HEALTHCARE DELIVERY IN THE FACE OF AUSTERITY

On Sunday 16^th Nov 2014, the Coordinating Minister for the Economy and Minister of Finance introduced some austerity measures and scaled down the crude oil price bench mark for the 2015 budget and the same time assured that the government will continue to fund infrastructure, job creation, agriculture and human capital development particularly in the education and health sectors. On hearing this I began to ponder on the implications of this to the populace, the common man on the street, the middle class and how will it affect the healthcare sector. Inasmuch as they assured us that the health care sector funding will not be affected, I still have my concerns.

In the not too distant past, we faced a similar situation in the 1980s following the oil boom of the 70s and subsequent fall in oil prices world over. Our income has been a monolithic one since the 70s and the income from crude sales were not properly managed which led to severe economic hardship on Nigerians with consequent riots in major cities in Nigeria then.

What does austerity mean?

Wikipedia describes it as policies used by government to reduce budget deficits during adverse economic conditions with development projects, welfare and other social spending targeted for cuts. Taxes, ports, airfares, and bus fares are common sources of revenue that will be increased. Retirement ages may be raised and government pensions reduced. In most cases this has led to a reduction in the living standard of the people.

As part of measures to reduce wastage, foreign travels by civil servants except for purposes that could be fully defended as absolutely necessary and foreign training programs would be stopped. All training done in-country unless foreign sponsorship for such travels and training can be obtained abroad. Government will Eliminate duplicate functions among ministries, departments, and agencies (MDAs). Taxes on luxury goods such private jets, yachts, champagne etc will be increased. Also about  N500Billion subsidy on petroleum products will be removed in the coming year.

How will all this affect healthcare services?

1.    There will be reduced employment opportunities within the healthcare sector. Already positions for residency training in virtually all the tertiary  health institutions In Nigeria has been on hold for about a year now. And many medical graduates don’t have opportunities for internship for about a year now, some temporary licenses are about to expire without the individuals doing their mandatory internship. This scenario coupled with reduced funding for the sector means that the likelihood of further employment will be diminished in the coming months.

2.    Reduced available man-power. With the aforementioned scenario and ever increasing population figures, automatically available man-power will be reduced. Patients will experience longer waiting hours in the consulting room, surgeries will be delayed, available hospital staff will be stressed and consequently productivity will be reduced which is detrimental to effective service delivery.

3.    Reduced pension and welfare benefits. With reduced funding in the health sector it will only be wise for government to reduce or withdraw certain welfare benefits. The elderly in the society who are dependent on their monthly pension will not get it all or it may be delayed leading to hunger, starvation and debilitating health conditions, leading ultimately to their demise.

4.    Cut in hospital budgets. With this, developmental projects and  research projects will be reduced sending us back to the years of archaic medical progress. Recent diagnostic equipments will not be available delaying accurate diagnosis and treatment. Most tertiary health centers in Nigeria do not have CT scans or MRIs which has contributed to the delay and in some cases inaccurate diagnosis leading to delay in interventions necessary to save lives.

5.    Increase in infectious diseases and other illness. Funding for some intervention programs such malaria,TB, HIV etc will be reduced which will increase the incidence and prevalence rates of these diseases. This is because availability and access to the drugs for treatment of this diseases will be reduced. Also in Greece and Spain, high rates of suicide, mental illnesses, depression, alcoholism were also recorded during the periods when the instituted austerity measures.

6.    The Cost of healthcare will be shifted to the patients. As a consequence of reduced funding to the hospitals, costs previously born by the hospital will be shifted to the patients. Some centres run free antenatal clinic(ANC) services may now start collecting fees for ANC. Some special clinic for special cases such as sickle cell clinics or pain clinics maybe closed till alternate sources of funding are available to run them.

So the bottom line is that there is no way the healthcare sector will not be affected. Knowing the way our country operates, when fuel subsidy is removed, prices of goods and commodities may rise. Also with the Naira falling rapidly against the dollar, and an economy depending mostly on imported items, the cost of running the hospitals will increase and medicare will increase as well. Bearing in mind that majority of our countrymen and women still live on less than a dollar a day and cannot afford 3 square meals per day, talk more of  affording adequate and proper healthcare,  we run a risk of increase in spread of infectious diseases, increase in infant mortality, increase in maternal mortality and a possible return of Ebola virus disease.

What should be done?

Government at a levels must prioritize what is most important at this time. All forms of frivolous spending must be discouraged. Corruption within the health sector is massive and must be checked. Managers of hospital resources must be prudent in spending and allocation of available funds.

Let me end with the words of David Stucker…… “our politicians need to take into account the serious and in some cases profound health consequences of economic choices”.

Please politicians and leaders should bring back the days of our economic glory by diversifying our economy such that we will be independent of oil.

Thank you.

Dr Nnanna Agwu.

Twitter:@drscopey

Email: dr_nnanna@yahoo.com