By Sani Sa’idu Baba

My dear country men and women, this week I am taking us on a journey to demonstrate some issues that are important to the development of our dear country Nigeria, especially in the areas of research and health where I professionally have a comparative advantage. But before I go into that, let me briefly explain what has drawn my attention to a topic of this nature, generally considered a less talk about issue in the media and scientific spaces in our country. I believe my readers today. irrespective of their professional backgrounds, will be convinced that we are living in starvation in the midst of plenty, especially in the inseparable areas of research and health. These two go hand in glove, such that research outcomes are translated into modality or therapeutics, and the therapy outcome also give rise to several hypothesis and speculations that eventually requires further research.

Earlier in the week, I received a call from my Professor and academic mentor, Prof. Isyaku Umar Yarube, a Professor of Human Physiology and Neuroscience, equally the Head of Neuroscience and Pathophysiology unit, Bayero University Kano, asking me to participate in a symposium and launching of Biomedical Research Training (BioRTC) center organized by Dr Mahmoud Maina, on a mission to facilitate research and training of Nigerian scientists, using modern methods that will enable them to contribute to solving local and global biomedical science problems through scientific research. The first of its kind-centre is located inside the Yobe State University, Nigeria. Let me recommend that this centre be replicated in other areas of the country, especially in our universities and teaching hospitals. Lack of state-of-the-art research instruments in our country is perhaps the reason neuroscience and other biomedical researchers in Nigeria choose oversees for postgraduate studies, especially those that could afford, but certainly not due to lack of the best brains that can handle advanced research in Nigeria. Let me confess at this point that Nigeria is blessed with the needed human resources and brains that can turn around situation of things in this country. More often than not, people are of the view that Nigeria is not well equipped with the technical know-how and skills in the field of traditional research, not knowing that the only thing sadly lacking is the key to unlocking such potentials.

Nigeria has a population of over 200 million people, the largest in Africa. Among the West African countries, it has the second highest density of medical doctors, which is, however, still very low compared to the actual figure that will meet the need of our population. Government expenditure on health is considerably slimmer than what comes from private contributions, differing by over two thousand billion naira. About 3.8 percent of Nigeria’s GDP is invested in the health sector. In OECD countries, the average percentage of GDP spent on healthcare was 8.8 percent. Also, OECD member countries are mostly high-income countries, whereas Nigeria is an emerging economy and belongs to countries with lower middle-incomes. Nigerians usually have to pay for medicine out of their own pocket. Often the medicine is very expensive and difficult to afford.

Though our population is very high, we still have potential that if appropriately and adequately explored will place us in the forefront in the fight against diseases bedeviling the situation in our country today. For a proper understanding of the current health situation in Nigeria, it is important to state briefly the evolution of its healthcare system and within that framework examine some of the factors that led to our sorry state. Prior to the coming of Europeans to Nigeria, the indigenous peoples that make up the country relied entirely on indigenous herbal and fauna knowledge to resolve various health conditions. The healthcare system was based on the quality knowledge of practitioners as well as defined ways of apprenticeship to qualify as a healthcare provider. The medical student was expected to go through years of training both in herbal knowledge, therapeutic processes, and psycho-social relations. The underlying principle of traditional medical system was a sacred calling toward the preservation of lives and to serve as a cohesive element in the society, rendering services for peanuts or even free. However, with the coming of Europeans from the fifteenth century and the subsequent introduction of Western medicine, healthcare services became monetized so that health services were rendered for a standard fee. Although the colonial government did not overtly introduce Western medicine to rural folks, the importation of Western-trained medical doctors as well as Western medicine coupled with the influx of missionaries that used Western drugs as a means of evangelism, the seeds of drastic change in traditional medicine were sown. One key factor that led to the undermining of traditional medicine and its subsequent neglect was the missionaries’ association of traditional medicine with witchcraft, Satanism, and evil.

Let me comeback to one of the backbones of my article today. During that symposium paper presentations, Professor Isa Hussaini Marte of University of Maiduguri and the current Chief of Staff to Borno State Governor presented a very mind blowing paper on cancer and the potentials of some of our medicinal plants largely found in the North-central of Nigeria in the therapy of cancer. These plants has been thoroughly researched in its laboratory and their anti-tumor effect been proved. Not only was that, but a woman who was referred to him with a very large tumor was significantly improved and tumor shrank after being treated with the extract of the plants. This marvelous development occurred in our dear country. So, it was clear to me that despite the popular claim of the absence of definite cure for cancer, Nigeria still has the potentials to drive the world in this regard. However, the setback still remains lack of the modern state-of-the-art and cutting edge instruments and inadequate government commitment towards funding the research. Though, the professor has acknowledged some support given to him in the establishment of his multi-million naira laboratory, but that was just not enough. The financial implication in establishing this type of laboratory is largely beyond an individual capacity or small organization. For example, the demand for absolute constant and uninterrupted electricity for the lab to function, not to talk of the expensive reagents and other gadgets needed in the lab. Success in this type of anti-cancer research, especially in a resource constraint settings like in Nigeria will go a long way to provide alternative to the most expensive cancer management strategy like the chemotherapy and radiotherapy that has been in use, though with minimal success. Besides, there are only two working cancer radiotherapy centers in Nigeria, one in National Hospital Abuja, and the other in Lagos. Let us reflect on our population and the prevalence of the disease in our environment here! Interestingly, the success story of cancer management lies in the use of traditional medicines, which is quite in abundance in our environment.

Furthermore, apart from cancer that has been considered a top killer disease not only in Nigeria but globally, another disease that is affecting a large chunk of Nigeria population is cognitive impairment, hypertension, diabetes, chronic kidney disease and stroke among other chronic diseases. Although these diseases affects largely the elderly population in Nigeria, but the burden associated with them on the government especially vis-à-vis reduced productivity, increase dependency and reduced quality of life of the affected people is very alarming. For instance, the cost of stroke management was estimated to be 173.8 billion naira in 2011, excluding nursing care for stroke victims per annum in Nigeria. This is quite huge for an average citizen who lives on per capital income of less than $2 per day. That was in 2011 when the Naira was relatively stable. What can we now guess as the situation with the current devaluation of Naira? That is quite enough as a burden. In line with this, Professor Isyaku Umar Yarube of Bayero University Kano has took a giant stride towards utilizing research to understanding the root cause and interconnections of these chronic diseases, and most importantly proposes some recommendations that will go a long way to address issues and reduce the burden that comes with it not only on our government but generally population in our dear country. He has joined many international professors from US, UK and Germany to present a very interesting novel findings that stimulated many researchers and clinicians present during the symposium. Of particular interest is that his research showcases the potentials of some blood markers in early diagnosis of these diseases especially in resource constraint settings to by-pass the very expensive ways that majority could not even afford. Such contribution is worth supporting by the government, research bodies and other authorities.

More so, the comment made by Sir Richard Roberts, a novel Laureate winner, about the capacity and quality of Nigeria’s scientist was also very heart touching. It gave me hope and indication that even the world has already identified with Nigeria and the problems affecting us not going on the same page in areas of research with the rest of the world. He stated categorically that if we have the adequate laboratories and needed instruments, we can even produce our own covid-19 vaccine in our own country. Lack of enough laboratories in Nigeria has affected not only medical research, but even the covid-19 testing. Very negligible number of Nigerians were tested till today, not to talk of producing our own vaccines. He also warned that the issue of biomedical research in Nigeria should not in any way be politicized because it is one of the yet to be explored area that will be key to our development. This is enough to tell us how qualitative and dogged Nigerian scientist are on the eyes of the world. Nigerians are doing greatly wherever they find themselves in the world. More often than not, celebrated journalist, Chief Dr Dele Momodu, reports the success story of Nigerians doing great things in one country or another. Perhaps in almost every sector, Nigerians has taken the lead. Very encouraging!

Another key issue that stimulated my discussion today is about the need for social and financial risk protection for poor and vulnerable populations as a major developmental policy to achieving adequate healthcare coverage. In the context of health, social protection refers to programs and measures aimed at removing financial barriers preventing access to health care services and protecting poor and vulnerable populations from the impoverishing effects of medical expenditures. Financial risk protection is a key component of universal health coverage (UHC) and the health system goal of ensuring access to quality health care services without suffering financial hardship. But before then, let me briefly highlight the underpinning philosophy of the First Republic, and that was to ensure that Western styled healthcare delivery became the primary source of health service in the country, and in order to achieve this, the government invested heavily awarding scholarships to indigenous students to study medicine, nursing, and other allied professions abroad. At the same time, the government of the day was also building hospitals (orthopedic, specialist, and general hospitals) both in capital cities in the states and in key urban centers. Equipping hospitals with personnel and consumables became the priority of the government. On their return from overseas, the early trained medical doctors were placed in key positions in the health sector, while the public was encouraged by the government to patronize public hospitals and Western pharmaceuticals that were provided free or heavily subsidized by the government. This welfare orientation of Nigeria’s First Republic, incidentally, could not be sustained for long due to the downturn in oil price and the increasing corruption in political circles. The consequences of this development were scarcity of hospital equipment, epileptic payment of salaries of health workers became the order of the day, and a deteriorating condition of service precipitated the mass exodus of medical personnel out of the country. Let us not be carried away by the saying of the minister of labour and employment, Chris Ngige that the numerical strength of health workers in Nigeria is enough. He probably must has forgotten!

However, in the last decades, there were high maternal and children mortality rate in Nigeria perhaps due to lack of affordability of what the health system entails nowadays. Things has significantly changed for the worst in most cases. It is no longer about the patient in many places, it is rather about what I have accumulated for the government so that I will be recognized for further appointment. Sometimes it is not even the fault of the government because it has been misinformed about the true state of the situation. Patients mostly comeback on their appointment date without been able to buy the just N500 drugs they were prescribed before. I will never forget the story by the former emir of Kano, Sanusi Lamido Sanusi of the woman carrying a baby that he sighted on CCTV camera from his library. She came and joined a queue inside the palace where people usually come to collect some palliatives. He quickly asked someone to go and check, and he found that she was requesting for N3000 because the doctors in a hospital near the palace could not attend to her severely ill child by virtue of the money she doesn’t had. She was given immediately but unfortunately, before she left the palace for the hospital, the baby died. This is too heart touching and even the emir fell in tears when the news of the death was broke to him. Even though the governor of the state is one of the best performing governor in terms of health, but his effort might have been sabotaged due to the corruption that has engulfed most of the managerial sectors in Nigeria.

As of now, there are several schemes put in place by the government to ensure adequate access to health. These include the National Health Insurance Scheme (NHIS), National Immunisation Coverage Scheme (NICS), Midwives Service Scheme (MSS), Nigerian Pay for Performance scheme (P4P). So it is not a matter of absence, but willingness and efficiency. I believe not every Nigerian incuding the working class were able to benefit from these schemes. In fact, it has been alledged that something fishy is going on there especially in the NHIS. The removal of its former Executive secretary, prof Yusuf Usman who is known to be just and honest had generated a lot of questions, this by the way. However, despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.

Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. Social and financial risk protection can be provided through programmes and measures that are rooted in legislation. Lack of social and financial risk protection leads to high levels of poverty, vulnerability and inequality in health. When the majority of a country’s population encounters the aforementioned problems, governments have to be responsive and design programmes that are rooted in legislation. So far, states such as Kano, Osun, Niger, Kaduna, Ekiti, Lagos, Ondo, Enugu and Jigawa are known to have provided some free health policies at one point or another since the return of democracy in 1999. So government should ensure every citizen irrespective of status can access quality health, and should also support medical research. GOD bless our dear country Nigeria.

Baba writes from Kano, and can be reached via drssbaba@yahoo.com