As a fundamental right of any individual, healthcare is expected to be at the heart of every government’s main responsibility to its citizenry, as it is critical in ensuring longevity and effective and efficient productivity. However, most governments have relegated health care provision to the back seat: this can be clearly seen in the amount of budget allocation to this area. It is for this reason that the United Nations, in developing its Millennium Development Goals (MDGs), had four of its eight goals focused on health and health-related issues thus:

i. Eradicating extreme poverty and hunger

ii. Reduce child mortality

iii. Improve maternal health

iv. Combat HIV and AIDS, malaria and other diseases.

Unfortunately, as a nation, we are far from effectively and adequately providing the necessary resources – infrastructure and otherwise – to ensure that these goals are met. It has become increasingly difficult to meet the healthcare needs to the nation’s citizens as a result of many years of neglect that this sector has suffered. It is, therefore, no wonder that medical tourism as it relates to Nigeria is on the high side. And given the severe dichotomy of wealth and poverty in the nation, the gulf becomes wider as the poor becomes more impoverished in their quest for better treatment elsewhere.

It is, therefore, timely that we are beaming our torchlight in this area. While it serves as an opportunity for me to share with the international community, such as this gathering, the challenges and current efforts aimed at tackling the challenges – as well as the prospects in ensuring that the government lives up to its responsibility in making adequate health-care services available to the people – it also serves to bring to my view and remind me of the urgency that it places on our present administration of which I am part, in reversing the current position and replacing same with a system that works, and places us at par with global best practices.

In tackling this subject, I will be doing a background on the healthcare service system of Nigeria, with geographical and historical perspectives; the critical determinants and scope of healthcare service delivery in the nation and what we are doing to reverse the trend of medical tourism.

BACKGROUND

Geography and demography

Nigeria is a country on the West Coast of Africa; lying 5º North of the Equator and between 3º and 4º East of the Greenwich Meridian. It is bordered on the south by the Bight of Benin and the Atlantic Ocean, on the north by the Republics of Niger and Chad, on the east by Cameroon and on the West by Benin Republics. It has a land mass of 923,768 km² with an estimated population of about 182.2 million people, making it the most populous Black country in the world. A gender disaggregated distribution of Nigeria’s population further reveals 51 per cent male and 49 per cent female.

Women of child-bearing age and children under five constitute 22 per cent and 20per cent of the population respectively. Adolescents aged 10-24 years constitute 32 per cent of the population, while children under 15 years account for 42 per cent of the population.

Health-seeking behaviour is primarily determined by ability to pay, and secondarily by socio-cultural factors. Presently, it is estimated that over 65 per cent of Total Health Expenditure in Nigeria is paid from ‘Out of Pocket’, making this an unbearable financial situation, where other areas of need suffer at the expense of meeting healthcare needs.

Nigeria operates a Federal System of Government on three levels: the federal, the state and the local governments. There are 774 local government areas (LGAs) within the 36 states and Federal Capital Territory (FCT), Abuja. The 774 LGAs are further sub-divided into 9,565 wards. The states and FCT are grouped into six geo-political zones, namely: the South-south, the South-east, the South-west, North-east, North-west and the North-central zones.

The health sector is also three-tiered: the tertiary level care, secondary level and primary level care, undertaken by the federal, state and local governments respectively.

Evolution of healthcare services in Nigeria

The healthcare services system in Nigeria has evolved overtime. Before the advent of colonialists and the gaining of independence, traditional medicine and healing were predominantly the system of healthcare delivery available. These came in the form of herbalists, midwives, bone-setters, spiritualists, mental health therapists and others, after their mould.

Western-style healthcare service came with the influx of explorers and church missionaries who established healthcare centres as part of their means to promote their missions. Although these healthcare services were meant principally for the Europeans who brought them, with time it expanded to cater for the locals who worked for them, and much later to all other indigenes.

In 1880, a dispensary was the first healthcare facility opened in the country by the Church Missionary Society (CMS) in Obosi (Anambra State), while the Sacred Heart Hospital built by the Roman Catholic Mission in Abeokuta in 1885 was the first hospital established.

As healthcare service delivery expanded to cater for locals and indigenes, there was need to incorporate the services of indigenous persons who were trained to assist these European doctors, traders and missionaries, as part of the enhancing of their various missionary and trade work to the remote areas and, especially, as they were experiencing a high mortality rate from their exposure to the inclement weather and unfamiliar diseases found in these parts.

This led to the training of James Beale Africanus Horton, as the first Nigerian doctor, born of Nigerian parents who were freed Igbo slaves from present-day South-eastern Nigerian on June 1, 1830 in Gloucester village, Sierra Leone. He qualified in 1858 at Kings College, London, and later obtained a doctorate at Edinburgh University. Dr (Mrs) Elizabeth Abimbola Awoliyi (Nee Akerele), a 1936 graduate of Medicine in Dublin, was the first female Nigerian medical practitioner

In 1939, the colonial government established the first medical school in Nigeria, the Yaba Medical College. Fendall (1967) recounts: “At first, it trained medical assistants, but was later upgraded to train assistant medical officers. By special arrangement between the Colonial Office and The Royal Colleges of Surgeons and Physicians of Great Britain, most of the assistant medical officers were granted Licentiate Diplomas, after a short exposure in Britain.”

The colonial administration established the Federal Ministry of Health in 1946, to coordinate health service delivery throughout the country, including services provided by the government, private companies and mission hospitals. This was part of a 10-year health development plan, following persistent nationalist agitations by Nigerian health personnel trained overseas that were discriminated against.

According to Scott-Emuakpor (2010), medical services in Nigeria developed and expanded with industrialisation. Most medical doctors were civil servants, except for those working for missionary hospitals, who combined evangelical work with healing. Among the civil service doctors, one was appointed the Chief Medical Officer, who became the principal executor of health-care policies in Nigeria. Along with his several other junior colleagues (senior medical officers and medical officers), they formed the nucleus of the Ministry of Health in Lagos.

Between 1952 and 1954, each of the then three regional governments (Eastern, Western and Northern) set up their own Ministries of Health, as the control of medical services was transferred to them. Notwithstanding, much of the funding came from the federal government, while the regions appropriated same as they deemed fit.

As a forward movement in ensuring that health-care services were provided for all, a 1954 Eastern Nigeria Government report on Policy for Medical and Health Services’ incorporated this need and emphasised the importance of expanding these services to the rural areas.

As Scott-Emuakpor noted: “These rural services would be in the form of rural hospitals of 20- 24 beds, supervised by a medical officer, who would also supervise dispensaries, maternal and child welfare clinics and preventive work (such as sanitation workers). The policy made local governments contribute to the cost of developing and maintaining such rural services, with grants-in-aid from the regional government.”

As of today, the organisation of the public health service system in Nigeria is decentralised, as has already been noted above. The Federal Ministry of Health is responsible for the management and implementation of the national health policy, while overseeing health activities in the 36 states of the federation, the FCT and the 774 local government areas of the nation. It is also in charge of providing tertiary health-care through the teaching hospitals and federal medical centers. State ministries of health on their part co-ordinate secondary health-care service delivery through the general hospitals. The local government health departments in the 774 LGAs oversee primary health-care delivery through the dispensaries, maternities and other primary healthcare centres.

Notwithstanding the above, traditional healing practices still forms a large part of the health-care services provision to the populace, because of strong ethic and cultural belief in them.

CRITICAL DETERMINANTS AND SCOPE OF HEALTHCARE SERVICE DELIVERY

Status of healthcare services

I wish to state here that despite Nigeria’s strategic position in Africa and its ever-growing population, all is not well in the area of adequate healthcare service delivery. The country, by reason of inadequate healthcare facilities, is unable to cater for the growing need to meet the demand for healthcare services to the people, especially those at the rural areas. There is inadequacy in the number of health centres available to attend to the myriad of medical requests that bombard these centres, coupled with a worrisome lack of medical equipment, supplies, drugs and personnel necessary to complement these centres. From all indications, the country is greatly under-served.

Truth be told, the country’s administrators (past and present) have made considerable efforts at pushing reforms and policies aimed at dealing with the various concerns in the health-care service system of the nation. Time would fail me to reel out the various strategic and national development plans that were meant to entrench a “Nationwide Healthcare Services” framework. Implementing these policies has been rather slow and, at most, lacking of the desired will-power to see them through.

Notwithstanding, however, Nigeria has made some notable progress in a few healthcare delivery indices over the past decade. This is attested to by the recent increase in average life expectancy of Nigerians from 47 to 52 years, according to the World Health Organisation (WHO 2015 statistics). This increase is though nothing to be much celebrated when we compare this with countries considered less-endowed than ours (Liberia and Sudan; 61.4 and 64.5 respectively).

Other areas of specific progress include:

1. Maternal mortality rate reduction, from 850 to 550/100,000 births.

2. Child mortality rate reduction, from 280 to 240 per 1,000.

3. Total Fertility rate reduction, from 5.8 to 5.5 per woman

4. Total delisting of Nigeria from the list of polio-endemic countries in 2015

If you look closely, you will discover that these improvements have been marginal; a direct result of the less positive attitude to and the slow pace at which our implementation of health reforms and policies are being carried out.

Existing challenges in the health sector are now joined by emerging ones, reflective of new disease patterns arising from lifestyle changes, like non-communicable diseases. There is now a sizeable blend of diseases related more to the rich, like heart diseases, diabetes, cerebrovascular accidents (stroke), and those related to extreme poverty like malnutrition, cholera, etc.

There is a gradual increase in deaths arising from non-communicable diseases like ‘strokes’ and other causes of sudden death syndrome, kidney failures, etc. Maternal deaths remain a concern in Nigeria. It is estimated that over 100 women die daily from pregnancy and related complications. This is like a Jumbo jet full of passengers crashing every day. This is unacceptable

Poliomyelitis and other vaccine preventable diseases – malaria, pneumonia and diarrhoea – are still of concern among under-fives in Nigeria. Nigeria has the second highest number of people living with HIV/AIDS, second only to South Africa. The global burden of tuberculosis is disproportionately borne by Nigeria, as she has the second highest number of cases. Though significant gains have been made in malaria control in Nigeria over the past decade, she still accounts for about 40 million cases per year, second only to the Democratic Republic of Congo.

The health status indicators for Nigeria are among the worst in the world. On average, the health status of the population has declined, compared with the indicators of a decade earlier. Inequalities in health outcomes also exist between rural and urban areas; between northern and southern regions, and across income groups. High increase in the poverty level and inherent weaknesses in the health sector are basically responsible for these poor health outcomes.

Healthcare facilities

As of 2013, the Nigeria Health Facility Directory has over 34,000 health facilities spread across the country. Less than 35 per cent of these are privately owned. Public health facilities are mainly primary and secondary care facilities, while tertiary facilities are less than 1 per cent. Of the over 20,000 Primary Health Care centres in Nigeria, less than 1 per cent are fully functional (2015 UNICEF Rapid Survey).

With limited access to basic primary health-care due to poor facilities, little wonder our health outcomes remain deplorable. It is in the light of this, however, that the Federal Government of Nigeria – through the National Primary Health Care Development Agency (NPHCDA) under the National Primary Healthcare Revitalisation Initiative – has set plans in motion to ensure that at least one Primary Health Care becomes fully functional in all the senatorial districts in Nigeria. By this, we expect that primary healthcare is made accessible to all Nigerians. These PHCs will provide comprehensive health packages which cover the handling of communicable diseases, maternal and new-born care, HIV/AIDS, STDs, malaria, etc.

Healthcare funding

The Total Global expenditure on health, according to WHO, was $6.5 trillion in 2012, with an average global per capita figure of $948. The United States spends the highest: $8,362 per capita per year on health. Myanmar, at $2 per capita per year, had the lowest spending on health for the period in review. The Organisation for Economic Co-operation and Development (OECD) countries, with 18 per cent of the world’s population spends 84 per cent of the global financial resources on health. Nigeria is one of 34 countries where total health spending from all sources (government, partners, households and private sector is less than $50 per capita per year).

The World Bank estimates that of their total expenses, Nigerians spend over 65 per cent of their resources to obtain health-care. This is termed Catastrophic Health Expenditure, because it leaves nothing for use in meeting other needs like education, food, shelter and clothing. By this Nigeria has fallen short of the 15 per cent benchmark of total budget allocation for Health (AU Abuja Declaration, 2001). Nigeria is also way below the WHO recommendation of per capita spending on health for minimum service delivery, which is $44/person

The various tiers of government in Nigeria have not collectively ever spent up to 6 per cent of their total budgets on health over the past 17 years. In the 2017 budget, 5.2 per cent was allocated to health, an improvement on that of the previous year. There are still huge funding gaps for routine immunisation and Primary Health-care Revitalisation, Family Planning Commodities, etc.

According to an article written by Emejuiwe Victor of the Sun News (2016), it is estimated that to fund the gap needed to address the challenges at the primary level about N300 billion is required annually. It is for this cause that a National Health Act (2014) was passed to address the challenges of health-funding in the nation. Contained in this act is the provision for a minimum of one per cent of the total sum accruable into the consolidated revenue fund to be dedicated to Basic Health Provision Fund to finance health under the following:

a. 50 per cent shall be used for the provision of basic minimum package of health services to citizens, in eligible primary or secondary health care facilities through the National Health Insurance Scheme (NHIS);

b. 20 per cent of the fund shall be used to provide essential drugs, vaccines and consumables for eligible primary healthcare facilities;

c. 15 per cent of the fund shall be used for the provision and maintenance of facilities, equipment and transport for eligible primary healthcare facilities;

d. 10 per cent of the fund shall be used for the development of human resources for primary health care, and

e. 5 per cent of the fund shall be used for emergency medical treatment.

While this move is commendable, yet to be implemented, the 1per cent of the consolidated revenue fund as requested, is a far cry from the estimated N300 billion, as this would amount to just barely N35 billion.

LIMITATIONS AND CHALLENGES

Limitations of health-care services

So far in this paper, I have been able to establish that access to healthcare services in Nigeria has been and is still very poor. One of the limitations to the full achievement of a universal health-care delivery system is the limited coverage of Nigerians under the Social Health Insurance. The National Health Insurance Scheme (NHIS) in Nigeria was established under Act 35 of the 1999 Constitution by the Federal Government of Nigeria, to improve the health of all Nigerians at an affordable cost through various prepayment systems. Through this scheme, a universal coverage for all Nigerians is targeted at an affordable cost.

By its structure, it aims to provide social health insurance in Nigeria on a contributory basis, where health-care services of contributors and their dependants are made from a common pool of fixed regular amounts made by the contributors. However, the coverage of the National Health Insurance Scheme is still below 5 per cent. Some of the reasons for this can be attributed to ignorance, weak governance, funding, etc. Most people covered that make up this 5 per cent are workers in paid employment, where a direct deduction from their wages (their contribution) is made into the pool. The larger uncovered population are mostly the unemployed who live in the rural areas. There are people in paid employment who are yet to key into this plan for lack of proper machinery that seeks to enforce the provisions of the act setting up the scheme.

Also, essential (basic) healthcare services are lacking, as most PHC facilities are short of the minimum healthcare package stipulated by the National Primary Healthcare Agency. Where private clinics are available, they are not affordable, since about 70 per cent of Nigerians live below $1/day. Given that over 65 per cent of Nigerians live in rural areas, it is easy to understand why most Nigerians do not have physical and financial access to basic health-care services:

Secondary health facilities (general hospitals), though fewer in number, have not fared better in terms of human and material resources availability. Few state governments – like Lagos, Kaduna and Imo – have invested heavily in health infrastructure at the secondary level. For instance, Imo State Government, under His Excellency, Owelle Rochas Okorocha, has built 27 brand new general hospitals spread across all the LGAs in the state. However, investment in secondary healthcare needs to be complemented by provision of basic healthcare services at the primary level, which is most accessible to majority of Nigerians.

Tertiary Level Care is under the purview of Teaching Hospitals, Federal Medical Centres and other specialised centres. The Federal Government in 2005/2006 under the FGN/VAMED Project initiated an ambitious, phased scheme to refurbish and equip all teaching hospitals in Nigeria, designating some as centres of excellence for treatment of specific diseases.

A decade after this initiative, the upgraded teaching and specialist hospitals have not filled the manpower and equipment void they were meant to, prior to this intervention. There is, therefore, a compelling need to re-appraise the notion of government intervention in upgrading health facilities in Nigeria. A paradigm shift should be effected to allow innovative public-private models. The nation can take a cue from the GSM revolution that has made it easy and affordable for every Nigerian to have access to telecommunication services that were once a sole preserve of the wealthy.

A lot needs to be done to get the health sector working again. We must get to ask ourselves, why do facilities owned by the private sector work better?

Challenges of healthcare service delivery

Most critical challenges arise from the aforementioned limitations. Funding constraints play a major role in the non-availability of affordable and accessible healthcare services by Nigerians. There appears to be, in addition, insufficient political will by governments at all tiers to invest appropriately in healthcare.

There are also Human Resource Constraints. The health sector in Nigeria is facing a major human resources crisis. It has been a challenge trying to understand why with the large human resource-base the nation prides itself about, there still exists a huge deficiency in the health workforce. Elizabeth Omoluabi, in a contribution to the International Organization for Migration on the Needs Assessment of the Nigerian Health Sector, writes: “The needs assessment shows that Nigeria’s current stock of practising physicians (30,232 doctors by 31st December, 2013) is only about 35 per cent of the officially quoted numbers from a database whose content has never been updated since 1963. As a corollary, the density of Human Resources for Health is much lower than often officially acknowledged. With 0.17 doctors to 1,000 population, Nigeria’s physician density is actually among the lowest in Africa and compares very unfavourably with emerging countries like South Africa (5.5), Tunisia (11.9), Algeria (12.1), Brazil (17.2), Mexico (28.9); and developed countries, such as Greece (60.4), Austria (47.5) and Italy (42.4). Nigeria has less than one-tenth of the required number of doctors to meet its needs.”

With the mal-distribution of the available workforce, and the increasing brain drain, resulting in shortage of critically needed health professionals, the health sector recognises there is a gap that has to be filled if we are to measure up with key indicators. We must realise that human resources are critical in the provision of quality health-care. The shortage of health workers is the cause of the deplorable health indices in major parts of the country, poor quality of service in many public and private health establishments and a loss of confidence by many Nigerians.

There must be a conscious effort to nip in the mud the constant incidence of industrial actions and strikes that have further dragged the nation’s health sector aground in the collective interest of the nation and its citizens.

One major challenge also is the present economic downturn that the nation is currently grappling with. We are optimistic that soonest the nation will come out of the dilemma. This has its impact in the development of the health sector. However, substantial investment in health should not wait for the economy to improve, we can instead utilise it to assist the economy. Economic recovery can be buoyed by investment in health and human capital development.

In the same vein, we must unlock some negative socio-cultural determinants that hinder positive health-seeking behaviour among vulnerable Nigerians, especially the illiterate, poor and marginalised rural dwellers. The preferred resort to traditional medicine is a huge factor that hampers the drive to get quality healthcare to them.

The above challenges and many more are reasons why a lot of the nation’s citizens have lost faith in the Nigerian health system and will rather seek solace with other facilities outside the shores of the nation.

Medical tourism

Medical tourism has metamorphosed in how it is operationally defined in recent times. Originally, it was said to be the movement of patients from highly-developed countries to other areas of the world, to get treatment, usually at a lower cost. (This definition encapsulated the earlier concept whereby rich citizens from Western Europe and the United States went to Asia and Eastern Europe for medical treatment and holiday).

In contemporary times, medical tourism now includes travelling from one country to another in search of medical treatment, especially where such treatments and ailments are perceived to be better understood. (Unlike in the previous definition, this reflects an underlying superiority in the health system of the destination country, compared to the country of departure). This is more applicable to the current Nigerian scenario. Nigeria is currently grappling with an avoidable problem of extensive and unsustainable medical tourism, with the attendant social and economic consequences to our dear compatriots.

A few statistics will suffice. The Indian High Commission reports that of all the visitors from Nigeria to India in 2012 – 18,000 or 47 per cent - did so on account of medical tourism, and spent about $260 million in that process. In 2011, Dr Ngozi Okonjo-Iweala and Prof Babatunde Osotimehin, then ministers of Finance and Health respectively stated that 20 per cent or $200 million of the previous year’s health budget could have been saved, if most Nigerians who travelled abroad for medical treatment were treated locally. In October 2016, the Minister of State for Health, Dr Osagie Ehanire, said Nigeria is spending over $1 billion annually on medical treatment.

RAMIFICATIONS AND DIMENSIONS OF MEDICAL TOURISM

Social ramification

Most wealthy Nigerians perceive overseas treatment as a symbol of their affluent and higher status in society, without necessarily finding out if their ailments could be treated in Nigeria. There still appears a great deal of ignorance among the elite of available skill competencies and facilities in Nigeria. While some Nigerians have obtained excellent treatment in India, (the destination of choice for majority), others have come back with questionable treatments that have in some cases made the patients feel worse, when they were lucky to be alive.

India, South Africa, Dubai and Egypt remain destinations of choice because of the perceived availability of ‘world class’ facilities in these countries. Oblivious of the ethical prescriptions against advertisement among health-care service providers, some of these tourist health facilities hire Nigerian agents/brokers, who have engaged in unwholesome marketing and unbridled advertisements, occasionally making unverifiable claims of sundry treatments.

Beyond improvement in infrastructure, the attitude of Nigerian health workers must improve. The Minister of State for Health, Dr Osagie Ehanire noted: “There is a need for doctors, nurses and other health personnel to treat patients with dignity. In spite of the state-of-the-art facilities, bad attitude towards patients can be destructive.”

Economic dimension

Two ministers of health in Nigeria, at different times, Prof Onyebuchi Chukwu and Dr Ehanire have stated that Nigerians spend about $1billion yearly on medical tourism. Whereas the WHO recommends that developing countries spend 5 per cent of their GDP on health, Nigeria Government at all tiers aggregately have not spent up to 4 per cent of her re-based GDP on health, while South Africa spends about 8.5 per cent.

Nigeria needs to spend up to 10 per cent of her national budget over the next two years on health, and steadily increase to 15 per cent over the subsequent decade, to attain the required minimum standards prescribed by the WHO. This can happen if we initiate a paradigm shift in wholesome healthcare financing.

Reversal Actions

Federal Government

Previous governments did their best to reverse the trend of medical tourism in Nigeria through various initiatives, including the FGN/VAMED Scheme of 2005/6. The current administration identified, and is implementing a two-pronged strategy to address this: PHC Revitalization, to strengthen basic healthcare, and upgrade of key tertiary health institutions.

While a revitalised PHC system will promote universal health coverage, an upgrade of teaching and specialist hospitals will reduce the efflux of Nigerians on medical tourism, while promoting better research and enhanced medical education. This can be complemented by a robust private sector participation, anchored on on-going changes on the National Policy on Public-Private Partnership.

State Governments

While some states (Lagos, Kaduna and Imo) have undertaken ambitious projects to strengthen general hospitals, Akwa Ibom and Bayelsa have completed World Class Specialist Hospitals. Other states (Ogun, Katsina, Bauchi and Anambra) are at different stages of refurbishment of their secondary health facilities to competitive standards. There is a need to sensitise and educate the governors of states in Nigeria on the need to treat health as a veritable human capital investment, as opposed to an intangible expenditure.

While there are on-going and planned efforts to upgrade Nigeria’s health infrastructure, the attitude of the average Nigerian health worker should be equally upgraded.

Recommendations

There is a compelling need to do things markedly differently, so as to obtain different outcomes, and here are some suggestions.

Revitalised PHC and secondary facilities should have a strong community involvement in their management. This will promote transparency and accountability.

Community-based organisations and non-governmental organisations (NGOs) in host communities should regularly monitor and independently report activities of government and privately-owned health facilities to respective state and LGAs’ bodies, thus providing some form of surveillance and checks on the activities of these institutions.

Nigerians of means should be encouraged to adopt and maintain some aspects of healthcare services in their wards and villages. This will provide additional extra-governmental resources to the facilities, especially at PHC level.

A national system of rewards, implemented by state governors, should be set up to encourage outstanding community performance in the support of PHCs; there should also be provision of incentives for health workers posted to rural areas.

Initiate a ‘Diaspora Support Scheme’ where health professionals are encouraged to come home and work during their annual leave at facilities in their states and LGAs’, with some support.

There is need to ensure that every citizen is effectively covered in the social insurance plan. The policy framework upon which the scheme runs can be enhanced to accommodate the larger population yet to be captured under the provisions of the scheme.

Given the provisions of the National Health Act (2014), haste should be made in implementing same. It is commendable that this administration is already looking in that direction, and the fund has been scheduled for launch shortly, with the President committing to be fully involved.

To address the crisis of human resource, more efforts should be made to reposition the public health sector to work in close collaboration with the private sector in order to train and retrain our workforce and develop them into capable and motivated professionals, to be properly distributed to meet the growing health-care needs.

Conclusion and the way forward

I wish to conclude by saying that the present administration of His Excellency, President Muhammadu Buhari, of which I am part of, is a forward-thinking one, poised to advance the good of the ordinary Nigerian citizen. Provision of quality and affordable healthcare at all levels is at the heart of this administration’s efforts in eradicating suffering and poverty, in line with the UN’s MDGs. It grieves my heart to see ordinary Nigerians languish under the burden of inadequate and unaffordable health-care. Many have died prematurely as a result, and a lot others suffer untold and unbearable pains and they would wish that death comes to end their grief.

It is for this reason that my colleagues and I of the Nigerian parliament are not leaving anything to chance to ensure that the comprehensive wellbeing of the average Nigerian is assured. We are making necessary efforts at playing our roles right, in order that the relevant framework and structure for a wholesome healthcare delivery system in tandem with the efforts of the executive arm is actualised.

As already mentioned above, the path to full actualisation of comprehensive affordable health-care delivery for all is not to be traded by government alone; individuals and private corporations should play an active role. It is in light of this that in 2016, rather than sit back and be content with just attending to the demands of my duties at the chambers of the National Assembly, I organised a free medical outreach for people living within the three LGAs that make up my constituency of Okigwe South in Imo State, Nigeria. The outreach which spanned over three months witnessed an unprecedented turn-out of people with various health challenges. It brought tears to my eyes to, on a first-hand basis, fully appreciate the enormity of the health-care delivery challenge we have in our hands as a nation.

On a first-hand basis, I came to realise and appreciate the very wide gap that existed in meeting the health needs of the Nigerian people, especially those living in the rural areas. I came to appreciate better that unless we go from sitting on the sidelines and blaming government for its seeming failures to joining hands with government by complementing their efforts, we add to the already existing challenge. I came to appreciate greatly that there were over 10,000 people living within these three LGAs who without this intervention would have been living less happier lives. I realised and appreciated that while we pray and proffer solutions to government on the right path to take, my fellow Nigerian brothers and sisters in the Diaspora and at home can actually mobilise friends and resources back home to bring the needed intervention within the health sector of our nation. I realised full well also that the saying, “Health is wealth” is true in all its ramifications. With access to quality and affordable health-care, poverty reduction is hastened. Is this not why God has blessed us? To give back to society and make it a better place for us all.

I have always been positive and will remain a positive thinker and idealist. I believe that there is no challenge that is insurmountable. The present administration has a mindset of destroying the structure that existed prior to its emergence: fraught with corruption and impunity. This endemic malady had eaten so deep into the fabric of the Nigerian system such that the common man paid with his life. Our health-care system, among other key sectors, has borne the brunt of it. However, I believe in the glorious future of the health-care delivery system and the drastic reduction in the incidence of medical tourism as the right and conducive atmosphere is established. By this, more of our professionals based abroad who have attained milestones in the medical field could come back home, set up their facilities and render the same quality services they do for other climes where they are based. The hospitals we have within the nation, as a result of the right atmosphere, can place national interests first and dedicate themselves to being part of the solution, rather than the problem.

There is, therefore, no reason why any single Nigerian should be deprived access to quality affordable healthcare. There is no reason why every Nigerian, rich or poor, cannot walk into a hospital of very close proximity or choice and well-equipped to obtain treatment at whatever time necessity demands it.

It is not all gloomy for Nigeria, there is hope.

•Hon Okafor, member, House of Representatives and Chairman of the House Committee on Health-care Services, delivered this lecture at the Grand Campus, Eastern Kentucky University, United States of America, on Friday, April 7, 2017.

•Photo shows Hon Chike Okafor with some of his audience after speaking at Eastern Kentucky University, USA, on April 7.

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