Peter Cunliffe-Jones, Lagos | Monday
NIGERIA, which this week hosts a major conference on tackling Africa’s three biggest killers – malaria, tuberculosis and HIV/Aids – is a case study of how not to go about public health, experts and concerned officials here say.
Nigeria, Africa’s most populous country with a population of more than 120 million, will this year spend under three dollars per head on public health.
And some 70% of the budget actually spent on health goes into funding Nigeria’s giant teaching hospitals, leaving little for basics such as primary health care for the population, mostly living in places remote from the main centres, health workers and administrators say.
On Tuesday through to Friday, the cash-strapped country, struggling with a foreign debt of more than $30bn, will host a major conference backed by the World Health Organisation (WHO) and the Organisation of African Unity, on Africa’s big three diseases.
A host of dignitaries have been invited by President Olusegun Obasanjo. UN Secretary General Kofi Annan and former US president Bill Clinton are expected to attend.
But while the aim sounds worthy – raising the profile of the three biggest killer diseases in Africa – health workers and administration officials here are expressing serious doubts.
First, there is the cost – put by officials at between $1.5m and $3m – with the largest chunk to be paid by the Nigerian government.
Second, commented one health worker, is the meeting’s potential impact: “To put it plainly, we have had a lot of conferences and what they produce most is hot air and not much else. Where’s the impact?”
Around the world 36.1 million people are known to be living with the HI virus, the great majority in developing countries.
According to the WHO, malaria kills one million people per year, 90% of them in Africa, while 500 people suffer from the disease each year.
And in Nigeria, tuberculosis affects 260 000 people, causing 70_000 deaths per year.
But, said one health worker, there is no effective public health service in Nigeria.
“You cannot say there is an effective public health system at all in Nigeria,” said the health worker, working with a foreign development organisation.
“What there is is private, and often that’s inadequate,” added a health administration official with a major foreign aid agency.
“There are a number of big public hospitals but the staff there are generally badly trained and often go on strike. Primary health care barely exists. Many people cannot afford to go to doctors, and drug sellers do not know the right prescriptions or dosages to hand out. Public health education is a joke. The system has not improved at all under Obasanjo,” she said.
Since the last malaria conference last year the government has lifted all taxes on mosquito nets and insecticides but has done little else which might have any impact, an administration official said, speaking like others on condition of anonymity.
“Now we have another conference. It’s hardly serious,” he said.