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Too Poor to Pay for Treatment: Government Corruption and Mismanagement Indirectly “Euthanizing” Nigeria’s Poor

A recent article piqued my curiosity to look into Nigeria’s healthcare policy and practice and how it might be “euthanizing” its citizens. According to Vice.Com, a “Nigerian hospital illegally detained a woman who could not pay for the maternal health services she received and denied her emergency services later on that led to her death.”[1]

Despite the various governments’ ministries, departments, and agencies’ habit of notoriously patting themselves on the back for a job well done in the healthcare sector, the general opinion is that the Nigerian health system is broken due to corruption and mismanagement.  Although there are those who oppose a state’s involvement in health care, insisting on individual responsibility; others, like the World Health Organization (including the Catholic church), insist that every human being has the fundamental right to obtain the best possible medical care, which the state has as a primary duty to promote.[2] According to WHO, it is only when the state properly appreciates how essential health is for individuals that it would double its efforts to provide underlying health determinants, “such as safe  and potable water, sanitation, food, housing, health-related information and education”[3] as well as health-related policies and investments. The 1999 Nigerian Constitution prescribes it as the government’s duty to protect citizens’ lives and ensure that “there are adequate medical and health facilities for all persons.”[4] Despite the constitutional mandate,  various governmental ministries, departments,  and agencies have often failed to effectively and efficiently carry out these constitutional functions, thereby entrenching a situation whereby citizens, especially the poor ones, lose their lives to preventable sicknesses almost daily.

Statutorily, different tiers of government (local, state, federal) in Nigeria share responsibility for providing health care or, at the very least, ensuring the existence of appropriate environment for healthcare delivery. However, endemic corruption, low health expenditure, and the government’s failure to invest adequately in population health constitute some of the major reasons the healthcare sector has often been unable to deliver effective health care to the citizenry of this large West African nation.

Six years ago,  Africa Check reported that a former Nigerian health minister declared,  “Nigeria has the lowest health budget in Africa.”[5] According to him, Nigeria’s health sector “has suffered from chronic underfunding for many years now.”[6] To underscore how grossly underfunded the Nigerian health sector is, in 2001 in Abuja, Nigeria, member states of the African Union (of which Nigeria is a key member) committed to spending 15 percent of their annual budgets to improve the health sector. But, as reported by Africa Renewal, as of 2018, only two countries had met the target, and Nigeria was not one of them.[7] Although being the largest economy in Africa, Nigeria’s public spending on health care in 2018 was only 3.89% of its $495 billion GDP.[8] This reality is disappointing and should raise questions.

One possible explanation for inefficiency in healthcare is corruption. Though corruption festers like an open wound in Nigeria’s public sector, one area where it is most ferocious is the oil subsector and the regime of oil subsidy (Nigeria is the world’s sixth-largest oil producer). It is hardly surprising that Nigeria’s annual budget for fuel subsidy continues to outspend its healthcare budgets by several million dollars. For instance, Nigeria’s healthcare budget for this year is roughly $3.4 million compared to an average spending of $2.3 billion each year for fuel subsidy.[9]

When elected officials and leaders (as well as colluding civil servants) steal from the commonwealth without qualms, the government stops being a protector of citizen’s life and a provider of critical health infrastructure that uplifts citizens’ wellbeing.  Such an action leads to medical inequity. Not surprising, in most cases, the victims of this government dereliction are mostly individuals and families who, through no fault of theirs, find themselves at the lower end of society’s economic and social ladder. Because they often do not have medical insurance, they give in to either disposing of their valuable property or getting some loans to pay for medical expenses. Exacerbating this situation is the fact that many privately-owned hospitals often require patients to deposit some percentage of the cost of treatment before they can start receiving treatment. Whereby the patient or their family are unable to pay such a down payment, some hospitals would refuse to treat a patient for fear that the patient or their family might default from paying the medical bills post-treatment. Because of the inability to pay, some patients are forced to seek help from unqualified persons, self-medicate, or seek divine intervention. When these levels of support prove to be ineffective treatments, frustrated families and their sick ones resign to divine intervention and eventually, slowly but surely, watch their loved ones die from a preventable sickness.

Given that many of these people died not because they asked for it (a human being instinctively strives at preserving its own life), but mostly because the state has failed to provide them with basic medical care as mandated by the Constitutions, could we then say that the state might be complicit in the killing of its citizens? If we agree that these victims died not because they wished it but rather due to the government’s negligence and irresponsibility, to what extent does the state share in their deaths? While it may be true, and most people would subscribe to this line of argument, that the government cannot be morally culpable for the death of any person who died because they could not pay for their medical care, being that the government is not directly involved in the killing of the person, I would, however, argue that the government might be indirectly complicit in the death of these people. Considering the enormous oil reserves and revenues available to the government, I would be inclined to argue that the government’s failure to guarantee a system where no one should have to die for lack of money makes the state indirectly involved in the death of the poor.

Besides deaths resulting from the medical system’s failure, there are countless other instances – the many unresolved law-enforcement extra-judicial killing of citizens readily comes to mind here – where the government has been negligent in investigating these killings and taking steps to prevent future unwarranted deaths. This nonchalance toward protecting lives lends credence to the perception that the state does not care about the lives of ordinary citizens. Also, the penchant of government officials and their families for traveling overseas for treatment while most hospitals are left ill-equipped is another strong evidence of apathy toward the people’s health. This action gives the impression that some lives are more worthy than others, that the lives of the poor are less important relative to those of the well-off.

Because of the state’s unconstitutional negligence in matters of health of its citizens, Nigerians and the ethical community must reclaim their role in holding the government accountable for the lives of citizens who died due to poor healthcare delivery.  Recently, Nigerian lawyer Emmanuel Ekpenyong has taken the government to task for the loss of lives as a result of “unlawful acts of commission or omission by the Nigerian State.”[10]  He instituted a lawsuit against the Federal Republic of Nigeria’s president, requesting the Court to clarify and “define what the Right to Life of persons in Nigeria actually means.”[11] He is seeking the Court to declare that the right to life under Section 33 (1) of the Nigerian Constitution extends beyond “mere physical and animal existence” to include also the right to “complete and dignified life” as well as the “right to health care.”[12] This step is commendable and a good beginning. The government must realize how it is knowingly or unknowingly “euthanizing” fellow citizens.

While many can excuse the state simply because it cannot possibly provide health care for all its citizens, it has no excuse not to support private investors in building hospitals, pharmaceutical and medical equipment manufacturing companies to help improve health and extend the lives of the populace. Unfortunately, the notoriously inefficient, corrupt, and unpredictable government machinery makes needed changes in the health sector almost impossible.  Commendably, the present government of general Muhammad Buhari has signed an executive order to ease and promote business in the country. However, how this has translated to better health care is not immediately apparent.  Nevertheless, this is a step in the right direction that, if maintained, would no doubt usher in a new era where most people can access health care without constantly fearing the possibility of dying from lack of adequate medical assistance.

The current federal government’s fight against corruption is also laudable not only because there is a link between corruption and poor quality of life and but also because of correlation between good governance and people’s wellbeing. In the spirit and letter of the Constitution of Nigeria, which mandates the state to protect citizens’ lives, the government will be judged by how much it can make healthcare accessible by all. It is only reasonable, therefore, that government begins to redirect policy and resources to this essential service it owes the people if the country is to flourish materially and humanly. A country or culture that does not take the health of its citizens seriously runs the risk of failing in other parameters, such as weakening its competitiveness in the global social and economic systems. The government should consider the vital connection between healthcare and a nation’s development to prevent this. In that case, health care must be addressed as a priority and not a privilege.  This priority must include efforts to redress the perception that governmental inefficiency indirectly participates in the “killing” of its citizens.

[1] Emma Bryce and Wana Udobang, “Nigerian Hospitals Are Locking Up Women Unable to Pay Their Childbirth Bills,” Vice.Com (April 1, 2019).

[2] “Human rights and health,” WHO (December 29, 2017).

[3] Ibid.

[4] Nigeria’s 1999 Constitution, Chapter Two.

[5] Vinayak Bhardwaj, “Does Nigeria have the lowest health budget in Africa?” Africa check online (May 16, 2016).

[6] Ibid.

[7] Agnes Gatome-Munyua and Nkechi Olalere, “Public financing for health in Africa: 15% of an elephant is not 15% of a chicken,” Africa Renewal (October 13, 2020).

[8] Simona Varrella, “Health expenditure as share of GDP in Nigeria from 2006 to 2018,” Statista (Sep 22, 2021).

[9] Kiran Pandey, “Can Nigeria kill the fuel subsidy?” (May 22, 2019).

[10] Fred-Young & Evans LP, “Nigeria: I Am Confused. What Does My Right To Life Mean In Nigeria?” (August 10, 2020).

[11] Ibid.

[12] Ibid.