Nigeria Recognizes Right To Health Health And Social Care Essay
obligations under international treaties and domestic legislations mandating specific conduct with respect to the health of individuals within its jurisdiction. Prior to the economic travails of the mid-1980s, the health sector witnessed robust growth, principally as a result of unfettered support by the government, coupled with assistance from international donor agencies. Except in rural areas, access to health care was readily available at public hospitals and clinics at no charge. However, by 1985, this positive development had screeched to a grinding halt, owing to a plurality of factors, two of which clearly stood out: precipitous economic decline and military usurpation of power, the latter marking the genesis of many of the intractable challenges besetting the health system. The current state of health in Nigeria is intertwined with its history of political governance. In its forty seven years (1960 - 2007) as an independent nation, the military has held the reins of power for twenty nine years. But it was the last phase of military dictatorship (1983 -1998) that altered the socio-political and economic landscape of Nigeria. As noted in a recent article, the deterioration currently experienced in the health sector is directly attributable to long years of kleptocratic repressive military dictatorship and widespread corruption and mismanagement of that era. A report released by the United Nations (UN) shortly before democracy was restored came to the same conclusion, implicating the military as being non-responsive to the deficiencies and continued rot of the health system. This rot is evident in a patchwork of decrepit public health infrastructure strewn across the country, most of which are severely understaffed and suffer extreme shortages of even the most basic equipment and medicine. Even in spotty instances where medical treatment and consultation are available, escalated cost means that millions are effectively shut out of the system. Bleak picture, indeed, but to a large extent, these observations are fairly accurate depictions of the conditions in Nigeria.
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With the demise of military dictatorship in 1999 came new expectations and rekindled hope for a change in status quo. In response, or so it seems, the democratically-elected administration introduced several innovative policy initiatives, some of which are presently being pursued at different tiers of government. These initiatives aim to restructure and revamp the health system and, concomitantly, realize the goals of the recently revised National Health Policy and other health programmes, including the health-related benchmarks of the Millennium Development Goals (MDGs). Although the process has been far from perfect, the development and implementation of these programmes represent a significant departure from the errors and deficiencies of the past, at least in terms of openness and greater public participation.
Better health care is a primary human need, According to the World Health Organization (WHO, 2005), fifty percent of economic growth differentials between developed and developing nation is attributable to ill-health and low life expectancy. Developed countries spend a high proportion of their Gross Domestic Product (GDP) on Health Care because they believe that their resident health can serve as a major driver for economic activities and
development . To this end, Governments in Nigeria over the years have been making frantic efforts at ensuring that there is an increase in the level of public expenditure on health. In 1970, recurrent expenditure on health was N12.48 million. This figure rose astronomically to N52.78 million and N132.02 million in 1980 and 1985 respectively. This trend continues as the expenditure rose steadily form 575.3 million in 1989 to N68.20millions 1991 and further
to 72290.07 million and 98.200 million in 2007 and 2008 respectively. The aforementioned scenario clearly underscores the fact that health care expenditure in Nigeria has been on the increase over the years.
However, in spite of all these increase, much impact has not been made in the area of reduction of infant, under five and maternal mortalities since 1970. For instance, the Nigeria's rate of infant mortality (91 per 1000 live births) is among the highest in the world,
and the immunization coverage has dropped below thirty percent while the mortality rate for children under age five is 192 deaths per one thousand. By year 2007, it was reported that more than one hundred and thirty four thousand women died from pregnancy complications. In addition, the life expectancy ratio on the average has been on the decline over the study period. It should however be noted that despite the increase in government
expenditure in health care in Nigeria, the contribution of this to health is still marginally low whereas the extent and magnitude of its impact on economic growth is undetermined.
The interactions between health care expenditure and economic growth have received a lot of attention of researchers. Baldacci (2004) explore the role played by health expenditures. He constructed a panel data set for one hundred and twenty developing countries form 1975-2000 and found that spending on health within a period of time affects growth within that same period while lagged health expenditures appear to have no effect on growth. He inferred from this result that the direct effect of health expenditure on growth is a flow and not a stock effect. Bloom et al (2004) estimate a production function of aggregate economic growth as a function of capital stock, labour and human capital (education, experience and health). Their main result is that health has positive, statistically significant effects on economic growth. They however, do not consider how health is created.
Olaniyi and Adams (2000) descriptively analysed the adequacy of the levels and composition of public expenditures and conclude that education and health expenditures have faced lesser cuts than external debt services and defence, but allocations to education and health sectors are inadequate when related to the benchmark and the performance of other countries.
2.6 RELATIONSHIP BETWEEN HEALTH AND EDUCATION.
Education and health are the two most important characteristics of human capital. Their economic value lies in the effects they have on productivity: both education and health make individuals more productive. Education and health have a considerable impact on individual well-being, as well. The wealth of nations is to a large extent determined by the educational attainment and the health status of its population. According to the 2003 Human Development Report, "Education, health, nutrition and water and sanitation complement each other, with investments in any one contributing to better outcomes in the others" (UN, 2003, p. 85).
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The positive association between education and health can be partly attributed to differences in income between countries. Health and prosperity are positively related. For
Example, Behrman and Rosen Zweig (2004) show that there is a strong negative association between the log of purchasing power parity (adjusted by GDP per worker) and the percentage of low birth weight babies. Low income countries have fewer resources to spend on publicly financed education and health care. Most individuals in low income countries also do not have the means to purchase education and health care themselves. On the other hand, investing in education and health provide the way out of poverty and are necessary conditions for increasing standards of living.
There are three potential explanations for the positive relation between education and health:
1) A better health enables one to invest more in education;
2) Common factors - such as genetic endowment, social background or time preferences - affect health and education in a similar way;
3) Education leads to a better health.
Education affects health, but investments in health and education also have some common attributes, as argued by Theodore Schultz in his seminal paper "Investment in Human Capital":
Education as well as health expenditures are both consumption and investment. Returns to investments in education and health are uncertain. There are third-party effects involved in both education and health. And the involvement of the public sector in the provision of education and health care is large.
2.7 CHALLENGES FACING HUMAN CAPITAL.
Following the many years of military rule in Nigeria, the present government on assumption of office was faced with an array of complex, social, economic and political problems. These problems include pervasive poverty and wide spread unemployment, deterioration of government institutions, wide spread corruption, religion and ethnic violence, high crime rate and general feeling of insecurity.
In relation to education development, the constraints include low enrollment ratio, owing to economic, demographic, socio-cultural and religious factors; declining educational expenditure as a ratio of total government expenditure, policy inconsistencies; low level of instructional materials, manpower, physical infrastructures and average number of years of schooling completed per student at each level of education, power remuneration, poor conditions of services, incessant strikes etc.
In relation to health development, one the constraints is child heath; despite ratifications of the major international treaties on the rights of the child and the enactment of a child-centered domestic legislation in 2003 - the Child Rights Act - available data paints a depressing picture. According to WHO, Nigeria is among five countries that contribute 50% of the annual global mortality among infants and children under five years of age. Poverty, poor health status of mothers, high prevalence of malaria, pneumonia, measles, diarrhoea, HIV/AIDS, malnutrition and inadequate immunization coverage in the country are blamed for most of these deaths. Nigeria has an abysmal infant mortality rate (IMR), reported to be 85 and 195 deaths per 1000 live births in 1990 and 1995 respectively.In 2005, the figure stood at 101108 but slightly declined to 97 the following year. Worse still, Nigeria was among twelve countries identified in a recent report by the African Development Bank(ADB) as regressing from, and in danger of not, meeting the 2015 MDG of reducing infant mortality by two-thirds. IMR was found to be higher in rural communities than in urban areas, and this was attributed to disparity in access to health care, as health facilities are more readily available to urban residents than rural dwellers. Current efforts at combating morbidity and mortality among children center on expanded immunization programmes. Other constraints are: inadequate infrastructure and poor compensation packages, emigration of physicians and other medical professionals to other countries in search of better fulfilling and lucrative positions.
Also, human capital challenges can possibly be traceable to the much reported corruption and misappropriation of public funds (Transparency International, 2011) allocated for capital projects such as the installation of educational and health infrastructure in Nigeria. As at 2010, Nigeria scored 2.4 out of 10 in terms of transparency and the country made a position of 134 out of 178 (Transparency International, 2010).
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