Demystifying Social Economic Predicaments of Public Health in Nigeria: Inference for West Africa.

AuthorBadmus Bidemi, G.

Introduction

Given the fast growing population of Nigeria and her current status as the most populous Black nation in the world with estimated population of 184,201,962 inhabitants, the country currently host 47% of the West Africa population (World Bank report 2015). In contrary, unofficial reports have put the Nigeria's population around 250 million, by implication almost 60% of the West African population. Nigeria's huge population is also endowed with a robust cultural diversity, intellectual capacities and enormous natural resources which should ordinarily allay the fear of socio-economic challenges to public health and other developmental issues.

However, just like many other African nations, Nigeria has been confronted with enormous challenges particularly with surge of public health related problems occasioned by the recent economic crisis which is primarily caused by gross corruption, mismanagement of both human/natural resources and the snowballing effects of other external factors. It is instructive to note that with the Nigeria's socio-economic potentials, the country falls among nations with extreme poverty and poor health system For example, over 70% of Nigerian population live on $1.25 or even lesser per day. The foregoing deplorable socio-economic and political situation in Nigeria has continued to affect the quality of lives, existing social and medical infrastructures that could help to improve public health standards among others.

Pathetically, as the Nigerian population increases, the electric power generation supply which serve as a cardinal instrument in health services and poverty alleviation drastically reduced to as low as 3760 megawatt as at year 2014 (National Electricity Regulation Agencies, 2014). In the recent time, it has further decreased to as low as less than 2000 megawatt.

Put differently, the recent economic crisis in Nigeria has contributed to the prevalence of health related problems such as mental illness, hypertension, stress among others and the solution to the socio-economic crisis in Nigeria has remain sluggish due to increase in the number of people living with some of the aforementioned health related problems. According to Stuckler D et al (2009) economic crises may have mental health effects, however, problem associated with mental health problems have significant economic effects. For example, the economic implications of mental health problems may include; lost productivity: like in European Union (EU) countries where los of productivity as a result of mental illness are estimated to average 3 and 4% of their gross national product (GDP).

In addition, Nigerian economic crisis and enormous cutback in her national revenue has resulted in unprecedented level of poverty, unemployment, high rate of inflation, vulnerability to health risk factors and drastic decline in the value of naira against U.S dollar. The foregoing explications explain why it is difficult for Nigeria to adequately tackle widespread of public health related problems due the huge financial burden involved. In the United Sates alone, the estimated direct and indirect cost of caring for high blood pressure among other health issues (BP) in 2009 was $51.0 billion (Go AS, Mozaffarian D, Roger VL et al 2013). This nature of financial burden is highly impracticable and difficult for developing countries like Nigeria to shoulder considering the ever increasing number of hypertensive patients in Nigeria.

By implication the overall financial burden to provide cares for hypertensive patients including the cost of catering for all the complications arising from hypertension such as cerebrovascular disease, ischemic heart disease and congestive heart failure as well as indirect costs such as the lost productivity of workers struck by stroke, heart failure, and ischemic heart disease (Van de Vijver et al 2013).

However, despite the huge funding from global health actors such as World Bank, United States Agency for International Development, European Union, the media and the business community (Human Impact Report, 2009), Nigeria is still lagging behind in showing commensurate outcomes for such investment as s result of corruption and poor health sector management.

This paper is divided into six major sections; introduction, an overview of public health status in Nigeria, economic recession and implication for socio-economic standards in Nigeria, the study interrogates the interplay between public health and the socio-economic predicaments in Nigeria. First, to demystify the dilemma created by current socio-economic crisis for effective public health system; and to provide answer to why the solution to the socio-economic crisis in Nigeria may become sluggish due to increase in the number of people living with any of the public health related problems, conclusion and the way forward are suggested.

An Overview of Nigeria's Public Health System

In the contemporary global system, it highly impracticable for any nation to achieve good governance and meaningful socio-economic development without developing a robust public health sector system. The foregoing is truism because 'health is widely regarded as wealth'. By implication a healthy population is sine qua non for a wealthy nation. For instance, mental health is an important economic factor. Good population mental health contributes to economic productivity and prosperity, making it crucial for economic growth (Weehuizen, 2008). Thus, in Nigeria and many other African countries, prevalence of precarious public health sectors has contributed to their economic woes/crisis and developmental failure.

More importantly, Nigeria has fallen below several require standards that are presumed to be the determinant of quality and quantity of public health system such as; level of education, adherent to safety in the working place, degree of public awareness on health related matters, prevailing socio-economic situation, existing standard of living, dietary level/personal hygiene, existence of cultural values that is suitable for robust public health system, behavioural/lifestyle of people and the nature of country dependency on foreign aid/assistance for public health management among others.

For instance, In 2009 World Health Organisation report shows that one million Nigerian children die at birth out of the nine million infant deaths recorded globally (WHO 2009). In a related development according to Akinrogunde, (2011) cited by Eme et al. (2014), it was reported that in Nigeria, healthy life expectancy at birth for male / female is between 41 and 42; Probability of dying under fire (100 have birth) 191; Probability of dying between 15 and 60 years (per 1000 population) is 447 for male and 399 for female; The under-five mortality rate is currently fix at 157 children per 1000, this implies that 1 out of 6 children born in Nigeria usually die before their fifth birthday- half of this number actually involve those less than one year old. It was also revealed that the health indices that concern the adult female population in Nigeria are among the worst in the world record: at least some 800 per 10,000 women die in Nigeria every year due to pregnancy related cases. In some parts of the country, the figure is actually more than twice the quoted average. Three quarters of all maternal deaths occur during delivery and the immediate post-partum period.

According to World Health Organisation, WHO (2009), it was reported that one million (1,000,000) Nigerian children die at birth out of the nine million (9,000,000) infant deaths recorded worldwide. In the same vein, the World Heart Federation in 2008 reported that an estimated 40% of adults aged 25 and above had been diagnosed with hypertension globally. And the number has continued to increase from 600 million in 1980 to 1 billion in 2008: which represents almost 15% of the world's population. It was also projected that by 2025 the number of hypertensive cases will rise up to over 1.5 billion. In tracing the growth trend of hypertensive cases, Developing countries particularly Africa will account for two thirds of those with hypertension patients due to their poor health systems.

In the same vein, the National Strategic Health Development plan 2009-2015, asserts that the health indicators in Nigeria have fallen below country expectation and internationally standards, due to very slow progress over the years. The health indicators in Nigeria shows that life expectancy at birth is 49 years while the disability adjusted life expectancy at birth is 38.3 years; vaccine-preventable diseases and infectious and parasitic diseases continue to exact their toll on the health and survival of Nigerians, remaining the leading causes of morbidity and mortality. The 2013 Demographic Health Survey reports that about 61% of women who recently had a live birth sought antenatal care from a skilled provider while 36% had their recent baby at a health facility.

Uptake of immunization for children in Nigeria is also low as only 25% of children are fully immunized at age one. Uptake of immunization in Nigeria has not improved from the 23% reported in the 2008 by NDHS, when compared to its neighbouring countries like Ghana where in 2008 79% of children aged between 12 and 23 months were fully immunized (National Population Commission 2008).

Consequently, cardiovascular disease (CVD) or heart related problems, has remain one of the most popular cause of death in Nigeria and ranked first among cardiovascular disease with its complications constituting about 25% of emergency medical admission in urban hospitals in the country (Ogah 2006). It was responsible for more deaths than malaria in Africa in the year 2000 alone (Ekwunife OI, Aguwa, 2011). As observed by IFPMA (2016) 80% of deaths due to CVD occur in poor communities and countries where health systems are frail and poorly manage. The poor health service delivery system and degraded...

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