the proportion of doctors, nurses, and midwives are still low to enable the health care system to deliver basic healthcare services to the population. Brain drain is one of the reasons that are causing shortage of healthcare providers in Nigeria. Uneke, Ogbonna, Ezeoha, Oyibo, Onwe, and Ngwu (2008) state that poor compensation packages, inadequate infrastructure, and overworking conditions are some of the reasons that cause the brain drain in Nigeria. Poor coordination of private and public sectors affect the distribution of healthcare providers and consequently health disparities. Nigerians in urban areas can easily access healthcare services because healthcare providers offer quality services. Comparatively, in rural areas, Nigerians obtain poor quality of healthcare services for healthcare providers grapple with motivational issues such as absenteeism, laxity, deprived examination procedure, and lack of courtesy. Therefore, the issue of insufficient human resources in the health care system makes Nigeria an appropriate case study of policy development to alleviate this state of affairs.
Social Determinants of Health
As a developing country, Nigeria has numerous determinants of health. The physical environment is a social determinant of health in Nigeria. Being in a tropical region, infectious diseases such as sleeping sickness, malaria, and polio are common. Osazuwa-Peters (2011) argues that tropical latitudes and high temperatures in the Northern part of Nigeria are responsible for the high incidences of polio in the region. Likewise, high tropical temperatures favor the survival of mosquitoes and tsetse flies, which causes malaria and sleeping sickness respectively. Hence, the physical environment is a significant social determinant of health because it determines the incidence of polio, malaria, and sleeping sickness in Nigeria. Sanitation and hygiene comprise a social determinant of health in Nigeria because sewage systems are poor and water is prone to contamination (Osazuwa-Peters, 2011). In this view, diseases such as polio, cholera, and dysentery in which their transmission occurs through oral-fecal route are prevalent.
Poverty and illiteracy are two social determinants of health, which correlate with health conditions of the population. Poverty determines the distribution of infectious diseases such as malaria, cholera, dysentery, and polio. Essentially, poverty comprises of factors that relate to lack of income and low social status, such as powerless, voiceless, vulnerable, inaccessibility to healthcare services, and poor lifestyles. Since the distribution of resources has gender orientation, women are poorer than men in Nigeria are. Statistics indicate that, “67% of Nigerians live below the poverty line of less than $1 a day and only 49% of people in rural areas have access to safe drinking water” (Osazuwa-Peters, 2011, p. 118). According to a survey done, the prevalence of malaria is higher among the poorest households than the richest households are and is high among adolescent girls and pregnant women than men (Ricci, 2012). Moreover, diseases such as cholera, polio, and dysentery are common in slums and rural areas, where sanitation and hygienic conditions are wanting. Regarding the aspect of illiteracy, it is a considerable health determinant in Nigeria because it relates to poverty and disempowers individuals from making appropriate healthy choices.
Culture is a health determinant in Nigeria because some communities or ethnicities do not recognize conventional medicine. Cultural values and beliefs emanate from their respective religious backgrounds, which are predominantly Christian and Islam. Muslims, who are dominant in Northern Nigeria, believe that the evil spirits cause polio by drinking the blood of the patients and paralyzing limbs (Osazuwa-Peters, 2011). Such a belief has affected the immunization rates in Nigeria because a considerable number of families are unwilling to vaccinate their children as a means of preventing the evil spirits. Additionally, over 80% of the population in rural areas prefer traditional medicine owing to their beliefs, and thus, people seek medical attention from traditional doctors. Deprived awareness of prevention and treatment interventions due to the inaccessible and poor healthcare services characterizes the health care system of Nigeria. Utilization of healthcare services is low among the Nigerians because of the traditional and religious beliefs.
Possible Public Issues
Health literacy is a possible health issue because the population still relies on traditional beliefs when undertaking preventive and treatment interventions. Osazuwa-Peters (2011) argues that 80% of the population in rural areas believe in the use of traditional medicine and interventions in the prevention and treatment of diseases. Since over 50% of the population live in rural areas, it implies that 70 million Nigerians rely on traditional medicine and doctors in the prevention and treatment of diseases. Atulomah and Atulomah (2012) assert that health literacy among Nigerians is unacceptably low as over 60% of the people are unable to make informed decisions about their health. The high prevalence rates of infectious diseases such as polio cholera, dysentery, and malaria are attributable to low health literacy level.
Cultural awareness is also a public issue in Nigeria for a significant number of people holds cultural beliefs, which prevent them from utilizing conventional medicine. In the Northern part of the Nigeria, Muslims underutilize healthcare services because they strongly believe in their traditional medicine and religious beliefs. Osazuwa-Peters (2011) asserts that polio is common in the Northern Nigeria than Southern Nigeria since religious beliefs of Muslims prohibit vaccination of children. Regarding the spread of sexual transmitted infections, cultural values have also contributed to their high incidences. Dibua (2010) highlights that cultural beliefs and practices of inheritance of wives and polygamy enhance the spread of HIV/AIDS among the population. Thus, cultural believes affect the delivery of healthcare services in Nigeria.
Health Inequalities and Life Expectancy
The life expectancy of Nigerians is low when compared to other African Countries due to health inequalities that are prevalent. Ichoku and Nwosu (2011) acknowledge that health inequality is a national issue for it lowers life expectancy of the population in Nigeria. Given that the poor, who live in rural areas, cannot access and afford healthcare services such as maternal care and antenatal care, infant mortality is very high. Ogungbenle, Olawumi, and Obasuyi (2013) state that public health spending correlate with life expectancy in Nigeria. Increased public health spending geared towards promoting accessibility and affordability of healthcare services would improve the lives of the poor in rural areas and in turn enhance their life expectancy. Jones (2010) argues that the problem with health inequalities is that it reduces accessibility and affordability of health services, and thus, disproportionately affects life expectancy of the population. In this view, health inequalities in Nigeria are responsible for the reduced life expectancy.
The life expectancy of Nigerians is among the lowest in the world because of poverty, illiteracy, religious beliefs, sanitation and hygiene, and culture. According to United Nations Children’s Fund (2014), infant mortality rate of Nigeria is 78, which is the highest among the developing countries. Such a high mortality rates occur because children are prone to infectious diseases such as pneumonia, polio, cholera, and other immunizable diseases. Audu, Ojua, Ishor, and Abari (2013) report that, in Nigeria, life expectancy during birth is 52 years for females and 77 years for males. This implies that life expectancy is very low in Nigeria when compared to that of African countries like Kenya and South Africa. Evidently, the low life expectancy is attributable to health inequalities in Nigeria. Statistics show that over 80% of the population in rural areas are poor and utilize traditional remedies in treating various diseases (Osazuwa-Peters, 2011). Moreover, inaccessible maternal and antenatal care reduce the life expectancy of the population. Therefore, health inequality is responsible for the reduced life expectancy in Nigeria when compared to the developed and developing countries.
Current Efforts to Reduce Health Inequality
The first current effort that aimed at reducing health inequality is expansion of primary health centers. To reduce health inequalities, the Nigerian government in conjunction with the health care system is establishing primary health care centers in rural areas to promote accessibility and affordability of health care. According to Osain (2011), the health care system of Nigeria has about 20,278 primary health centers and approximately 33,303 general hospitals, which support the population of about 150 million. Since the primary health centers and general hospitals are insufficient, the health care system in currently expanding its primary health centers and equipping them appropriately so that the population in rural areas can access healthcare services easily. Although the primary health centers are significant, Osazuwa-Peters (2011) states that they are not equipped well due to lack of resources. In this view, as part of the effort of reducing health inequality, the health care system is trying to equip these health centers so that patients in rural areas can receive quality services.
The second effort of reducing health equality is alleviating the shortage of healthcare providers. Brain drain of healthcare providers is a major issue that is contributing to the brain drain in Nigeria. World Health Organization (2014) lists Nigeria as among the countries that face human resource for health crisis across the world. The listing has made Nigeria to devise means of alleviating shortage of healthcare providers by preventing brain drain. Uneke et al. (2010) recommends that the healthcare system can alleviate the shortage of healthcare providers by increasing funding for the health care system, providing incentives to healthcare providers, increasing remuneration packages, and improving working conditions. These interventions have the potential of reversing the trend of brain drain and increase the number of healthcare providers, and thus, promote health equality among the population.
Development of a Health Policy
Development of a health policy is a rigorous process because it requires the inputs of various stakeholders in the health care system. The inputs of healthcare providers are paramount in the development of the health policy since they are professionals, who have the insights about the inefficiencies in the health care system, and thus, they have the capacity to provide valuable information and implement programs effectively. Koh and Nowinski (2010) argue that healthcare providers play a central role in the implementation of policies and programs because they have appropriate knowledge and skills. In this view, to develop a policy that should get massive support across the country, the health care system of Nigeria should consider healthcare providers as important stakeholders. Hence, development of a healthy policy using inputs of healthcare providers and promoting its adoption and implementation among them is essential in gaining massive support.
Moreover, other important stakeholders that should take part in the development of health policy are the professional bodies, government, health insurance companies, and communities. Professional bodies of doctors, nurses, physicians, and other healthcare providers should give their input for consideration in the development of health policy. Since the government has political powers and resources, it can easily mobilize other stakeholders to develop, adopt, and implement certain health policy. Abdulraheem, Olapipo, and Amodu (2012) argue that government can sponsor bills, formulate legislations, and develop frameworks, which support the development of health policy. In conjunction with health insurance companies, the government can develop health policies that offer comprehensive health reforms to promote health equality and affordability. Since culture is a determinant of health, involvement of communities is critical.
Conclusion
The development of health policy is a rigorous process that requires consultation among various stakeholders. Since Nigeria experiences health issues, which include shortage of healthcare providers, poverty, poor sanitation and hygiene, and negative cultural and religious beliefs, the health care system should address them. Therefore, to address these health issues, the health care system should develop a comprehensive health policy. For the health policy to gain national support, major stakeholders such as healthcare providers, professional bodies, government, and communities should make their contributions.
References
Abdulraheem, S., Olapipo, R., & Amodu, O. (2012). Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of Public Health and Epidemiology, 4(1), 5-13.
Atulomah, B., & Atulomah, N. (2012). Health literacy, perceived-information needs and preventive-health practices among individuals in a rural community of Ikenne local government area, Nigeria. Ozean Journal of Social Sciences, 5(3), 95-104.
Audu, D., Ojua, T., Ishor, & Abari, C. (2013). Inequality and class difference in access to healthcare in Nigeria. Research on Humanities and Social Sciences, 3(16), 45-51.
Dibua, E. (2010). Socio-Economic and Socio-Cultural Predisposing Risk Factors to HIV/AIDS: Case Study of Some Locations in Eastern Nigeria. Internet Journal of Tropical Medicine, 6(2), 9-19.
Ichoku, E., & Nwosu, E. (2011). Social determinants and dynamics of health inequality in Nigeria. Central Bank of Nigeria Economic and Financial Review, 49(3), 47-70.
Jones, C. M. (2010). The moral problem of health disparities. American Journal of Public Health, 100(1), S47–S51. Retrieved from the Walden Library databases
Koh, H. K., & Nowinski, J. M. (2010). Health equity and public health leadership. American Journal of Public Health, 100(1), S9–S11. Retrieved from the Walden Library databases.
Ogungbenle, S., Olawumi, R., & Obasuyi, T. (2013). Life expectancy, public health spending and economic growth in Nigeria: A vector autoregressive (VAR). European Scientific Journal, 9(19), 210-235.
Osain, M. (2011). The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems. International Journal of Collaborative Research on Internal Medicine, 3(4), 204-212.
Osazuwa-Peters, N. (2011). Determinants of health disparities: The perennial struggle against polio in Nigeria. International Journal of Preventive Medicine, 2(3), 117-121.
Ricci, F. (2012). Social Implications of Malaria and Their Relationships with Poverty. Mediterranean Journal of Hematology and Infectious Diseases, 4(1), 2001-2011.
Uneke, C., Ezeoha, A., Ndukwe, C., Oyibo, P., & Onwe, F. (2010). Development of health policy and systems research in Nigeria: Lessons for developing countries’ evidence-based health policy making process and practice. Health Policy, 6(1), 109-126.
Uneke, J., Ogbonna, A., Ezeoha, A., Oyibo, G., Onwe, F., Ngwu, F. (2008). The Nigeria health sector and human resource challenges. Internet Journal of Health, 8(1), 11-33. Web.
United Nations Children’s Fund. (2014). At the glance: Nigeria. Web.
World Health Organization (2014). Nigeria. Web.