The effectiveness of a country's healthcare system is based on its ability to meet its objectives. The health systems everywhere irrespective of whether they are centralized or decentralized should be equitable meaning that the services available should be delivered in a fair and just manner. Nigeria can be classified under the developing nations with their health systems changing at a slower rate as compared to the first class nations. The military rule seriously undermined the performance of the country's care system in the late years of the 20th century. Recent reports show that healthcare services are somehow substandard and should be improved whenever there are alternatives. However, there are some positive aspects of the care unit that encourage the Nigerians to work towards the improvement of their conditions. The following is a review of some of the primary aspects of the Nigerian health care system in line with the development and performance of other global health sectors.
A Brief Description of the Health System in Nigeria
Nigeria lies in the western part of the African continent where it borders with Cameroon close to the coast in the Gulf of Guinea. The country is among the most populated states in the globe with an estimated population of 190 million in the year 2017. The overall growth rate is 2.6 percent which is not proportional to the rate of income generation in the country. As a result, most individuals live on less than $1 a day. As of 2017, the country's fertility rate was 5.3 births per woman and a birth rate of 39.2 births for every one-thousand women. The country constitution recognizes the access to health as a right where the government is divided into federal, state, and local government levels. According to the World Health Organization, WHO (2013), it is through these tiers that health development projects are enacted.
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The government is responsible for financing and control of service programs where the local leaders are obligated to reaching out to the populations at the grass levels. Some of the primary services offered by the local government include vaccination, the establishment of new centers, and management of community health clinics. The secondary health services are mainly provided under the state and federal management. At the tertiary level, the government provides extra services that cannot be accessed through primary care facilities. Examples include the in-patient and out-patient programs for general medical care, surgical operations, and control over national epidemics. The tertiary institutions represent the highest level of health care services in the country (Blaya et al. 2014). Other institutions in this level include medical schools and national specialist centers.
Different management programs are used to ensure the development of the health sector in the country. The main body is the Federal Ministry of Health (FMOH) that runs under the federal government. The organization develops and implements policies to be followed by both public and private institutions. Other policymaking bodies include the Society for Quality Care that was founded in 2014, the Dental Council of Nigeria, the Pharmacist Council among others. Despite the supervisions of the hospital services by the government, the degree to which medical center offer their facilities is highly dependent on the individual hospital itself and available resources.
Nigeria vs. the United States
Cost and financing - Nigeria has a healthcare system funded by the government. As a result, citizens spend less on their hospital bills. The reason is that the majority of the citizens cannot afford private healthcare due to their low and middle-income levels. The government spends approximately 1.5 percent of its annual income on health services. In the year 2017, the country was estimated to have a population of 190.9 million individuals. As a result, the government expenditure is too low to cover the majority of the health costs. Patients are, therefore, forced to pay for most of their services. The country has a history of consumers seeking help from traditional healers due to the lack of enhanced governmental services.
The country operates under medical health insurance called capitation. Every month, the insured individuals pay their hospital bill irrespective of whether they have used the National Health Insurance Scheme (NHIS). The amount paid by every individual is dependent on the personal ability to pay bills. The objective of this system is to eliminate social, economic barriers in the country that may hinder individuals from receiving adequate care services (Yeşilada & Direktouml, 2013). The NHIS is yet to be fully effective in the country due to poor management and lack of sufficient government support. Another major problem is that the majority of the citizens are under the low-income earner's bracket. In this case, it is not possible to spend a large portion of their income on hospital bills.
The system is somehow different from the American care plan in that the Affordable Care Act is more active than the NHIS in Nigeria. However, America has one of the most expensive care systems in the world due to their level of development and rate of income generation. When compared to Nigerians, a more substantial proportion of the Americans can be able to pay for health services from their pockets irrespective of their system. There are also higher expectations for improved health outcomes in America through the Affordable Act as compared to that of Nigeria. The central element of variation is the level of income generated by each country.
Quality - despite its system, America can be classified under the top leading care services providers in the world. Their health insurance system provides coverage for preventive service and reduces the risk of high financial costs anytime services are needed. On the other hand, the Nigerian system has several lapses in that most of the consumers depend on the monthly payment to settle their medical and insurance bills. According to West (2015), the NHIS system also lacks access to better funding by the consumers and the government. A significant challenge that contributes to the low-quality services is the high level of corruption in Nigeria. Medical organization leaders are corrupt and dishonest in that they do not remit funds paid to them by the care providers.
In the year 2016, approximately 376 thousand death occurred as a result of lack of quality care systems in the country. The country also has a mortality rate of 67 deaths per every 100000 live births. The main reason for the high mortality rate is the effects of poor quality health care in the country and the under-utilization of the already available facilities. Recent research shows that most of the epidemic diseases in the country can be prevented through enhanced lifestyles and improved awareness on the increased need to utilize health facilities provided by the government.
Access to Care - in most indices of human development including the provision of health facilities, Nigeria was poorly ranked in the recently released global report. The ranking is mainly based on the government ability to provide health services and the level of customer satisfaction. With the ranking being from zero to 100, the county scored 51 points which are a low mark in the provisions of basic human facilities such as housing and healthcare (West, 2015). The primary challenge behind the controlled access to services by citizens is poor coverage. Despite its launch in the year 2005, the NHIS covers approximately 15 percent of the country's population leaving the other residents at the mercy of private providers.
The access to medical facilities in America is also controlled due to the lack of a fully established health insurance program. The country's growth rate is, however, more supportive than that of Nigeria. Nigeria's federal government and public financing have an aim of providing universal health coverage, but their rate of operation is slow. However, with both the government and private healthcare providers being involved, the changes are likely to be implemented in the future. The government should consider setting new policies and standards for the non-governmental care providers that will ensure equitable provision of care.
Impact of the Health System on Vulnerable Population
The NHIS was implemented with the aim of providing social and financial risk protection by reducing the cost of healthcare facilities in the country. The most vulnerable populations in the state include the elderly, individuals with disabilities, pregnant women and the unemployed. Although the government sometimes provides free care from these groups, sometimes the individuals are forced to pay from their pockets. The main reason as to why the free programs are not fully operationalized is due to poor leadership and politicizing of medical plans. The Nigerian health system has also suffered numerous downfalls over the years making it hard to implement new reforms.
In most developing countries, the unemployed groups are classified under the vulnerable population in that poverty is a leading cause of ill health and barrier to accessing available services. The relationship is financial; the majority of the unemployed individuals are poor and cannot afford to live a healthy lifestyle (Kingma, 2018). Examples of unaffordable commodities are healthy foods and better housing. When viewed from a different perspective, ill health, in turn, is a leading cause of poverty. Healthcare involves partly the costs of seeking assistant which include consultation and tests fees but also extra charges such as transportation costs and informal payments to healthcare providers.
Impact On Women's Health and Maternal Child Health
The maternal mortality rate in Nigeria is quite high with a rate of 800 deaths per every 100000 live births as per the year 2017. In the country, pregnant woman and children under five years are generally charged when accessing health facilities. In 2005, the Nigeria federal government declared free services for the pregnant women and children, but the plan was not enacted due to lack of enough funds (Blaya et al. 2014). In most countries, free health care services and exemptions arise as campaign promises but are never put into action.
The country has also experienced increased infant mortality rates since 1990. The case can be in part explained by the persisting low numbers of birth in the hospitals and the low number of experienced maternal services providers. In the year 2005, more than half of the births in Nigeria still occurred at homes increasing the risk of child and maternal mortality. Poverty and demographic pressures also contribute to the high ratios of maternal and neonatal mortality. As a method of reform, the ministry of health in 2016 announced a plan to provide free health services to more than a hundred million Nigerians with most of them being pregnant women and children in the next three years.
Disease Management and Practice of Health Promotion
The global aspect of human development has contributed to the increase in nutritional, demographic and epidemiological cases that have a significant impact on human health. The African countries are the most affected with Nigeria not left out especially in the prevalence of chronic non-communicable diseases. Examples include diabetes, stroke, and hypertension. The disorders have placed a double burden on the already poorly financed Nigerian health system. The chronic diseases account for approximately 24 percent of the total deaths in the country. According to Olu-Abiodun & Abiodun (2017), the increasing trend is connected with the high exposure to risk factors such as smoking, alcohol consumption and a decrease in infrastructure for health.
To be able to control these challenges, the Nigeria government has established health promotion programs that are both strategic individual and population-wide prevention oriented. These interventions are then adequately integrated into the national health scheme for controlled management. Some of the public-wide interventions include increment in tobacco tax, limits on smoking especially in public places, and the introduction of enhanced public places for physical activity. The government is also controlling the manufacturing and distribution of fast foods that contribute to the high levels of chronic diseases.
Factors Affecting Health, Illness, and Distribution of Health Services
Some of the behavioral and social issues that impact on health include poor diets, smoking, and lack of physical exercise. However, good health starts from where we live and what we consume. To be able to tackle the healthcare problem in Nigeria, some health-seeking behavior model have been introduced. The process involves a sequence of remedial actions that individuals undertake to rectify their behaviors (Bertakis & Azari,2017). Some of the primary methods used include household surveys, facility-based processes, and other quantitative studies. Other factors such as genetics and personal behavior also contribute to the overall low levels of health and can be controlled through change in lifestyles conditions.
On the other hand, maximum utilization of services is essential in improving the health status of an individual. The most important thing is to ensure that citizens can easily access these facilities at the time of need. Some of the factors influencing the distribution of health services in Nigeria include inadequacy of health workers, poor management of human resources, corruption, illiteracy and lack of motivation. Therefore, there is uncertainty in how healthcare will look in the future. Nigeria among other developing nations should consider improving health status as well as the responsiveness to the expectation of the public.
Comparison with the Health Systems of Other Nations
Most of the healthcare systems in sub-Saharan Africa among other developing nations tend to relate. Taking an example of Ghana, the country has taken similar steps to those made by Nigeria to work towards universal coverage (Lovett-Scot & Prather, 2018). The most prevalent diseases in the Ghana include HIV/AIDS, malaria, and respiratory infections. Ghana has a life expectancy of 66 years which is slightly higher than that of Nigeria. Additionally, the democratic shift in Ghana has affected the country reform programs contributing to the prevalence of some infectious diseases (Yeşilada & Direktouml, 2013). The country has a national insurance scheme in place to work towards the improvement of health levels.
Another leading similarity between the two countries is that they both have a highly respected system of traditional medicine. The culture, therefore, discourages most of the citizens from seeking medical care from legalized government institution hence low access to facilities (Lovett-Scot & Prather, 2018). The ministry of health in the country funds the health care system. Women and children are more favored by the medical system in that the government has introduced intervention measures to reduce their payment for medical services. Other countries such as Russia an India have more developed systems, but there is a big gap between their urban and rural facilities as well as public and private sectors. Lack of enough coverage in India means that the majority of the citizens turn to private healthcare facilities. Both India and Russia have higher market values regarding GDP which means they spend more on their health sectors as compared to Nigeria.
Conclusion
As an essential element of national security, health improvement not only functions to provide modern healthcare facilities but also controls the outbreak of diseases in a country. Therefore, how a nation finances its health system can be an explicit parameter in accessing the expected level of public health. Health is a critical development component that requires adequate planning and funding. Nigerian government should collaborate with different partner to intensify optimal awareness and education programs to emphasize on the increased need for better health facilities.
References
Bertakis, K. D., & Azari, R. (2017). Obesity and the use of health care services. Obesity research , 13 (2), 372-379.
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Kingma, M. (2018). Nurses on the move: Migration and the global health care economy . Cornell University Press.
Lovett-Scott, M., & Prather, F. (2018). Global health systems: Comparing strategies for delivering health services . Retrieved from: https://content.ashford.edu
Olu-Abiodun, O., & Abiodun, O. (2017). Perception of transformational leadership behaviour among general hospital nurses in Ogun State, Nigeria. International journal of Africa nursing sciences , 6 , 22-27.
West, D. M. (2015). Using mobile technology to improve maternal health and fight Ebola: A case study of mobile innovation in Nigeria. Center for Technological Innovation at Brookings , 19 , 308-312.
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Yeşilada, F., & Direktouml, E. (2013). Health care service quality: A comparison of public and private hospitals. African Journal of business management , 4 (6), 962-971.
