PHILIP NYAM reports on how a recent public hearing by the House of Representatives for the establishment of a University of Medicine and Health Sciences in Bida, Niger State, exposed the decay in nation’s poor health sector
As part of its resolve to make enabling legislation for the improvement of the nation’s healthcare sector, the House of Representatives recently organised a public hearing on the bill for an act to establish the Federal University of Medicine and Health Sciences in Bida, Niger State.
At the public hearing, which drew stakeholders from across the country, startling revelations were made about the deteriorating state of healthcare in the country, particularly, Niger State. The statistics presented by various stakeholders were worrying and scary.
The proposed legislation titled: “A bill for an act to establish the Federal University of Medicine and Health Sciences, Bida, Niger State for the purpose of providing qualitative education in medicine and health sciences; and for related matters,” is sponsored by Hon. Saidu Musa Abdullahi representing Bida/Gbako/Katcha federal constituency of Niger State.
While presenting the bill, Abdullahi who is the deputy chairman of the House Committee on Finance, said the proposed legislation is an important phase in their collective struggle to put in place a strong framework for delivering decent public education and health care systems for his people, who are in dire need of a degree awarding institution dedicated to training of health workers. His words: “It is on record that Niger State is the only state in North Central Nigeria that has no degree awarding institution in Medicine and Health Sciences.” According to the lawmaker, the current situation is unacceptable considering the strategic importance of Niger State in the scheme of things in the country.
Aside being the largest state in the country with 76,363 Square Kilometres, accounting for about 10 percent of the nation’s total land mass, Niger State is home to Nigeria’s major hydroelectric power stations – Kainji Dam, Shiroro Dam and Jebba Dam as well as the Zungeru Dam which is currently under construction. Speaking further, the lawmaker noted that “paying attention to the place of education of our people in today’s fast changing world of globalization, information and communication technology becomes inevitable.
Let me therefore thank the Speaker of the House of Representatives, Hon. Femi Gbajabiamila and my colleague-honourable members for their sustained interest in the establishment of a specialised university that would be dedicated to the study of Medicine and Health Sciences in Niger State.”
Abdullahi explained that the overall objective of the bill is to secure a national mandate to teach and train high calibre healthcare professionals, provide healthcare services and to operate various schools and specialties that offer exemplary training and quality research in healthcare.
“Once the university comes on stream, it will provide more opportunities and fair chance for Nigerians seeking to pursue careers in the medical sciences and most importantly address medical workforce shortfall in the country,” he said. Hon. Abdullahi lamented that the number of candidates seeking admission to study Medicine in particular and Health Sciences in general is on the increase but unfortunately, a significant percentage of them fail to secure placements in medical schools not because they do not possess the required qualifications but because the tertiary Institutions do not have the capacity to accommodate them.
He said Nigeria with an estimated population of over 200 million, the doctor to patient ratio is said to be one to 4,000. According to him, “this is against the World Health Organization (WHO) recommendation of one doctor to 600 people for effective health care delivery.” Continuing, the lawmaker observed that “if we compare our position with countries like India, Brazil and Malaysia, we will realize that Nigeria is lagging behind in this very important sector of human endeavour.”
He explained: “India has over 479 medical schools with annual intake of over 67,000 MBBS students. The number is almost equal to the total number of registered medical practitioners (72,000) in Nigeria, 50 per cent of whom are said to be practicing abroad.
In 2018, India achieved WHO recommendation of one doctor to 1,000 people. “Available record has it that Malaysia has a doctor to patient population of 1,633 with an ambitious target of 1,400. There is even a call for regulation in order to avoid a situation of oversupply of medical doctors in the country. In 2018, Brazil achieved a doctor/patient ratio of 2.18 per 1,000.
In Africa, South Africa has 4.3 per 1,000, while Egypt has 2.8 per 1,000. “Also, the Executive Secretary of the National Universities Commission (NUC) was quoted to have said that Nigeria needs additional 300,000 medical doctors to meet up with the WHO standard and I add that we urgently need to move away from the fixation of scarcity of doctors to deliberately take necessary steps in changing the narrative.” Justifying the need for the university in Niger State, he informed that the only two existing universities in the state; Federal University of Technology, Minna and Ibrahim Badamasi Babangida University Lapai, currently do not run courses in Medicine and health related areas.
“The very high competition for health workers’ training placement in catchment universities for Niger State leaves much to be desired as the number of our children considered for admission continues to dwindle, with attendant far reaching negative consequences on the wellbeing of the people of our dear state. “At the moment, there are 1,335 health facilities in Niger State, out of which two are tertiary health facilities, 21 secondary health facilities and 1,322 (99 per cent) are Primary Health Care (PHC) facilities.
One thousand ninety-five (83 per cent) of these PHC facilities are publicly owned, while the remaining 227 (17 per cent) are privately owned. “A recent survey by the National Demographic Health Survey shows Infant Mortality Rate (IMR) of 100 deaths per 1,000 live births and an under-five mortality rate of 149 deaths per 1,000 live births.
Sadly, Niger State has the highest underfive mortality in the North Central geo-political zone of Nigeria and above the national average of 128 deaths per 1,000 live births. “Conversely, Niger State has one of the highest numbers of under-five children with fever, seeking medical attention from health facilities or healthcare providers (73.2 per cent), above North Central average of 71.8 per cent, national average of 63.4 per cent. “The pronounced disproportions in health outcomes and access to health services in Niger State raise the question about the availability of qualified health care professionals.
Because of the sheer size of Niger State, access to PHCs is a problem. “Only recently, United Nations Children’s Fund (UNICEF) identified more than 4,000 communities in the state as hard-to-reach, which by definition means the communities located more than five kilometres from a functional health facility.
The solution to this problem is to scale-up the education and work force of healthcare professionals in training institution and health facilities, respectively. “Going by WHO standards, Nigeria is not on track to meet the very low benchmark of 2.5 doctors, nurses and midwives per 1,000 people. Niger State has a doctor population ratio of one doctor to 9,000 population, far worse than the national average of one doctor to 4,000 population against WHO recommendation of one doctor to 600 population for effective healthcare delivery.
“The Medical and Dental Council of Nigeria is said to have registered over 70,000 medical and dental practitioners in the country, 50 per cent of whom are said to be practicing abroad and over 70 per cent of the remaining are practicing in cities and economically sound state, leaving states like Niger with about 400 doctors to cater for her entire population.
“This may be one of the reasons why WHO ranked Nigeria health system 187 out of 190 sampled countries of the world. The story is not different when we look for pharmacists as Nigeria currently has only 17 schools of Pharmacy accredited by the Pharmacists Council of Nigeria (PCN)) offering courses from Bachelor of Pharmacy degree to the Doctor of Philosophy (PhD) level. “There are 25,870 pharmacists in the register of the PCN as at January, 2020.
With our ever increasing population, the country has one of the lowest pharmacist to 10,000 population of less than one. WHO recommends one pharmacist per 2,000 population. In Nigeria we have approximately one pharmacist per 7,731 population and Niger State has one pharmacist to about 38,000 population as 140 are currently licensed and practicing in the state in both the public and private sector. “This pharmacist to population ratio may not improve significantly very soon as our universities are only producing an average of 1,165 pharmacists per year (2012- 2014 data).
The sad state of affairs in health sector of Niger State is the justification for the establishment of a University of Medicine and Health Sciences in the state. “Our choice of the ancient town of Bida for siting of the proposed University of Medicine and Health Sciences is because it currently has a Federal Medical Centre (FMC) which would serve the training needs of the proposed university.
The Federal Medical Centre (FMC) Bida has a reservoir of highly trained and skilled manpower consisting of officers trained in the all the disciplines known to medicine,” Abdullahi explained. Declaring the event open, Speaker Femi Gbajabiamila said public hearings are an important part of the legislative process in the National Assembly.
He listed the bills scheduled to be considered by the committee to include a bill for an act to enhance and promote the health and wellbeing of Nigerians to boost local healthcare capacity; a bill for an act to establish the Federal University of Medicine and Health Sciences, Bida, Niger State for the purpose of providing qualitative education in Medicine and Health Sciences; a bill for an act to provide for the establishment of the Federal Medical Centre, Wase; a bill for an act to establish the Federal Medical Centre Igboho, Oyo State and a bill for an act to amend the Orthopedic Hospitals Management Board Act, Cap. 010 Laws of the Federation of Nigeria; 2004 to provide for the establishment of Orthopedic Hospital, Jos, Plateau State.
He explained that each of these bills seeks to alter the architecture of the nation’s public health services in ways that will hopefully improve the lives of Nigerians, either through increasing options available for medical training or providing access to medical facilities in places where there is an evident need.
“The purpose of this public hearing today is to harvest the views and opinions of stakeholders so that through the aggregation of those contributions, the House can act to improve each of these bills in line with the best expectations of the citizens whose mandate we serve in the hallowed chambers,” he said,