The role of health in economic growth and development can never be overemphasized.
The importance of health was also stressed by endogenous growth theory. WHO
(2003) defined health as a state of complete physical, mental and social
well-being. In this perspective, good health is a major source for social, economic
and personal development and an important dimension of quality of life. Health
improvements contribute to other development objectives such as increased productivity,
high income growth, political stability etc. Health capital also determines
the total amount of healthy time available for people.
Record has shown that the health status of countries in Sub-Saharan Africa
is very poor. The reproductive health indices in these countries are deplorable.
Maternal mortality rate is estimated at an average of 500 deaths per 100,000
live births in 2010. People living in Sub-Saharan Africa have the least access
to an improved water source that could supply safe drinking water as only 45%
of people in rural areas have access to improved drinking water source (World
Bank, 2014). In Western and Central Africa, mortality rates for under-five
are among the highest in the world. The figures stand at 184% compared to global
average of 88% (Enabudoso et al., 2006).
Based on the poor nature of health situation in the World generally and in
Sub-Saharan African particularly, the World leader in 2000 came together to
declare Millennium Development Goals (MDGs) of which three out of eight goals
is based on health. These development goals on health are reducing child mortality;
improve maternal health or maternal mortality and combating HIV/AIDS, malaria
and other diseases (United Nation, 2014).
To achieve these health development goals, the Nigerian government has set
up several programme and policies. These include Safe Motherhood Initiative
(SMI), Primary Health Care Scheme and Guinea-worm Eradication Programme, Better
Life for Rural Women (BLP), The Family Support Programme (FSP), The National
Health Insurance Scheme (NHIS), The National Action Committee on AIDS (NACA)
and its associated programme for the Prevention of Maternal to Child Transmission
of HIV (PMTCT) programme, National Strategic Health Development Plan (2010-2015)
(Makinde, 2005; Innocent et
However, despite these policies and programs, health situation has not improved
in Nigeria. The World Health Organisation (WHO) has also identified Nigeria
as one of the 46 African countries that have failed to meet the Abuja Declaration
13 years on and one of the 38 that are off track in meeting the health-related
Millennium Development Goals (MDGs) by 2015. The WHO also stated that only Rwanda
and South Africa have achieved the Abuja Declaration target adopted by the African
Union (AU) in April 2001 to increase government funding for health to at least
15% (WHO., 2011).
This study, therefore, appraises the attainment of the health-related millennium
development goals in Nigeria between 1990 and 2013.
MATERIALS AND METHODS
In this study, a critical review of secondary data on health indicators was
conducted to examine the attainment of health-related millennium development
goals in Nigeria between 1990 and 2013. These healthrelated goals are
to reduce child mortality, improve maternal health or maternal mortality and
combating HIV/AIDS, malaria and other diseases. Targets for each goal are enumerated
and the trends of some selected health indicators for monitoring progress of
respective targets were examined through the use of descriptive statistical
tools such as percentage, charts and tables. Apart from these monitoring indicators,
trends of public expenditure on health were also assessed in order to show the
level of governments commitment to health. All data used in this study
were sourced from the World Bank (2014).
For the first health-related millennium development goal, the target is to
reduce by two-thirds between 1990 and 2015 the under-five mortality rate. For
this goal, indicators considered are under-five mortality rate, infant (under
1) mortality rate, proportion of children age 1-59 months that receives vitamin
A supplement and the proportion of 1 year-old children immunized against measles.
For the second goal, the targets are to reduce by three quarters, between 1990
and 2015, the maternal mortality ratio and achieve, by 2015, universal access
to reproductive health. Progress monitoring indicators examined for the attainment
of these targets in this study are maternal mortality ratio, proportion of births
attended by skilled health personnel, adolescent birth rate and prenatal care
The targets for the last MDGs on health is to have halted by 2015 and begun
to reverse the spread of HIV/AIDS, achieve by 2010, universal access to treatment
for HIV/AIDS for all those who need it and have halted by 2015 and begun to
reverse the incidence of malaria and other major diseases. The indicators considered
for these targets are HIV prevalence among population aged 15-24 years, proportion
of children under-five sleeping under insecticide-treated bednets, proportion
of children living with HIV, incidence of tuberculosis and proportion of tuberculosis
RESULT AND DISCUSSION
In this section, the attainment of three health-related millennium development
goals in Nigeria is assessed based on some selected health indicators.
Reducing child mortality: Based on the data presented in Table
1, Nigeria government has performed well in reducing under-five mortality
rate by almost two-thirds. There has been a significant decrease in the under-five
mortality rate in Nigeria, from 213.2 deaths per 1000 live births in 1990 to
75.1 death per 1000 live births in 2013. This represents about 65% decrease
in under-five mortality rate. Also, infant mortality (under 1) substantially
reduced from 126.3 per 1000 live births in 1990 to 74.3 deaths per 1000 live
birth in 2013. Also, the percentage of children receiving vitamin A supplement
has increased tremendously since 1999. From mere 23% in 1990, the number of
children receiving vitamin A increased to about 91.5% in 2010. As in 2013, this
figure stood at 78%.
However, Nigeria did not perform well in-terms of immunization coverage. The
proportion of children immunized against measles (Percentage of children ages
12-23 months) in the country fluctuated between 1990 and 2013. The immunization
coverage which stood at 54% in 1990, significantly declined to 33% in 2000.
It slightly increased to 41% in 2005 and declined to 37% in 2012. As at 2013,
immunization coverage stood at 59%.
Improve maternal health or maternal mortality: Generally, Nigeria recorded
slow progress in reducing maternal mortality and creating universal access to
reproductive health. Performance in this goal, especially, in universal access
to reproductive health, has been sluggish and possesses greater challenge to
women health. Although, there is a significant reduction in maternal mortality
rate between 1990 and 2013, the level of reduction in maternal mortality (about
53%) is still quite below the target of 75% reduction. As can be seen in Table
2, maternal mortality rate (per 100,000 live births) reduced from the value
of 1200 per 100000 live births in 1990-560 deaths in 2013. Also, the percentage
of pregnant women receiving prenatal care has been fluctuating. It increased
from 56.5% in 1990 to 61.8% in 2000 and then reduced to 58% in 2005. As at 2013,
prenatal care coverage stood at 66.8%. The proportion of birth attended by skill
health personnel improves marginally from 30.8% in 1990 to 48.9% in 2012. More
so, adolescent fertility rate reduced slightly from 148.01 births per 1000 adolescent
in 1990 to 118.02 births per 1000 adolescents.
The poor performance in the mortality rate and access to reproductive health
can be attributed to many factors which include; poor medical facilities, incessant
strikes by medical practitioners, difficulties in relocation of midwives to
the rural areas etc. (Omowaleola, 2013).
||Health indicators for improving maternal health and maternal
|World Bank (2014)
||Health indicators for combating HIV/AIDS, malaria and other
|World Bank (2014)
Combating HIV/AIDS, malaria and other diseases: The HIV/prevalence rate
in Nigeria still remains high and increasing. As can be seen in Table
3, HIV prevalence in pregnant women aged 15+ years increased from 53.2%
in 1990 to 58% in 2013. Also, number of children living with HIV increased from
160-320 thousand between 1990 and 2013.
As can be seen in the table above, the incidence of tuberculosis is still very
high in Nigeria. In 1990, the incidence of tuberculosis which was 128 per 100000
persons increased significantly by about 37% to 175 per 100000 people in 2005.
It later reduced to 108 per 100000 people in 2012. Tuberculosis case detection
rate increased throughout the period under review. It value raise from 8.9 in
1995 to 53% in 2013. The percentage of children sleeping under insecticide-treated
mosquito net raise significantly from 1.2% in 2000 to 29.1% in 2010. It then
fell to 16.6%.
Budgetary allocation to health sector: In Fig. 1,
the level of government expenditure on health in Nigeria was examined. The trend
is considered from 1995-2010. Public health expenditure consists of recurrent
and capital spending from government (central and local) budgets, external borrowings
and grants and social health insurance funds. The Fig. 1 shows
that government commitment to health is very low in Nigeria. The expenditure
on health as percentage of total expenditure was below 10% throughout these
periods. The proportion of health expenditure in total expenditure averaged
6.14 for the periods. Health care expenditure as percentage of total expenditure
which was 7.05% in 1995 fell drastically to 3.2% in 2001 and rose to its peak
of about 9.14% in 2007 it then declined to 4.41% in 2010. In terms of health
expenditure as percentage of GDP, the result is similar. The proportion of income
allocated to health care in Nigeria is also very small. It ranges between 3.91
Nigerias health expenditure per capita was also examined. As can be seen
in Fig. 2 health expenditure per capita is rising throughout
this period. It rises from 50.32 USD per head in 1995 to about 135.92 USD per
head in 2009 before declining to 121.36 USD in 2010. Although, the health expenditure
per capita is rising in absolute term, it still remain relatively low compare
to health expenditure per capita of countries such as Egypt, Algeria and South
Africa and. As in 2010, health spending per capita in these countries is 288.57,
330.01 and 934.95 USD, respectively (World Bank, 2014).
Overall Nigeria seems to have performed poorly in relation to the health-related
MDGs targets. A cursory review of the health statistics shows that much remains
to be done. The statistics demonstrates the deplorable condition of the health
sector in Nigeria. Couple with the fact that most of the health related MDGs
targets have not been achieved, in Nigeria, the maternal mortality rate, adolescent
fertility rate, incidence of tuberculosis, HIV prevalence among adult and children
and infant mortality rate are very high by world standard.
There is also low accessibility level to reproductive health. Proportion of
birth attended by skill health personnel is still below 50% and the percentage
of pregnant women receiving prenatal care hovers around 60%. According to Omowaleola
(2013), most pregnant women attended by skilled health personnel are located
in urban area since medical practitioners are reluctant to relocate to remote
areas due to poor communications and amenities.
||Health expenditure as percentage of total expenditure and
GDP, Source: World Bank (2014)
Although, Nigeria has not achieved any of the health-related MDGS, the country
performs well in-terms of reducing under-five mortality rate. The achieved rate
of reduction in under-five mortality is 65% and is almost equal the set target
of 66% reduction. One space only Achievement made possible by mass immunization
of children against killer diseases such as measles, diphtheria, pertussis (or
whooping cough) and tetanus, high coverage rate of vitamin A supplement for
children; assistances from international communities etc.
The poor records in other health-related MDGs in Nigeria could be attributed
to several factors such as gross under-five of the health sector (Igbuzor,
2006), shortage of skilled medical personnel at the primary health care
level (Abdulraheem et al., 2012); poor human
resources planning and management practices (Makinde, 2005),
lack of infrastructural facilities in the rural areas and poor compensation
packages (Igbuzor, 2006; Omowaleola,
2013), internal and international migration of health workers (Omowaleola,
2013) and inadequate mass education on personal hygiene, environmental sanitation
and family planning.
It could be deduced from above discussion that Nigeria is yet to achieve any
of the three health-related MDGs. Although, the country performs well in attaining
65% reduction in under-five mortality rate, statistics shows that health conditions
is deplorable in the country especially in-terms of maternal mortality, HIV
prevalence rate, universal access to health facilities etc. It, therefore, can
be concluded that the country may not achieved most of the heath-related MDGs
Healthcare problems in Nigeria are multifaceted and result from combination
of socio-cultural, economic, political factors as well as poor planning and/or
poor implementation of health policies and programmes. There is also the problem
of availability, accessibility, affordability and sustainability of healthcare
facilities and services. Low budgetary allocation is also a very significant
problem facing the health care system. It was noted that the developing world
bears 90% of the disease burden but allocates less than 10% of its annual budget
to healthcare. Even Nigeria government failed to allocate up to 10% of its budget
to health sector.
Thus, increasing investment in health facilities is a required policy intervention
for long term development of the Nigerias
health sector. Stepping up both public and private investment in health sector
would also ensure attainment of health MDGs in Nigeria. Also, health systems
should be strengthened with both human and material resources to make them functioning
and functional. The availability of skilled health workers and providers (particularly,
nurses, midwives, doctors and obstetricians) is critical in assuring high quality
health care delivery in the country.