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The
APC in its manifesto has a section on healthcare. It is unclear why
they have chosen the term “healthcare” rather than the broader term
“health”, but the PDP which has a section on health also says it will
formulate a policy on “healthcare”.
Within the healthcare section of its manifesto, the APC says that it will:
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Prioritize the reduction of the infant mortality rate by 2019 to 3%; reduce maternal mortality by more than 70%; reduce HIV/AIDs infection rate by 50% and other infectious diseases by 75%; improve life expectancy by additional 10 years on average through our national healthy living program;
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Increase the number of physicians from 19 per 1000 population to 50 per 1000; increase national health expenditure per person per annum to about N50,000 (from less than N10,000 currently);
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Increase the quality of all federal government owned hospitals to world class standard within five years;
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Invest in cutting edge technology such as telemedicine in all major health centers in the country through active investment and partnership programs with the private sector;
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Provide free ante-natal care for pregnant women, free health care for babies and children up to school going age and for the aged and free treatment for those afflicted with infectious diseases such as tuberculosis and HIV/AIDS;
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Boost the local manufacture of pharmaceuticals and make non adulterated drugs readily available.
First,
we must commend the APC for actually publishing some measurable targets
and timelines. However there are many questions raised by these
commitments.
For instance, the reduction in maternal mortality rate in the best performing country in the world between 1990 and 2013 was in Belarus which had a reduction of 13 per cent.
An ambition to reduce Nigeria’s very high maternal mortality rate by 70
per cent raises questions of feasibility, especially when one looks at
the numbers in the table below, which show an average annual reduction of 3.3% in Nigeria.
The ambition to improve average life expectancy by 10 years is perhaps more attainable, given that between 1990 and 2013, Liberia saw a 20-year increase (from 42 years in 1990 to 62 years in 2012) and three other African countries a 19-year increase (Ethiopia from 45 to 64 years, Maldives from 58 to 77 years and Rwanda from 48 to 65 years as stated here). Nigeria has also seen an increase in life expectancy of 6.7 years in that period (see table below).
On reducing infant mortality to 3 per cent by 2019, the table below shows the trends in infant mortality in Nigeria between 2010 and 2013, suggesting that the APC target is very ambitious, looking at global trends.
It is unclear where the party gets its estimate of 19 physicians per 1,000 population as the World Bank estimate of physicians per population in Nigeria as at 2010 was 0.4 per 1,000. Even if the APC estimate were right, their target suggests that they would facilitate the training of over three million additional doctors in Nigeria in 4 years, which is impossible.
The second section of the manifesto unfortunately has no measurable indicators, and so it is impossible for us to assess objectively.
The PDP section on health says that:
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The party shall present a comprehensive health-care policy for the country, the essential aim of which shall be:
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Health-care for all citizens;
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Free medical services in all institutions of learning; and
- Free medical services to the aged and the handicapped.
As its strategy, it says that:
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PDP in government shall:
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Ensure that all Nigerians, particularly the young and the aged, shall have access to free medical services;
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Provide free immunization to all children;
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Progressively establish primary health centre, equipped with pharmacies, within the reach of every Nigeria, particularly the rural dwellers.
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Progressively provide General Hospitals in all Local Government headquarters; specialist hospitals in all State Capitals.
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Encourage research into traditional medical, practices and integrate these practices into the orthodox medical system.
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Equip and expand the teaching Hospitals in the country;
- Embark on mass training of paramedical personnel to meet the needs of our ruralpopulace;
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Encourage more students to train as medical doctors;
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Provide special incentives for medical practitioners and other medical Personnel with particular emphasis in those located in remote areas;
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Stimulate the local production of medical drugs and other supplies;
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Encourage family planning by providing family planning services and materials free of charge;
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Regulate private hospitals, medical clinics, and pharmacies to protect Nigerians against exploitations; and
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Make and enforce stringent laws against the manufacturing and sale of fake and adulterated drugs; and promote a healthy physical environment by intensifying the present periodic environmental sanitation exercises
As the PDP manifesto on health has no measurable targets or timelines, we are also unable to assess it objectively.
Generally
speaking, both main parties promise to raise the number of medical
doctors, provide free healthcare for children and the elderly, improve
the quality of government/teaching hospitals, fight fake and adulterated
drugs and boost the local pharmaceutical industry. In addition, the APC
wants to improve maternal and child health, invest in cutting-edge
technology and reduce the prevalence of infectious diseases, while the
PDP aims to achieve universal healthcare, offer free medical services in
all institutes of learning and free healthcare for the handicapped,
improve the quality of private hospitals, promote environmental
sanitation exercises, offer free family planning, increase medical
personnel especially in rural areas, integrate traditional medical
practices and increase the number of general hospitals, specialist
hospitals and primary health centres.
Both
manifestoes are not comprehensive and lack concrete details. Topical
issues such as ambulance services, non-communicable diseases, security
of medical personnel, health sector strikes and many more are not even
mentioned. The new, and potentially groundbreaking National Health Act
signed into law in December is not mentioned by either party; nor is
there any meaningful recognition of the wider determinants of health or
mention of issues like tobacco control or road traffic accidents.
Universal health care, which is an increasing area of global focus, only
receives a cursory mention in the PDP manifesto and no mention in the
APC manifesto.
On
the private sector, which provides a significant proportion of
healthcare in Nigeria, the APC only says that it will invest in cutting
edge technology such as telemedicine in all major health centers in the
country through active investment and partnership programs with the
private sector; but it does not have much to say about ensuring quality.
The PDP on the other hand highlights the need to regulate private
hospitals, medical clinics, and pharmacies to protect Nigerians against
“exploitations”;but does not examine any other ways of improving quality
and does not mention driving innovation in the private health sector.
Time
frames within which these goals will be achieved are mostly absent. In
addition, the means to achieve these goals are not always explained,
e.g. the APC simply states that it wants to increase the number of
medical doctors. The PDP on the other hand promises to encourage
students and provide special incentive for medical personnel, but it is
still unclear what kinds of encouragement and incentives will be used.
Neither manifesto explains how these goals will be financed.
Both
manifestoes are also silent on how they will ensure that the progress
made on polio is sustained, how the lessons learned from the Ebola
outbreak will be applied and how the coverage of the National Health
Insurance Scheme will be improved.
On
the whole, our rapid analysis suggests that neither party understands
or takes the issue of the health of Nigerians as seriously as they
should. Perhaps it is all down to a failure of communication, as for
instance the PDP fails to say anything about its record on health in the
last sixteen years. Whatever the reason for the shoddy manifestoes on
health, we will all need to keep challenging our politicians more to
ensure that health does not take the back seat, especially at a time of
economic difficulty.
