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COVID-19 and decentralisation of healthcare delivery



ONE of the indestructible proofs of the monumental havoc done to socio-economic growth and development in Nigeria is the centralization of governance as against the realistic system of federation as was in place in the first republic. The coronavirus pandemic otherwise known as “COVID-19”, has pointedly exposed the disastrous and decrepit condition of the healthcare delivery system which was as a result of the bastardization of the realistic federal system of governments in the country. 

  In management, especially the public sector organizations, over-centralization is an open sesame to gross inefficiency, maladministration, distorted mode of operations, corruptive tendencies and all manner of impunity and abuse of office. In a federal system the world over, the central government has no business establishing hospitals in addition to ministries, departments and agencies, MDAs since the state [or regional as the case may be] governments, are better placed going by their geographic peculiarities and jurisdictions to make policies and design programmes and execute projects that will tackle the challenges of those related MDAs to meet the needs and aspirations of their people.

   Since the willful bastardization of the realistic federal system by the military junta and retained by the succeeding civilian administrations, what the central government could have done is to restrict itself on over-arching policy matters for detailed implementation as suited to the sub-national governments. This should have been the cue in designing policies and programmes for a particular disease that break out sparingly and the globally trending COVID-19 pandemic. The parlous condition has made it imperative for fulsome decentralization of health-care delivery system which is inexorably tied to restructuring of the federation to achieve meaningful socio-economic growth and development.

   With the responsibility of health matters resting on the shoulders of the state governments, the share of statutory allocations to the federal government should have substantially reduced and that of the state governments boosted to re-jige the healthcare delivery system given that Primary Health Care [PHC] remains a ready resort of the people at the hinter-land before the need for referrals could arise.

It is logical to assert that COVID-19 pandemic would not have spiraled in the country if the Primary Health Care had been given adequate financial sustenance because of paying attention to the health needs of the people at the grassroots level. It was the outcome of bastardizing federalism that led to a situation where the headquarters of Primary Health Care was domiciled in the federal ministry of health where policy guidance are made and sent to the states. A situation where a policy on polio meningitis which had fertile ground in the far northern part of the country are sent to other states of the federation is a case in point to illustrate the flip side to over-centralization of policies and programmes in a multi-ethnic and multi-religious society.

   Onuoha Ukeh, writing under “COVID-19 has opened our eyes to restructuring”, contended that “…for some people, the talks about restructuring are mere politics. It does appear that the states of the federation do not really know the powers they have individually and collectively. Owing to their ignorance, they timidly stand aside while the federal government calls the shots.

   “However, the coronavirus pandemic has opened our eyes to know that there are many things we assume, regarding the powers of the federal government,that do not really exist… It does seem that the problem is the state government not fully understanding their rights in a federal state like Nigeria. We have instances where states excercised powers nobody thought they had, and court affirmed it”.

  Lamenting on the decrepit health status of the country with respect to the parlous handling of COVID-19 pandemic, the former Archbishop of Abuja, His Eminence, Cardinal John Onaiyekan contended that lack of principles of federal system of government which includes ethos, ethics and principles of democracy has led to the ill-preparation of government to curtail the rampaging monster.

   He said: “We have had 21 years of broken democracy; unless we want to deceive ourselves, all these years we have been stumbling and wobbling along with democracy…If you have a democratic system where governance and I mean ruling in the best interest of the people, that is not guaranteed, then you have a deficient democracy”.

  Levi Obijiofor, a columnist in Daily Sun equally rueful on the bastardization of federal democratic system of government in Nigeria observed thus: “Healthcare in Nigeria is illusory. The government does not regard the health sector as a problem that requires priority attention. Increasing deaths of patients in hospitals across the country are direct outcomes of the government’s failure to live up to its obligations to the sector. Public hospitals in Nigeria have been described as a place where sick people go to die, not to be treated or have their health restored. That description is apt”, Obijiofor stressed.

   A new paradigm shift is needed to reinvent healthcare delivery system in the 21st Nigeria to meet the global standard. In many developing countries like Nigeria, the programmes and expectations of the Millennium Development Goals [MDG] were far from being accomplished due to financial constraints that dogged full releases for the appropriated provisions in the annual budgets. It is also feared that the MDG replacement called Sustainable Development Goals [SDG] might suffer the same fate going by the failure of Nigerian leaders to embark on fulsome decentralization of governance which will make the health sector and other sectors that could be properly handled and administered by the sub-national governments.

  Sequel to the COVID-19 global scourge, there was breakdown of world economy and in Nigeria, the price of crude oil which is the major foreign exchange earner was severely affected. The crude oil benchmark of $70 used in the preparation of the 2020 budget plummeted to $20 which needed that the entire budget has to be reviewed.

   In his analyses of the adverse effects of the COVID-19 on the health sector, Gbenga Omokhunu, who noted that health is wealth and an important element of national security contended that “public health not only functions to provide adequate and timely medical care but also track, monitor and control disease outbreaks.

    “It is no news that the Nigerian healthcare system had had to content with outbreaks of several infectious diseases over the years. Tackling the problem headlong has been a major challenge. Healthcare provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. Private providers of healthcare also have a role to play in healthcare delivery”.

  He observed that healthcare delivery in Nigeria has faced many challenges towards achieving universal health coverage. “While significant progress was made in the first two decades after the country’s independence in 1960, the economic downturn resulting from plummeting oil prices on which Nigeria was dependent, led to a series of twists and turns in the health sector, he concluded.       

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