Healthcare System in Nigeria: Challenges and Problems During the COVID-19 Pandemic
The main goal of this research proposal is to examine the problems and challenges of the Nigerian healthcare system during the COVID-19 pandemic. In Third World countries, like Nigeria, healthcare systems are usually weak and underdeveloped. Healthcare workers and patients face such challenges as unconcerned and corrupt leadership, poor working conditions (Obi-Ani et al., 2021), poor quality of health services and health status of the population (Ephraim-Emmanuel et al., 2018), underinvestment in healthcare systems (Akunne et al., 2019), obsolete infrastructure (Omoleke & Taleat, 2017), and low income. The main purpose of the proposal is to prove that the current healthcare system of Nigeria is vulnerable and cannot resist outbreaks of such diseases as Covid-19.
Moreover, since the outbreak worsened the economic crisis of Nigeria, the healthcare system of this state suffered too. Awucha et al. (2020) claim that “Nigeria is highly dependent on other countries for its medical needs” (p. 1630). For example, about two-thirds of all medicines used in Nigeria are imported from China and India (Awucha et al., 2020, p. 1630). Thus, when all borders were closed with the beginning of the Covid-19 pandemic, Nigeria’s population suffered from limited access to medicines and higher prices on medical equipment, sanitizers, personal protective tools, medications, and face masks. Therefore, it is important to examine the current status of the Nigerian healthcare system and pharmaceutics and the impact of the pandemic on healthcare workers, patients, and the whole system in general. Unpreparedness to disease outbreaks and weak health care may lead to fatal outcomes if the state does not take steps to solve the existing problems today.
- To explore challenges and problems in the Nigerian healthcare system before and during the Covid-19 pandemic.
- To examine the role of social, economic, and political factors in the healthcare system of Nigeria.
- To assess the preparedness of the Nigerian healthcare system for the Covid-19 outbreak and find possible solutions to the problems that occurred during the pandemic.
- What challenges did healthcare workers encounter during the Covid-19 outbreak in Nigeria?
- How did the Covid-19 pandemic influence access to essential medicines by the population of Nigeria with chronic diseases?
- What is the role of government in the healthcare system of Nigeria, and how do the governmental policies address the challenges related to drug supply and health services during the pandemic?
- How did the worsening of the economic crisis affect the healthcare system in Nigeria?
- The closure of the national borders during the Covid-19 pandemic will have a negative impact on the access to essential medicines by the Nigerian population with chronic diseases, which will lead to adverse health outcomes.
- The governmental response to the Covid-19 pandemic and the implementation of new policies are positively associated with Nigeria’s drug supply and health services.
- There is no significant difference between the challenges healthcare workers faced before and during the Covid-19 pandemic in Nigeria.
The healthcare system in Nigeria is weak and underdeveloped due to the poor economic status of the country. Thus, it faces many problems and challenges, especially in the sphere of public health. During the Covid-19 pandemic, all the existing problems became even more crucial and serious. Moreover, the healthcare system of Nigeria has met new challenges that need to be addressed immediately. This research proposal will explore the challenges and problems of Nigerian healthcare systems that existed before and during the Covid-19 pandemic. It will also investigate the role of the government in the healthcare system and the impact of various social, economic, and political factors on health systems. One of the purposes of this project is to evaluate the state’s preparedness for the Covid-19 outbreak and find out what challenges the health care workers encountered during the pandemic. In addition, the impact of the pandemic on the access to essential medicines by the population with chronic diseases will also be examined.
The healthcare system in Nigeria is not perfect, and it faces significant challenges now, during the Covid-19 pandemic. One of the main problems of the healthcare sector in Nigeria is its inadequate programs (Muhammad et al., 2017, p. 6). Although these programs were aimed to address numerous health problems, they led to no or insignificant improvement in health care. Research showed that the top causes of death in Nigeria are “malaria, lower respiratory infections, HIV/AIDS, diarrheal diseases, road injuries, protein-energy malnutrition, cancer, meningitis, stroke and tuberculosis” (Muhammad et al., 2017, p. 6). One can see that most of these diseases can be prevented, and the proper design of programs will help improve the health status of Nigerian people. However, the economic crisis led to inadequate investment in preventive services and healthcare systems.
At the same time, with the Covid-19 outbreak, the government of Nigeria had to reconsider both the financial investments in the healthcare system and the new policies needed to address the pandemic. Thus, the Federal Government released a US$ 12.5 million fund for emergency responses and US$ 25 million “to Lagos State, the epicenter of outbreak” (Amzat et al., 2020, p. 222). Although it may seem that such actions were positively associated with healthcare system improvements, in reality, they only occurred after numerous positive cases of coronavirus were confirmed in the country. One can see that the country was unprepared for the Covid-19 pandemic, and it could not react to the new problems adequately. The inadequate governmental response to the pandemic led to panic among the citizens of Nigeria and “the medical tourism, embarked on by the Nigerian elite” (Amzat et al., 2020, p. 222). Consequently, those citizens who had more money could travel to other countries and receive health care there, while those who were poorer remained in Nigeria and sought help in the public health sector.
Since most of the Nigerian population lives on or under the poverty line, most of its citizens use public health services. With the Covid-19 outbreak, healthcare workers’ workload increased significantly, and the state had to deploy professionals from different departments, including those who had “limited experience in the management of infectious diseases” (Okeridan et al., 2020, p. 364). The lack of health care workers with proper experience was one of the main challenges during the Covid-19 pandemic in the healthcare system in Nigeria. Thus, the healthcare practitioners were supposed to provide their patients with psychological support and symptomatic care, which led to overload and burnout. As a result, they required psychological assistance and the rest of full value. However, despite all these challenges, the health care workers exhibited commitment, humanity, and professionalism in Coronavirus care (Okeridan et al., 2020, p. 364). The main challenge was the lack of resources and medicines, especially after the closure of the national borders.
The population of Nigeria was at risk of limited access to essential medicines during the Covid-19 pandemic. The country purchases about 70 percent of all medicines needed for its population in other countries, such as India and China (Awucha et al., 2020, p. 1630). Thus, the closure of the national borders would make it difficult for the citizens of Nigeria to find the medicines they need. The most vulnerable population is people with chronic diseases, who need to take medicines regularly. If the country cannot import such medicines and does not produce them, these patients will be at risk of worsening their health. To address this issue, “the Chairman of Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN), in January 2019, made a case for drug insecurity in Nigeria” (Faiva et al., 2021, p. 1). He insisted that the local governments increased the local production of medicines from 40 to 75 percent (Faiva et al., 2021, p. 1). Still, this policy did not change the situation with drug insecurity significantly. Global drug businesses created unfair competition between multinational manufacturers and local representatives, suppressing the locals and leading to drug scarcity.
Although all the challenges and problems mentioned above are related to the Covid-19 pandemic, similar problems have existed in the Nigerian healthcare system before the outbreak. For example, the recent research showed that the four top problems in the healthcare system in African countries were “inadequate human resources,” “poor resource allocation to health,” “poor maintenance of healthcare system infrastructure,” and “lack of political will” (Oleribe et al., 2019, p. 397). One can see that these problems mostly involve the healthcare workforce, leadership, governance, and financing, with the latter one as the crucial factor affecting the entire healthcare system. Poor healthcare conditions and lack of access to education and training lead to the scarcity of human resources. People migrate to big cities and other countries to find jobs there, and those who are left demonstrate a poor attitude to their work (Oleribe et al., 2019, p. 400). As a result, the whole healthcare system suffers because it depends on the people who provide patients with services. If the economic situation does not change in the country, the healthcare workforce will continue to decrease.
In addition, political factors affect the healthcare system of Nigeria. The unsettled political order leads to various insecurity challenges, including insecurity with life and property (Omoleke & Taleat, 2017, p. 213). Many young people feel that “there is no equity in the distribution of national wealth to Niger Delta geopolitical zone” (Omoleke & Taleat, 2017, p. 213). The situation is similar in other geopolitical zones, especially in the poor ones. As a result, many cases of kidnapping, crime, and bumping occur daily in Nigerian cities. One can see that the implementation of healthcare policies is problematic in such a hostile environment.
In addition to strikes and crimes, corruption in the health sector is another problem in Nigeria. During the Covid-19 pandemic, this problem became even more crucial. Thus, healthcare providers often try to shift public hospital patients to private hospitals, which is an example of corrupt and unethical behavior (Omoleke & Taleat, 2017, p. 214). As a result, those who have more money are treated better than those who cannot afford private medicine. In addition, healthcare workers violate the rules of professional conduct, demonstrating rude attitudes to their patients and even abusing them when they need care (Omoleke & Taleat, 2017, p. 214). Although such cases may exist in other countries, corruption and ethical misconduct have almost destroyed the healthcare system in Nigeria.
One more factor that negatively affects the healthcare system of Nigeria is fake drugs. In the 2000s, more than 60 percent of all drugs available in Nigeria were fake (Klantschnig & Huang, 2019, p. 443). Moreover, that small amount of medicines produced in the country was banned in the neighboring countries because of quality concerns. Since that time, Nigeria began its fight against “fake drugs,” engaging its main regulatory agency, “the National Agency for Food and Drug Administration and Control (NAFDAC),” in this fight (Klantschnig & Huang, 2019, p. 443). However, since the unregulated trade in drugs had a long history in the country, it would not be easy to eradicate the problem. The biggest issue is that all types of drugs can be falsified, including “antibiotics, antimalarials and vitamin syrups” (Klantschnig & Huang, 2019, p. 450). Some fake drugs are not dangerous and do not affect human health, while the others are poisonous and may damage health and even lead to death (Klantschnig & Huang, 2019, p. 450). During the Covid-19 pandemic, this problem is vital because many people with this disease receive drugs to relieve pain and improve respiratory activity. If the medicines they take are ineffective or even poisonous, people will have a high chance of dying.
One should consider the role of government in drug regulations to understand how to solve the problem. According to Klantschnig and Huang (2019), two specialized state agencies were involved in addressing the issue of fake drug manufacture and trade in Nigeria: the Pharmacists Council of Nigeria (PCN) and the NAFDAC, as mentioned above (p. 452). The first agency was responsible for controlling the profession of pharmacists and their licenses, while the second agency focused on the registration and trade of drugs. However, the PCN received no support from the state, and it became a self-regulatory agency, which was not as influential as a state-regulated stance. On the other hand, the NAFDAC was more influential and received funding from the federal government, but numerous cases of corrupt practices and dependence on huge drug corporations did not allow the agency to regulate the manufacture of drugs fully. Thus, the problem of fake medicines is still relevant today, and the government should address this issue immediately to improve the situation with the Nigerian healthcare system.
The health system in Nigeria demonstrates underperformance in different sectors. At the same time, in the past several decades, the government of Nigeria has implemented new policies and regulations to improve the healthcare system. These policies and development plans resulted in the National Health Act of 2014 (Adeyi, 2016, p. 285). This Act explains the responsibilities, instruments, institutions, rights, and obligations of patients and health care practitioners and various regulations related to health care. Although the Act covers almost all possible aspects of healthcare, it does not achieve full coverage for the poor population of Nigeria. Good health depends on different factors, including the environment, agriculture, education, and infrastructure. Since poor people live in poor conditions and cannot afford education and good nutrition, their health is weak, and the government does not address all these social factors (Adeyi, 2016, p. 286). During the economic crisis, the situation worsened, and those who were poor became even poorer.
Moreover, local governments have the weakest capacities, but they are responsible for primary health care, and they cannot choose the most cost-effective services without the federal government’s agreement. Thus, if changes are needed at the local level, the authorities of that area must seek approval from the federal government and wait for their decision to be accepted. Evidence-based planning is also absent in the Nigerian healthcare system. Finally, financing depends on the inputs in health care, which means that smaller areas receive a smaller amount of money while those areas where the number of hospitals and medical forces is bigger receive higher investments. As a result, poor regions remain underdeveloped and suffer from a scarcity of medical equipment and workforce. The government should address all these issues to improve the situation and make the healthcare system more accessible and affordable to all Nigerians.
One of the objectives of this research proposal is to examine the role of social, economic, and political factors in the Nigerian healthcare system. People’s attitude to the delivery of health services often depends on their political trust in the government. In 2012, the federal government launched the national health program, “the Nigerian Subsidy Reinvestment and Empowerment Programme Maternal and Child Health Intervention (SURE-P MCH)” (Chukwuma et al., 2019, p. 2). The program positively affected the population’s trust in the federal government but had little effect on their trust in the local council and political agencies and parties. Moreover, people who lived closer to the intervention facilities were better “educated, employed, and urban” (Chukwuma et al., 2019, p. 8). Such a statistic may be related to better promotion and education programs in these areas and an apt illustration of the positive effects of the intervention program. Thus, one can see that if the government implements some health programs and informs the population about them, and demonstrates their effects, the citizens will be more likely to trust in it. On the other hand, if the population does not believe in the importance of the government’s actions, the situation with the healthcare system will not change.
The preparedness of Nigeria for the Covid-19 pandemic and other disease outbreaks plays an important role in assessing the country’s health care. Research showed that Nigeria was not prepared for the challenge posed by the new coronavirus disease (Etteh et al., 2020, p. 3). The only institute that could provide leadership for scientific and technical research was the Nigeria Centre for Disease Control (NCDC), which had already dealt with the Ebola pandemic in the past (Etteh et al., 2020, p. 3). However, the institute was not ready for such changes, and the country had to find novel solutions to the problems that occurred during the Covid-19 pandemic. The Presidential Task Force (PTF) and the NCDC coordinated the multi-sectoral response and provided the response resources to the local institutions (Etteh et al., 2020, p. 4). Despite limited access to pharmaceutics and personal hygiene tools, the NCDC showed an effective response to the pandemic and provided people with guidelines on making and using face masks, conducting transportation, and using protective equipment rationally. However, early communication and guidelines are not enough to address the pandemic and prevent its adverse consequences.
Nigeria was not ready for many challenges of the Covid-19 outbreak. Thus, one of the challenges was a lack of capacity to deal with a rise in cases and to accommodate all patients with beds in hospitals. The lack of diagnostic capabilities led to diagnostic delays and scarcity of personal protective equipment (Obaseki et al., 2021, p. 2). Health care providers’ infections decreased the number of available employees, and those who were left had to stay at work longer. All these challenges stimulated the Nigerian health system to change and develop during the pandemic. The state government promptly responded to all changes and acted respectively. The schools were closed, and public and social gatherings were prohibited. These actions gave the hospitals more time to prepare for the spread of the disease and plan their response (Obaseki et al., 2021, p. 3). Nowadays, one can see an optimistic model of healthcare development in Nigeria. Still, it is not enough, and the country has to take additional steps to improve its health systems and reach a new level in medicine.
I will use mixed methods of research to write the research project. The first and main method will be secondary data analysis. This method is the most appropriate one to achieve my research goal because it is quick and precise. The subject of the health care system in Nigeria is not new, and there are many peer-reviewed sources, which are credible and relevant today. Moreover, the COVID-19 pandemic is a pertinent question because it still exists globally, and Nigeria is not an exception. While writing this proposal, I have found dozens of peer-reviewed articles written within the last 2-5 years, which means that there will be no problems finding the necessary resources for my research.
At the same time, I would like to use surveys for my research if I had time for them. Surveys will allow me to comprehend the subject better and hear the opinions of health care workers and patients about the situation with the healthcare system in Nigeria. One of my research objectives is to discover how the pandemic influenced the patients’ access to medicines, so the surveys will help me gather primary data and use it along with the secondary sources. In addition, surveying health care practitioners will allow me to find out what challenges they faced before and during the pandemic. Although many secondary sources have already gathered this information, personal interviews and surveys will make the research project more full-blown and informative.
Since most of my objectives require qualitative data, I will use a qualitative approach in the research paper. A qualitative approach analyzes information that is not numerical, while a quantitative approach focuses more on numbers and statistics (Punch, 2008). For the first hypothesis, I will utilize both approaches to show the impact of the closure of the national borders during the Covid-19 pandemic on access to medicines. For example, I could use graphs to demonstrate how the situation with drugs and medical equipment changed during the pandemic. Such graphs will help compare and contrast the situation with pharmaceuticals before and during the Covid-19 outbreak and see whether the closure of borders had a negative impact on access to these medicines.
A qualitative approach will be used to analyze challenges and changes healthcare workers faced during the pandemic. Moreover, the patients’ attitudes to the healthcare system of Nigeria may also be examined with the help of this approach. Finally, the governmental response to the Covid-19 outbreak will also be investigated by analyzing qualitative data. I will use both content and thematic analysis to conduct qualitative research. I will transcribe the interviews and code the data to identify the key thematic elements and examine each theme more thoroughly. As to the secondary data analysis, I will use content analysis to categorize the themes and identify them with the research objectives.
The main limitation of the interviews/surveys is that they cannot be generalized because I cannot interview all health care workers and patients. Therefore, a limited number of interviewees will allow me only to comprehend the perceptions and attitudes of a small population group. At the same time, such interviews provide an in-depth understanding of the participants’ emotions and feelings, which may benefit the study.
The main strength of the secondary data analysis is that it does not require much time and effort. To find the research articles, I will use the Library and other research databases, such as ScienceDirect, ResearchGate, NCBI, PLoS One, JSTOR, Springer, and others. All these databases provide access to scholarly peer-reviewed articles, which can be used for my project. The main limitation of this research method is that not all data needed to test the hypotheses may be available.
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