By  Nnenna Nwoke

The health sector is a very crucial part of the economy. However, as crucial as it is and despite heavy annual budget allocations, the sector is yet to attain the goal of ensuring the wellbeing of the population. But, why the poor state of affairs and performance? Where is the point of disconnection – between huge allocations and the poor output?  The truth is that the nation’s goal of attaining health for all might never be realized as it was not structured to be. Our health sector is under siege. For long, it has been held hostage by other sectors of the economy and bullied into accepting responsibilities beyond its own ability and mandate. What has come to be generally referred to as health is conventional medicine, whose emphasis is more curative than preventive in approach.  Incidentally, our approach to health care has been dependent more on this aspect of health which is curative. Until now, the sector has run possibly unmindful of the missing features – the focus, target, and instrument or tool for the broader goal the structure required to accomplish the task. It, therefore, has not yielded the expected impact, predominantly among resource-poor and the vulnerable population, due to some limiting factors such as affordability, acceptability and accessibility.

It is worthy of note that most pressing challenges of the health sector do not belong to it. Rather, the sector is on a rescue mission. It has been saddled with the care of diseases because most sectors that have the primary responsibilities have either abandoned their duty or have failed to give it due attention. They, therefore, placed the burden of the primary sectors on the rescue sector. This was instructive and guided us to re-think ‘health.’ Malaria, the prime killer of children and adults, and malnutrition, the platform for development -plagues of widespread proportion, which we studied, are typical examples. Malnutrition, underlying factor of most diseases, lowers immunity of the individual, allowing opportunistic diseases to invade and take advantage of the weak body. This case is associated with drug influx for treatment which puts pressure on health, causing incessant and insatiable demands by health. ‘Where are the parent bodies? If these are curbed at the prevention level and malnutrition prevented, the health burden will be minimal. Malaria, another issue we researched on, is the prime killer of children and adults in Nigeria yet, the Ministry of Environment relates more with climate change than Malaria; both of which are struggling for the attention of the same budget. Great and commendable as this concept and program is, one wonders how many people climate change has killed as against malaria’s death toll per day, at least in Africa. The danger of such developmental arrangement, devoid of the fundamentals, is that once released, the victims fall back into the same condition or situation that caused the assault; referred back to the hospital, the cycle continues. It is the reason health issues re-occur despite huge budgets; mismanagement of resources and activity that encourages waste. These are affecting the health sector’s performance, our economy, and our development at large.

This rescue sector will continue to stretch, causing Oliver Twist’s ceaseless demands as long as prime owner sectors remain asleep or inactive. What could be more frightening than an economy running at the intervention level or suspended far from reality?  As it stands now, no amounts of resources, such as money, personnel, equipment, etc. spent on the health sector will make it fit to play the role of the primary sectors, which are the basic building blocks of any well-meaning economy. It is akin to pouring water into a basket, with the aim of storing it.

Generally, no budgetary allocation is ever enough unless programmed to be. Appropriate resource allocation must start with situating the problem well, identifying strategy, and synergizing. This realignment will immensely release the burden on the health sector and free a lot of resources that until now were locked up. For long, it has been held hostage by other sectors of the economy and bullied into accepting responsibilities beyond their ability and mandate.  These have put pressure on all resources – human and material; Nigeria is far behind the World Health Organization’s standard in doctor/ patient ratio. Efforts to reverse this might be met with resistance. Ignorance is possibly playing a huge role. And then it has become, for some, a conduit pipe for siphoning money.  But we are not just out to raise issues. The health sector must:  (1) Recognize its place/ position in economic development as a secondary sector- a rescue sector; not a primary sector.  (2) Accept its present victim-status; the health sector has been massively victimized; made a prey or wounded; A casualty of a wrong system and bulldozed into accepting this over the years. (3) Be assisted in the identifying, and profiling of the culprits; 4) Begin a redemption process through various vital steps with related sectors for a holistic delivery.  The health sector and the government must be assisted in putting pressure on the prime sectors to deliver on their mandates, as it relates to health, as a matter of necessity and urgency.

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If you hear Minister of Health is canvassing for increase in the budget of the Works and housing for better roads; or and pushing for more action from the Road safety Corps. How would you feel? Please know he is on the right path. He might have just realized a better road network and conduct of the users will reduce accidents whose victims are dumped on them?  If he is represented at a Food Conference, sponsoring/ promoting / upholding the bio-directional relationship between agriculture/food sector and health, and anchoring mainly on nutrition for preventive and curative purposes. He is saying preventing possible malnutrition is averting predisposition to opportunistic diseases which might weigh on the health sector.  If he is advocating that more budgetary allocation / adequate resources must be made available to the food sector, even if it means re-addressing budget from secondary care to high-cost valuable preventive intervention packages and strategies of which nutrition and food safety is foremost.

The appropriate interaction and well-alignment of relationships between the health sector and related prime sectors, and also the sequencing of such relationships is the only guarantee of an effective overall health system. Only an interplay and synergy between the sector and an effective program of the food sector will make a meaningful impact.

The health sector reform is timely. The committee recently set up for by the Federal Government on the health sector reform is novel, an acknowledgment of the poor state of our health sector which has been compounded by the COVID-19 pandemic.

Nwoke is the publisher of Food Security Magazine