I have been pondering over this topic for a very long time. Given my background as a medical doctor trained in my country, and haven spent significant part of my professional career working among the impoverished and vulnerable population in my country, I probably have a firsthand knowledge of the problems in the Nigerian health system. Nigeria has the potential to be ranked among the most advanced countries in areas of health care delivery in Africa. Aside from the huge natural resources, Nigeria is privileged to have doctors and other health professionals who have excelled in their endeavors and who would favorably compete with their peers anywhere in the world. We have had men and women who have shown unwavering dedication to their motherland that they had left lucrative job opportunities in other developed countries and had come home to make their contributions to health care development in Nigeria. This group of people serves as mentors to some of us, and had encouraged us to go into the field of medicine, not necessarily for the financial benefits that comes with it, but for the joy of serving humanity. They were never celebrated. Their contributions were often not acknowledged. Many could not stand the infrastructural decay of the health system that tend not to get worse year after year, and had to abandoned their dream and are now lost to other climes. Yet many still endured these frustrations of a system that does not encourage excellence in service, yet they soldiered on. These are the unsung heroes.
The problem with the health care development in Nigeria cannot be far from poor institutional development. Successive government in Nigeria, time after time, comes up with all varieties of programs. Most of these programs may seem world class and of good intentions of providing healthcare to the undeserved population. While these programs may have worked in other countries, the Nigerian story remains the same...poor program implementation. Its seems to me though, that the government agencies pays no attention to the fact that things seems not to work, so long as they believe in the fictitious figures manufactured by the program managers who could do anything to cover their failures. These practices have in a way encouraged corruption and embezzlement within the health care system. Much as the government and international donors are pushing funds into the system in the name of various kinds of programs, these corrupt managers have continued to siphon the funds in various guises. Little wonder why the health system in Nigeria does not have a well development monitoring and evaluation guideline for tracking project implementation. Where such guidelines exist in the name of project monitoring units in various states departments, you would notice that most of the people employed to manage the affairs of these departments do not have adequate training on monitoring and evaluation of public health projects. These appointments are often made based on political leaning, ethnic or religious affiliations. These officers therefore see their appointments as an easy access to wealth. I have once had the misfortune of having to be supervised in a project by someone who had no idea what the project was all about. All that the officer wanted was to be paid a certain some each time he came for project inspection. These situations tend to happens every day within in our health system, where round pegs are put in square holes.
Then come the issue of infrastructural decay. While many government officials compete for juicy allocations for provision of health care infrastructures, as it has turned out to be a lucrative business and means of siphoning the states funds, little efforts are being made as to the maintenance of these infrastructures. It has become a common place to see high tech machines purchased at a highly inflated cost, wasting in many health care facilities because no provision were made to ensure their maintenance. In some cases, these equipments are allocated to facilities where there are no manpower to operate them or where their use is essentially not intended, but simply on political grounds. The various federal, state, and local government most times go about commissioning health projects in their domain simply to score cheap political gains, and would do nothing to ensure that these projects actually are implemented to the benefit of the people. 
In Nigerian health system, again, infection and disease control is a big issue, yet neglected. It is not surprising that the bulk of the health care burden in the country is communicable diseases. While the government of Nigeria has a well documented hospital waste management policy, most health care providers in the country are still unaware of its existence. Secondly, most training schools in the country have yet to incorporate such in their curricula. Not long ago, a notable international agency, that conducted an expensive capacity building training program in the country that was meant to train health care providers on infection control, conducted an assessment survey in a facility where these trainings were being carried out in the state, only to discover that their program has had little impact on the knowledge and practice of the providers in that facility, yet this organization produce year end report that tends to say otherwise.
Addressing the issue of infection prevention goes beyond the health facility. The public need to be aware of their role in safeguarding their health through proper personal hygiene practices. This can be reinforced by introducing such courses in our primary schools through to colleges. We need to begin to be thinking of raising generation of a healthy population, who knows their role in safeguarding their health. Many countries have employed various means to reach these populations. Here in the United States, most cities were able to curtail the spread of H1N1 Virus in their communities through the use of volunteer corps educators in schools, of which I was privilege to participate in. The success of this approach is enduring and cost effective.
Our government should look beyond frivolous and wanton projects that has little bearing on addressing the needs of the people and begin to consider institutional development as a vital means of strengthening the health system.

To be continued........

God bless Nigeria.

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Yes Kelvin, thats why we have to speak up. We need to put the elected officials at task. Quality and accessible health care is an inalienable right of every Nigerian citizen. Stay blessed.

Your comment was well written and touched some subtle points that affects our health system. Lack of consistency in all areas of concern is affecting every institution in Nigeria. Many programmes which are being set up to help solve some of the major problems have been forgotten so quickly as they were formed. Hopefully someone, somewhere will do the right thing.


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