Economic Implication of Poor Health Infrastructure in Nigeria

Economic Implication of Poor Health Infrastructure in Nigeria
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Economic Implication of Poor Health Infrastructure in Nigeria
Health is regarded as one of the important determinants of sustainable economic development. This perspective means that countries seeking to expand their economies must treat health as a top priority. Although this point is widely acknowledged, some countries still lag in investing in their economies. Nigeria lends itself to the subject as one example of countries with a poorly performing health system. Nigeria is a distinctive nation with many opportunities. The nation is situated strategically on the Atlantic Ocean and the Gulf of Guinea in West Africa. Along with Chad and Cameroon, it shares borders with Niger, Benin, and Cameroon. It features varied geography, including semi-desert, wetlands, tropical forests, grasslands, and woodlands. The president serves as the leader of both the federal government and the state under this structured federal republic. The nation’s economy is mixed, promising some degree of personal independence alongside some degree of centralized economic planning and government supervision. It is well integrated regionally. It is one of the most populous nations, coming seventh on lists of the world’s most populous nations (Worldometer, 2022). There are at least 215,203,368 inhabitants, or 2.64 percent of all people on earth. The population is still expanding. The population was 206,139,589 as of 2020. The nation’s total land area is 910,770 km2. At least 52% of the populace are urbanites, with a population density of 226 persons per square kilometer (Worldometer, 2022). It is one of Africa’s most dynamic economies. The country remains committed to the pursuit of economic development.
The health sector significantly influences the economic progress of any country. Despite Nigeria recording the greatest gross domestic product (GDP) across the African continent, it has a low per capita income amounting to roughly 770 000 Naira (US$2000). Accordingly, wealth, income, and, as a result, healthcare is characterized by inequitable allocation, mostly culminating in access and quality disparities based on these parameters. It depicts deprivation amid abundance. Nigeria can be conceptualized as both an economically disadvantaged and an affluent country. Nearly 40 percent of Nigerians live below the poverty line and have poor neighborhoods (Babatunde, 2017). As a result, these populations are increasingly at risk of experiencing catastrophic costs from significant out-of-pocket healthcare costs incurred to access vital services.
In addition, the country’s overall healthcare outcomes prove increasingly undesirable, particularly in comparison to other African countries recording similar economic growth rates and earnings potential. Noteworthy, federal statistics fail to display the drastic discrepancies between the affluent and the economically disadvantaged, rural and city populations, as well as various geographical locations. Nigeria also has a lot of potentials. With 206 million citizens and a wealth of human talent, it is the most populous country in Africa. It also boasts 374 ethnic groups and dialects, a diaspora that spans the globe, and a decentralized federal style of government spelled out in its 1999 Constitution. In this Commission, we offer a hopeful vision that Nigeria can achieve fair and ideal health outcomes, both achievable and essential (Babatunde, 2017). The nation has the capacity to enhance the populace’s healthcare access significantly and quality through implementing innovative strategies to address the primary constructs undermining the nation’s economic viability – a flawed political system, inadequate governance practices, low accountability, inefficiency in service delivery, and corruption.
The inefficient use of available resources, a lack of dependable population-level health as well as mortality statistics, inadequate health and medical care funding, the suboptimal use of available health money to pay for healthcare services, and significant demographic disparities are major barriers. The country’s demographic payment has untapped possibilities due to its higher thresholds of dependency ratio, rapid population growth, and gradual decline in infant death rates. Female education and empowerment, family planning, and effective, high-quality maternity, reproductive, and child health services would possibly facilitate demographic changes as well as produce positive economic growth due to such transitions (Abubakar et al., 2022). This paper examines the economic implications of poor health infrastructure in Nigeria. There are various negative economic effects of a poorly performing healthcare system. The economic implications are varied and include constrained economic sustainability, losses associated with outbound healthcare tourism, brain drain, and unemployment, in addition to missed opportunities for improving trade and addressing social inequalities.
Overview of the State of the Health
Nigeria’s problematic health care system implicates various factors, including infrastructure and human resources. Indeed, according to Abubakar et al. (2022), the country’s healthcare system was constructed haphazardly, overlaying colonial medicine, and designed to maximize resource exploitation rather than deliver real value for the population. Because of its origin, there are inherent disparities and a dysfunctional emphasis on curative care, but with minimal patient or population-centeredness. Problem-solving post-independence measures that would have solved the issues have only been partially put into practice. The divided attention of policymakers has aggravated health issues. The current healthcare has a poor track record of protecting against financial risk, yet it is large, multifaceted, disjointed, and usually inaccessible to patients (Abubakar et al., 2022). Nigerians look for healthcare services from various unofficial sources, including medical professionals and their auxiliary staff, community health workers, pharmacists, marabouts and spiritual healers, traditional midwives, and others. This system is premised on fragmented funding approaches and insurance schemes that fail to meet the population’s needs.
Nigeria is ranked the fourth worst among countries with poorly performing healthcare systems. The health infrastructure is poor, characterized by the lack of ambulance services, poorly staffed hospitals, inadequate patient beds, and drugs. Scenes of patients lying on the floor and waiting in queues for medical attention have been commonly documented (Premium Times, 2022). Health is underfunded and fails to meet the needs of the growing population. This notwithstanding, the country’s investment in the health sector is still low relative to its GDP. Figure 1 summarizes the problematic investments in the health sector over the years.
Figure SEQ Figure \* ARABIC 1: Trends in Nigeria’s health expenditure as a fraction of GDP.
The population has increased in the last ten years by 50 million, but the health sector funding remains the same. The funding stands only at $1.07 billion, intended to serve a population of over 206.1 million. The current expenditure per capita has been fluctuating around 3.03 percent of GDP (The World Bank, 2022). In order to achieve the global average, healthcare real estate assets would require an investment of $82 billion and 386,000 more beds (Smith, 2021). This investment is also low compared to other nations. Table 1 summarizes the performance of Nigeria’s health investment compared to other countries.
Table SEQ Table \* ARABIC 1: Comparison of Nigeria’s health expenditure compared to other nations (The World Bank, 2022).
Country

Current medical expenditure (percentage of Gross domestic product, GDP) -

Nigeria

3.03

Afghanistan

13.24

Armenia

11.34

United States

16.77

United Kingdom

10.15

Poor health infrastructure leads to poor staffing. The American healthcare system is more advanced than that of the majority of other nations around the globe. In 2004, there were 2.67 doctors for every 100,000 people in the United States. In 2005, there were 9.82 nurses and midwives for every 100,000 people. In 2000, there were 0.88 pharmacists for every 100,000 people, 2.28 laboratory health workers for every 100,000 people, and 1.63 dentists for every 100,000 people. As of 2008, Nigeria had 0.40 physicians per 100,000 people, 0.13 pharmacists, 0.17 lab medical professionals, 2.51 health management as well as support employees, 0.03 dentists, 0.14 community and traditional medical professionals, and 1.61 nurses and midwives per 100,000 persons (Essen et al., 2018). Table 2 summarizes these problematic statistics.
Table SEQ Table \* ARABIC 2: Staffing levels — Nigeria vs. the United States
Area

United States

Nigeria

Number of Physicians

2.67 physicians per 1,000 population

0.40 physicians per 1,000 population

Nurses and midwives

9.82 nurses and midwives per 1,000

1 .61 nurses and midwives per 1,000

Pharmaceutical personnel

0.88 pharmaceutical personnel per 1,000

0.13 pharmaceutical personnel per 1,000

laboratory health workers

2.28 laboratory health workers per 1,000

0.17 laboratory health workers per 1,000

Dentistry personnel

1 .63 dentistry personnel per 1 ,000

.03 dentistry personnel per 1,000

Strikes mar the country’s healthcare system due to underfunding. All types of healthcare workers in Nigeria have participated in several strikes. Public healthcare facilities close as a result of frequent healthcare worker strikes, denying Nigerians access to high-quality medical care. Poor compensation schemes, problematic working conditions, inadequate infrastructures, the lack of personal security and safety, unresponsive policy changes, and bad governance are the main causes of doctor and healthcare worker strikes. These factors disillusion and demoralize healthcare workers. Increased patient mortality is not the main effect of these strikes but a result of the failing healthcare system. Overall, Nigeria’s healthcare system is in a problematic state, which can be hypothesized as having far-reaching consequences on its economic sustainability position.
Economic Implications
The weak state of Nigeria’s healthcare system has far-reaching consequences on economic performance. This perspective creates an allowance to argue that if these issues are not addressed, the country will not be in a position to realize the economic growth agenda. Some of the tremendous negative economic implications of poor health infrastructure include constrained economic sustainability, losses associated with outbound healthcare tourism, brain drain, unemployment, and missed opportunities for improving trade and addressing social inequalities. These factors are discussed in the following subsections.
Constrained Economic Sustainability
Health and sustainability and inextricably connected. According to Jelsøe et al. (2018), a weakness in health affects environmental and economic sustainability. In essence, nations need to address these three components based on an integrated system approach when thinking about realizing a functional economy. Figure 2 summarizes the inextricable relationship between these factors. Therefore, investing in health systems is important in realizing economic goals. Sustainability emphasizes future generations, natural ecosystems, and the health of other species. Health emphasizes equity, its concern with the larger social ecology, and its concern for human health. The failure to resolve health issues results in various issues, including economic and environmental problems that further impede nation growth.
Figure SEQ Figure \* ARABIC 2: The inextricable connection between health and sustainability (Source: Author).
More importantly, a functioning economy largely depends on a population with good health. Subsequently, this type of economy also needs to deliver funding support that can effectively transform health services. The provision of high-quality, universal and sustainable health care is the main duty of health care. Health care also contributes significantly to the functioning economies through spending and investments (Barrett et al., 2020). These economic gains are varied and not easy to measure sometimes.
Health systems significantly promote an equitable and sustainable economic development agenda through ethical practices, responsible employment practices, and informed consumer spending. It is not commonly known or currently taken into account in various practices and policies that health care systems have a positive social impact. Sustainable development depends on the social, economic, and environmental factors, which are intricately connected to the extent that ignoring one would affect the outcomes in other areas. In addition, it argues that eradicating prejudice and boosting fairness are essential steps toward creating a sustainable society and economy. The process of securing economic growth partly counts on the initiatives directed towards reforming healthcare that touches on the welfare of every individual (Barrett et al., 2020). If this step is properly addressed, it will lead to desired outcomes in many facets of economic development, including gross domestic product and employment, in addition to improved educational achievement and nutritional gains.
Inclusive and sustainable growth can boost economies and lessen health disparities caused by income. Directing investments in two areas can improve community wellbeing and promote long-term growth, according to a study on health and social equality spending in 25 European nations. Investments in human capital are essential for long-term growth and tend to be followed by accelerations in growth (Boyce & Bown, 2020). However, the demands that international and monetary institutions place on nations frequently conflict to enhance everyone’s health. For instance, the conditions promote an unsustainable form of economic growth, which results in low salaries, more taxes, and cuts to important services like health and social care. The health sector plays a crucial role in a nation’s stability and economic performance. Creating jobs and purchasing goods and services favor how other critical sectors of the economy function. Because of its effects on employment, conditions of work, and household incomes, it can play an important role in addressing issues related to social exclusion at different societal levels. By fostering employment opportunities, supporting training, and enhancing purchasing at the local and national level, it can also improve its position in relation to the quest for sustainable development at various levels of the economy (Barrett et al., 2020).
Out-Bound Healthcare Tourism
One of the economic implications of a dysfunctional health system marred with poor infrastructures and poor funding is outbound healthcare tourism. In this case, medical tourism can be defined as the practice of patients traveling outside of their home nation to other nations to receive better medical attention. It is worth noting that this definition does not necessarily include patients or individuals who seek emergency medical attention while in foreign countries for other reasons such as tourism, studies, or traveling because of bilateral agreement duties.
In Nigeria, the rich class prefers to receive medical care in the United States or Europe, whereas the majority of Nigerians prefer to fly to India and South Africa because of their diverse preferences. This trend is largely a result of the fact that public servants and politicians are paid to have medical care overseas. However, this cover is often abused, as many other government officers and politicians fly abroad to receive treatment for minor conditions that might have been handled in Nigeria.
Nigerians seek services abroad in light of the struggling local healthcare system. The estimation reveals that the country spends over 1 billion US dollars on funding medical tourism. At least 500 patients seek medication in foreign countries (Shehu, 2019). Some leading destinations include India, Europe, and the United States. The services sought include oncology, orthopedics, nephrology, and cardiology. This amounts to almost 20 percent of the $5.85 billion that the government channels towards the health sector to cater for salaries for all public sector physicians, nurses, and other healthcare professionals as well as other health initiatives like the prevention of polio, malaria, tuberculosis, and HIV/AIDS. The country is losing substantive revenue to foreign economies seeking services that could have been accessed locally and amount safety for economic development purposes.
Orekoya and Oduyoye (2018) documented that the preference for outbound medical tourism has gained momentum. This trend is attributed to various factors. These factors include technology, trade liberalization, religion, geographic proximities, cultural preferences in terms of language, longing for privacy, bioethical laws such as abortion and euthanasia, and the lack of certain services in Nigerian hospitals.
However, in many cases, a complex web of factors that interact with one another affects travel patterns, making it challenging to isolate these factors, particularly market by market.
People travel abroad to receive medical care for a variety of reasons, including dissatisfaction with their domestic health care, poor quality or lack of access to appropriate treatment, and the expensive medication provided in domestic health facilities (Boyce & Bown, 2020). Globalization affecting technological, economic, social, and cultural aspects is one of the factors influencing medical tourism. Stringent eligibility requirements, waiting time, and shifting priorities for the health service sector substantially impact how consumers make decisions in certain domestic health systems under significant strain. The unexpected emergence of consumerism and patients’ freedom to choose among nations with historically public-funded services are additional factors fueling medical tourism. Different countries and hospitals across the world are competing to offer these services.
Push and pull variables have also been used to categorize the causes of medical tourism. The push factors include established medical practices in one’s native country, a lack of insurance, expensive costs that must be paid directly from the pocket, and delays in service delivery. On the other hand, the push factors are specific to individuals from wealthy nations and include high-quality medical facilities, vacation options, shared languages, religious affiliation, and political environment.
Due to this tendency, many other important sectors in the country’s economy will no longer have access to US$1 billion due to foreign health care demands. The $1 billion spent on international medical travel significantly negatively influences Nigeria’s economy. Individuals traveling abroad to receive medical care are in a position to afford some services available in Nigerian hospitals. Using this US$1 billion, it could be possible to cross-subsidize medical care expenses for people who cannot afford them. The US$1 billion spent on international medical travel to other countries results in a significant loss of at least 3.7 million patient treatments per year in Nigeria. This value is equivalent to a gross margin of 45 percent and an average health care cost per capita of $120 for the entire Nigerian population (Orekoya & Oduyoye, 2018). This data creates an allowance to infer that Nigeria is losing substantial amounts of funds that could be otherwise channeled to domestic healthcare improvement and national building processes for sustainability. If Nigeria can reform its health sector, it could use it as an avenue to tap the health tourist market. This could also help earn foreign exchange and lessen our dependency on oil.
Brain Drain
Another significant economic implication weak health care system in Nigeria is brain drain. This problem contributes to the shortage of qualified healthcare professionals, exacerbating the country’s economic challenge. Economies across the world are affected by the domestic tourism trend (Orekoya & Oduyoye, 2018). When wealthy patients leave a country for medication in other countries, the funds available for enhancing national healthcare are lost. These further limit government funding for bolstering the healthcare system and supplying cutting-edge tools and medications to help the general populace’s health.
Given how Nigeria treated healthcare personnel during the Covid-19 crisis, there is the possibility that the nation will experience a greater brain drain in the years to come. Doyin Odubanjo, a public health expert and former head of the Lagos State chapter of the Association of Public Health Physicians of Nigeria, predicted that as soon as international flights resume, medical tourism to Nigeria will rise. He also noted that close advisors to the presidents had left the nation in the previous two weeks despite the airport’s closure. The political and elite classes no longer care to use the country’s healthcare system, according to Odubanjo, who claimed that the lockout was only a minor inconvenience. He claimed that now that the borders have been opened, they will undoubtedly leave the country as soon as possible. In addition, he claimed that healthy people will leave the country as soon as possible because many nations worldwide are now in greater need of healthcare professionals. Nigeria’s health care delivery has halted even in the middle of a pandemic (Orekoya & Oduyoye, 2018). It is expected that Nigeria will continue to experience an exodus of medical tourists and healthcare personnel on a significantly greater scale.
When this happens, medical professionals start moving to nations with advanced medical technology advantageous to their line of work. Nigeria is one of the countries sending its doctors to other nations for health professional training. After completing their education at one of Nigeria’s medical institutions, many leave the country searching for better employment prospects and practical training. Nigerians are among the world’s top physicians, making exceptional contributions to the medical industry (Brock & Blake, 2017). This trend reflects missed opportunities for a skilled workforce that could otherwise serve the national health interests.
The poor funding is responsible for the brain drain of health workers. At least 20,000 doctors from Nigeria presently live in the US (Ogbu, 2019). Better conditions in foreign countries fuel this trend (Brock & Blake, 2017). Brain drain represents a big loss of skilled labor force that requires substantial national training resources. Indeed, Nigeria lacks the necessary number of healthcare professionals to provide for its population. It has 1.9 practitioners per 1000 citizens, which is significantly below WHO recommendations (Adeloye et al., 2017). This brain drain is also seen in other sectors.
According to Perside (2022), 45 percent of Nigeria’s adult population expects to leave the nation in the next five years. Nigerians placed first among those who fervently wish to go to other nations among the 12 countries surveyed from five continents. It showed that seven out of ten Nigerians were willing to relocate to foreign countries whenever opportunities arose. With 14 percent (13,609) of the total number of visas granted for the Skilled Worker - Health & Care category, Nigeria is second only to Indians, according to further data. At least 12,595 Nigerians moved to Canada in 2019 (Perside, 2022).
Nigerians have a strong desire to leave their country. In a survey done by the IOM, 81 percent of participants expressed a desire to leave their neighborhood for economic reasons and relocate to urban areas in Nigeria or non-African nations. The number of Nigerians in foreign countries has been increasing drastically over the years. The majority of Nigerians abroad reside in Sudan (24 percent), the US (14 p...