Nigeria is Africa’s largest economy, but its life expectancy is one of the lowest in Africa and the world. The average Nigerian dies at age 54, 18 years younger than the global life expectancy. Nigeria’s low life expectancy is a blanket statistic that hides an even more hideous figure-a very high rate of child mortality.
No other country with anything close to Nigeria’s economic endowment or size in which people die so young. People live longer in much smaller and poorer countries. There are only two countries in Africa in the world—the Central African Republic and Chad—where you are more likely to die younger than in Nigeria. Both are klepto-dictatorships ravaged for decades by war, with GDPs of $2.52 billion and $11.78 billion, respectively. In contrast, Nigeria has a GDP of $440.78 billion.
The menace of child mortality in Nigeria
In 2020, the United Nations Children’s Emergency Fund (UNICEF) announced that Nigeria had overtaken India as the country with the highest number of under-5 deaths. That year, around 858,000 children aged 5 or below died in Nigeria. This statistic represents about 42% of all deaths in the country. Child mortality is the primary explanation for Nigeria’s low life expectancy. Surprisingly, the loss of so many young lives is not on the list of the national woes we gripe about. The government has not deemed it fit to declare a “state of emergency” on the problem.
These depressing statistics reflect not only the decrepit state of healthcare in Nigeria but also a host of atrocious indicators of social and economic well-being. Death stalks the Nigerian child in the ugly shapes of largely preventable and easily treatable afflictions. Malaria is one of the most significant contributors to child death in Nigeria. It kills more children in Nigeria than anywhere else in the world. Pneumonia is the third major killer of Nigerian children.
When a child dies in Nigeria, 45% of the time, the inadequate quantity and poor quality of their food, i.e., the condition of malnutrition, is either the cause of death or a contributing factor. According to UNICEF, we have the “second highest burden of stunted children in the world, with a national prevalence rate of 32 percent of children under five”.
Initiatives to Reduce Child Mortality in Nigeria
We want the next President of the Federal Republic of Nigeria to prioritise the reduction of Nigeria’s shamefully high rate of child mortality. A presidential initiative could cut child deaths by 50% in 5 years despite formidable institutional barriers.
We propose the following measures to achieve this goal:
1. 50% of all additional healthcare spending should go towards extending the reach and improving the quality of primary healthcare.
Nigeria needs to spend more on healthcare and spend more of what it spends on primary healthcare,the level of healthcare best suited to saving Nigerian children from the simple ailments that kill them. This additional spending should include increases in the federal healthcare budget, donations from foundations, loans or grants from international development agencies, etc. The funds should be invested in building, equipping, refurbishing, and hiring staff for primary healthcare centres across Nigeria.
Nigeria spends about 3.5% of its budget on healthcare, much below the 15% it promised to spend 20 years ago. Nigeria’s healthcare budget is meager compared to the average of 12.49% of high-income countries and the 9.83% global average. Nigeria’s healthcare budget also falls short of 4.97%, the average for Sub-Saharan African healthcare systems. The World Bank estimates that Nigeria needs to spend N301 billion every year to be able to fight malnutrition effecto8oilkk,.ively. Yet, in 2020, the allocated N800 million for Ready-to-Use Therapeutic Food (RUTF), a life-saving supplement for children suffering from severe acute malnutrition (SAM), was removed from the federal health budget.
2. 100% Free Access to Prevention and Treatment
Nigerian children should have timely and free access to healthcare services to prevent or treat the three main ailments that kill them – Malaria, malnutrition, and pneumonia. The presidential initiative should aim to have all that is required – primary healthcare centres, medications, qualified personnel, etc. – within 30 minutes of reach of every Nigerian child in five years.
3. Campaign to Identify, Mobilise, Incentivise, and Reward (CIMIR)
Nigeria has a per capita income of $2,085; 72 infants out of 1,000 live births die in the country. In contrast, Turkey and the United Arab Emirates have per capita incomes of $9,587 and $36,285 and have 8 and 6 infants dying out of 1,000 live births, respectively. So, it is obvious that child mortality in Nigeria isn’t a result of Nigeria being a developing country. Senegal, Tanzania, Rwanda, Sudan, and Togo have per capita incomes of $1,606.5, $1,135.5, $833.8, $764.3, and $992.3, respectively, but lower infant mortality rates (per 1,000 live births) of 29, 35, 30, 40, and 44.
Nigeria clearly needs to spend much more on healthcare. But it is also evident that Nigeria must spend its current healthcare budget more honestly and efficiently to provide its citizens with decent healthcare services. Despite the vast need for funds, only 70% of the healthcare budget is released. 22% of the released budget allocation is returned to the treasury at the end of the year due to capacity and governance challenges.
It has to be understood that any presidential campaign to save the lives of Nigerian children is fundamentally an awareness campaign that identifies the areas of the greatest need and the biggest barriers to solving those needs. It will be a campaign to focus eyes on the problem and thereby enhance transparency as much as it is a drive to boost funding.
4. Digitize healthcare expenditure, monitoring, and evaluation
A junior healthcare worker was going for an examination on a final project for a nursing diploma. She gave everyone five treated mosquito nets to appreciate her teachers and other senior staff. This activity illustrates how materials and budgets disappear at every level of Nigeria’s healthcare system. The impunity escalates the higher you go. Information technology could link the materials that budgets are spent on, the quantities procured, the primary healthcare facilities they have been delivered to, and the identity of the ultimate individual beneficiaries.
The presidential initiative should organise an annual hackathon to crowdsource the best ideas on using information and communication technologies to monitor Nigeria’s healthcare expenditure. This initiative could result in ideas such as digital infographic maps that allow Nigerians to easily access data such as the state of healthcare facilities in their local governments. It shows them the position of their local governments in a national ranking of infant and child mortality; the monthly ranking of children who die at birth and from Malaria, pneumonia, and other causes; and the number of materials supplied, such as mosquito-treated nets, RUTF, and so on.
Nigerians should also be able to use digital primary healthcare maps to monitor budgeted sums for building or rehabilitating primary healthcare centres in their local governments and the progress of such projects. The annual hackathon would finetune and improve ideas and strategies that employ digital technologies to enhance capacity, transparency, and efficiency in Nigeria’s primary healthcare system.
5. Presidential Monitoring and Evaluation Council on Primary Healthcare Delivery (PMEC)
If frustrating monitoring and evaluation systems were to be a field of academic endeavor, half of the Nigerian public sector workers would have a PhD in the discipline. The envisaged presidential initiative to reduce child mortality would achieve only a fraction of its potential if entrusted to the existing healthcare system, no matter how much funding is increased.
The proposed Presidential Monitoring and Evaluation Council on Primary Healthcare Delivery will not be an addition to the litany of government agencies in the health sector. It will have full authority to control and spend 50% of the additional funding for Nigeria’s healthcare (see 1 above).
The PMEC will be co-headed by the head of UNICEF or WHO in Nigeria and a prominent Nigerian businessman or businesswoman (think of Aliko Dangote, Fola Adeola, Ifueko Omoigui Okauru, Atedo Peterside, or Yewande Sadiku). Membership will include representatives of major private sector organisations, international donor institutions and foundations, the Federal Ministry of Health, and the National Primary Health Care Development Agency (NPHCDA).
The key responsibilities will be two-fold; a planning function that identifies needs-versus-capacity gaps and designs strategies to plug the gaps. The second aspect would be a funding function that enjoys the autonomy to invest, monitor, and control funds (i.e., 50% of additional healthcare funding) to close capacity gaps and procure primary healthcare inputs (facilities, workforce, etc.).
The PMEC’s capacity building remit will include training existing staff and recruiting additional staff; it will also reward performance by enhancing the welfare and remuneration of frontline staff. The council will ensure that the Nigerian President, the healthcare system, and the nation have up-to-date information on the current state of healthcare across the country and the progress of interventions to improve healthcare delivery.
The quality of Nigerian institutions is a direct outcome of the politics we practice. Bad governance cannot be designed away. Yet, the courage to initiate bold institutional tweaks could deliver significant benefits, in this case, reducing child mortality by saving Nigerian children from dying of easily preventable diseases.
Nigeria’s next President has to increase funding, transparency, and capacity of the healthcare system to save children’s lives. There should be a collaboration with the private sector and international institutions versus pumping more funds into national institutions that lack incentives to improve governance and capacity.
International funding has previously been withdrawn from the Nigerian agency fighting malaria and the counterpart AIDS agency over misuse of funds. A presidential initiative that increases transparency and boosts capacity would see a more significant inflow of funds into healthcare from Nigeria’s private sector and international foundations. The goal is to ensure that every Nigerian child can access decent healthcare services.
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The initiative to reduce child mortality through improving primary healthcare delivery in Nigeria will have a significant spillover effect. It would become more accessible for primary healthcare facilities to acquire the capacity to treat various ailments that affect Nigerians in poorly served communities. It could also become a model for improving the delivery of public services in other areas.
Of course, Nigeria’s woeful child mortality figures are regionally skewed; the figures in the south of the country are similar to Ghana’s or perhaps Peru’s. Cultural factors and socioeconomic factors, e.g. the prevalence of polygamy, higher rates of poverty, higher fertility rates, etc. in mainly some parts of Northern Nigeria are responsible for Nigeria’s poor child mortality record. The recommended initiatives would focus attention and mobilise resources toward crisis areas of the country while also creating incentives for better-performing regions to improve.
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