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Need for re-organization of Nigeria’s healthcare system



Need for re-organization of Nigeria’s healthcare system

Title: Fixing Healthcare in Nigeria
Author: Dr. Ola Brown
Year of Publication: 2018
Pagination: 40
Reviewer: Tony Okuyeme



Public health is not doubt imperative to national development. As an important element of national security, it serves not only to provide adequate and timely medical care, but also track, monitor, and control disease outbreak.

There is no gainsaying the fact that the Nigerian health care system is poorly developed. The major public health challenges Nigeria faces include infectious diseases, control of vector some diseases, maternal mortality, infant mortality, poor sanitation and hygiene, disease surveillance, non-communicable diseases and road traffic injuries among others.

Against this backdrop, Dr. Ola Brown’s new book ‘Fixing Healthcare in Nigeria’, is no doubt a welcome development, especially as this is coming at a time when the World Health Organisation (WHO) ranks Nigeria’s health system 187th out of 190 countries. This WHO ranking, makes the Nigerian healthcare system one of the five worst healthcare systems in the entire world.


The 40-page book is divided into five chapters including an introduction and conclusion. Chapter 1 looks at ‘What Aliko Dangote can teach us about healthcare’; chapter 2 focuses on ‘How to finance healthcare in Nigeria’. ‘Task Shifting 101’ is the focus of Chapter 3; while Chapter 4 is on ‘Reinventing Primary’ Care in Nigeria. Chapter 5, which is the last chapter of the book, is on ‘The child death epidemic in Nigeria’.

In Fixing Healthcare in Nigeria’, Dr. Brown looks at the challenges facing the Nigerian healthcare system and the nation’s citizens from various angles: an organizational perspective, the financial challenge, the benefits of task shifting, and the re-prioritization of primary care and public health. She also examines how some commercial enterprises have achieved success in Nigeria and suggests that those in charge of delivering healthcare adopt some of the ideas that have proved successful in private enterprise.

One of the examples she holds up is the success of Dangote’s Cement Company. Dangote’s Obajana factory is one of the most advanced and largest cement factories in Africa. Much of the company’s success is due to its ability to reduce its costs while at the same time increasing its output. Central to this is Dangote’s massive network of small distributors spread out through Nigeria’s communities.

The author contrasts the success of Dangote’s decentralized system to the problems found in the Chinese cement industry where large centralized plants are located far from where the cement is actually used. She sees a parallel with healthcare in Nigeria, which she believes is overly dependent on large centralized hospitals and has too few decentralized primary care units. This is the focus of chapter 1.

She argues that “the current healthcare system is hospital-centric with an overemphasis on expensive hospital-based medical interventions that improve life for a very small number of people, at the expense of public health and primary. Primary care can take care of the majority of medical consultations in Nigeria.”

In Chapter 2, ‘How to finance healthcare in Nigeria’, the author notes that according to the World Health Organisation (WHO) no country has made significant progress towards universal health coverage (UHC) without increasing the extent to which its health system relies on public revenue sources. She lamented poor allocation of fund to the health sector.

“With low per capita income, limited growth prospects, poor domestic revenue mobilization potential, shortages of health manpower/brain drain and the highest disease burden in the world, Africa faces extremely complex health financing decisions,” notes Dr. Brown.

She calls for adequate funding of Nigeria’s healthcare system. “We can definitely improve healthcare, but the issue of financing still remains. To deliver healthcare that approaches the standard available in the developed world, African governments will not only have to find more source of finance but also tackle the following challenges: low tax revenue base; limited accountability and transparency; high levels of debt- large proportions of the budget allocated to debt financing: in Nigeria nearly 70% of our entire budget is used to service debt; and tiny to non-existent profit margins.”

In Chapter 3, the author explains why task-shifting is an essential part of building a functional healthcare system in Nigeria. The focus of Chapter 4 is on reinventing primary care in Nigeria. In this chapter, the author reviews the current primary healthcare model in Nigeria, as well as the impetus to change to address these unsettling indices. According to Dr. Brown, with a total population of approximately 182,200,000, Nigeria has some of the poorest healthcare outcomes in the world. For example, the under-five mortality rate has been reported by the World Health Organization at 117 per 1000 live births. In other words, 1 in 10 Nigerian children under the age of 5 die annually. Chapter 5 is on the child death epidemic in Nigeria.

Concluding, Dr, Brown called for a reorganization that emphasizes a more decentralized – but funded and supported – primary healthcare system along with an improved public health infrastructure. Good health, she says, is required for success in all levels of life, and a successful citizenry is required to move our nation forward, grow our economy, and improve opportunities for all. These will dramatically increase revenues available to invest in the public good.

“Further, we need to think a little ‘outside the box.’ Hospitals, specialists, and general practitioners are certainly integral to our healthcare system, but much of the routine care can be done by less specialized (and less expensive) workers. In the same way, we need to get the proper balance between primary health facilities and large hospitals. When funds are limited, they must be strategically invested so they do the most good for the greatest number of Nigerians. Finally, along with innovative approaches, we need to “go back to the basics.”

In this book, there are solid starting points explained in straightforward terms and supported by data as well as both her professional and personal knowledge and experience.

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1 Comment

1 Comment

  1. Like

    November 7, 2018 at 9:52 am

    Like!! I blog frequently and I really thank you for your content. The article has truly peaked my interest.

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