CHAPTER ONE
1.0.0
INTRODUCTION
It is an indisputable fact that a
healthy population and indeed work force are indispensable tools for rapid socio-economic
and sustainable development the world over. Despite this indisputable fact, in Nigeria,
like most African Countries, the provision of quality, accessible and affordable
health care remains a service problem.
This is because the health sector
is perennially faced with gross shortage of personnels, inadequate and outdated
medical equipment, poor funding, policies inconsistence, and corruption.
Evidence shows that, only 4.6 percent of both public and private Gross Domestic
Product (GDP) in 2004 was committed to the sector. Other factors that impede quality
healthcare delivery in Nigeria include inability of the consumer to pay for
healthcare services, gender bias due to religious or culture beliefs, and inequality
in the distribution of healthcare facilities between the urban and rural areas1. Sequel to the aforementioned,
the country is continually ranked low in healthcare delivery by international
organizations. In 2000 WHO report on healthcare delivery ranked Nigeria 187 out
of 191 Countries; eight years later, Human Development Report 2007/2008 ranked the Country 158 out of 1772. In 2005 only 48 and 35 percents of the children
within the ages of zero-to-one year old were fully immunized against Tuberculosis
and Measles respectively.
Between 1998 and 2005, 28 percent of
the children within the ages of 5 years who suffered from diarrhea received adequate
treatment.
Between 1997 and 2005 only 35
percent of births in Nigeria were attended by skilled health personnel. Further,
between 2000 and 2004, only 28percent of Nigerians in every 100,000 persons had
access to physicians. While the situation in the health sector persists,
Nigeria continually loses her professionals to other countries. It was reported
in 1986 that more than 1500 health professionals left Nigeria to other
countries. 1996 UNDP report revealed that 21,000 medical personnels were practising
in the United States of America and UK, while there was gross shortage of these
personnels in the Nigerian health sector1.
The health situation in the country
shows that only 39percent in 1990 and 44 percent of Nigerians in 2004 have access
to improved sanitation. In 1990/92 and 2002/2004, 13 percent and 9 percent of Nigerians
were undernourished respectively1.
HIV prevalence in Nigeria within the ages of 15 to 49years was 3.9 percent in
20051 In an
attempt to address the precarious and dismal situation in the health sector,
and to provide universal access to quality healthcare services in the country,
various health policies by successive administration were made, including the
establishment of primary healthcare centres, general and tertiary hospitals.
But the establishment of these health constitutions alone cannot solve the perennial
health problems of the country, hence the decision of their Head of State, General
Abdulsalam Abukakar to sign into law the National Health Insurance scheme (NHIS)
decree No.35 of 1999, with the aim of providing universal access to quality
healthcare to all Nigerians1.
More than four years of NHIS
existence in Nigeria opinion is polarized among Nigerians on the efficacy of
the scheme in addressing the health problems in the country, because of the disheartening
reports in the continual health situation. World Bank 2008 survey on the scheme
shows that only One Million of people in Nigeria or 0.8 percent of the population
are covered by NHIS, while many persons have to pay for medical care out of
their pockets or do without healthcare. The Report further reveals that many
low-income persons would not benefit from NHIS for at least another 10 years1.
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