THE GREATEST BARRIER TO HEALTHCARE IN NIGERIA

My exposure as a clinical one student gave me an impression that cost is the greatest barrier to healthcare in Nigeria, this was the primary reason I settled for the choice of health economics as a career goal. However my experiences in the field as I partook in different health outreaches for the next two years queried this assertion.

On 3rd of August 2019, alongside other members of the Medical and Dental Class of 2019, Obafemi Awolowo University (Praeclarus medicus), we had a medical and surgical outreach at Omo Olodo village, Ile Ife. Travelling to the village in a 30 seater coaster bus, I came to realize that for vast majority of Nigerians access is as much of a challenge as cost. The village, though not far from Ile Ife has very poor road linking it, there were points our bus almost tumbled, a colleague that drove his personal car couldn't go further at some point. As I sat in the bus, I thought to myself what if there's a medical emergency in this village? Say a woman develops complications during delivery, what happens, your guess is as good as mine, we can only hope on the Divine for a miracle.

On getting to the village, the case isn't different, there is no single health post for the over 200 people in this village, meaning they are at the mercy of quacks, traditional birth attendants, herbalists, patent medicine vendors etc. Once in a while, a miracle like ours come across their way and they rejoice in that light for a season. The case of Omo Olodo is not one in isolation, it's a rule rather than an exception. Other villages I have visited for outreaches have about the same story. Poor road network, no trained personnel, no health post (where present, the facilities are nothing to write home about).

The oral health care needs of the villagers didn't differ significantly from that I've always observed in the clinic, many of the villagers were having their first dental visit when they presented at the outreach, expectedly, they presented with poor oral hygiene. There was the case of a woman whose child had severe early childhood caries with multiple discharging sinus, knowing fully well the case is complicated and requires multifaceted treatment, we advised this mother to present at our pediatric dental clinic in OAUTHC. A follow up with my colleagues rotating the clinic at that time showed she never did, meaning the child will have to grow up with the consequences.

This experience made me conclude that cost is not the greatest barrier to healthcare in Nigeria, access and quality are as much of a challenge as cost. Unfortunately, these trio are the components that make up universal health coverage. By implication, we are off track in attaining Universal health coverage in 2030. To chart a way forward in Nigeria's health care delivery system, these challenges have to be solved simultaneously, we have to improve access by ensuring creation of new healthcare centers that are of sufficient quality and are affordable for every one of us. Doing anything short of this will be a disservice to our nation and continue to place the lives of innocent citizens at risk.