How Money Poses as an Obstacle to Health
STEWARD HEALTH FOUNDATION (SHEFON) SEMINAR ON
WHEN MONEY POSES AS AN OBSTACLE TO HEALTH
Date: 11th October, 2020.
It is said, “in our country our people are killed essentially from
poverty , not necessarily from sicknesses and diseases.” We are a
country where more than 80% of the population live below
poverty level, earning less than $1 (dollar)a day.
This is a further confirmed by report jointly presented by WHO, UNICEF, UNFPA and WORLD BANK in 2012 which reads thus; about 3.1 million
children died within the four weeks of life and an estimated
278,000 women died during pregnancy and child birth monthly.
Over 98% of these deaths occur in developing countries and most
of these are preventable with effective low-cost interventions
which regrettably are lacking.
The financial burden of sicknesses is so enormous and beyond the
reach of an average citizen. Malaria for example affects 97% of
Nigeria’s population and consumes an estimated 32 billion naira
annually only for the northern zone of the country. Yusuf (2019)
WHAT IS HEALTH?
The word “health” refers to a state of complete emotional and
physical well-being. Healthcare exists to help people maintain this
optimal state of health.
WHO, 1948, 1986 describes health as a state of complete physical,
mental and social well being and not merely the absence of
disease or infirmity.
Furthermore, health is a resource of
everyday life, not the objective of living but a positive concept emphasizing social and personal resources as well as physical
From the foregoing, this ultimately means that health is a
resource to support an individual’s function in a wider society,
rather than an end in itself.
A healthful lifestyle provides the means to lead a full life with
meaning and purpose.
When these are lacking ill-health, sickness and diseases set in.
COMMON PROBLEMS OF THE UNHEALTHY PERSON.
ALIENATION: The individual feels lonely, isolated and cut
off from family, neighbours and friends, errands, work
schedules and business opportunities are abandoned.
LOSS OF CONTROL: The sick person feels betrayed by his
body, which is vulnerable and no longer sure of what is
happening to it or how to plan for life, the future is
DISRUPTION OF ROUTINES: It disrupts normal running of
work places, church affairs, studies at school etc.
EXORBITANT: Taking care of sick people, more so, long
staying is very exorbitant, especially in a country like ours
where there is no meaningful assistance from government in
form of social welfare.
INFANTALISES: Many people even the rich have not
recovered from the losses incurred while sick and pulling
through an illness.
AWARENESS OF DEATH: It brings on the awareness of
death; this knowledge could be quite disturbing especially
among young people and people who never thought of
dying. It is said, “the pain of the death is often worst than
death itself.” (Wildersmith,1971)
HEALTH INSTITUTIONS IN NIGERIA
From available records, the country has thirty five (35)
teaching hospitals, sixty eight (68) federal medical centers
and specialist hospitals including Military health institutions.
Primary health centers from NPHCDA records are more
than thirty thousand (30,000) across the country. There are
numerous private health facilities both orthodox and
traditional medical practitioners.
Painfully, the financial demands of accessing health in all
these areas opposes a great obstacle to our citizens.
No wonder, UNICEF rates Nigeria as having the fourth worst
life expectancy in Africa; performing only better than the
Central African Republic, Chad and Sierra Leone.
WHEN MONEY POSES AS AN OBSTACLE TO HEALTH
In Malawi, when the authorities introduced user fees in her
health system 60.7% of respondents in a survey were not
willing to access health services because them could not
afford it. (Watson et al, 2016).
Another study between 2012 – 2016 shows that before introduction of user fees, hospital attendance was up to 90% but with the introduction of fees it came down to 15% – 18%
When the government discovered the dangerous
trend and removed the user fees, monthly attendance rose
to an average of 83% thus, removing user fees from facility
based delivery services makes for positive difference in sub
saharan Africa ie, Ghana, Kenya and Senegal experience(Mekinon et al,2015)
Aregbeshola and Khan (2018) reported the catastrophic
health expenditure which is the measure of the financial risk
a family or individual incurred when they pay out-of-pocket
for health care services that are unaffordable. Some scholars say when a household spends up to 40% of its income on
In their work, here in Enugu, Nigeria Okedo – Alex et al
(2019) reviewing the incidence and determinants of
catastrophic health expenditure reports of 40% households
were found suffering , occasioned by poverty,
underdevelopment, and low health motivation.
In their own work Barasa et al, (2017) that found annual
health bills pushed 453, 470 households into poverty.
NATIONAL HEALTH INSURANCE SCHEME (NHIS)
The Nigeria National Health Insurance Scheme (NHIS) was
designed to reduce catastrophic out-of -pocket expenditure
for healthcare in Nigeria to achieve universal health
coverage by 2015, however, only about 3% of the population
is covered by the scheme regrettably, only the formal
economic sector accounts for almost all the total enrolment.
(Adewole et al 2017, Adewole 2016)
With this, the large population of Nigeria still finds it
extremely difficult accessing healthcare.
ROLE OF NON GOVERNMENTAL ORGANISATIONS (NGO’s)
Numerous NGO’s are currently existing in Nigeria. Health
education and clinical services constitutes the major areas of
current activities of these NGO’s.
WHO reports that nearly half (42%) receive foreign funds.
Local funded NGO’s restrict their activities to mostly health
education with about 60% of them in this area.
While the largest number are sub-national and community
based NGO’s their activities are put at 40%.
The activities of these NGO’s have added to access to health
but a lot is still being desired.
Having looked at a few issues that impede access to health
these recommendations are put forward:
- Our Government should find ways to reducing poverty in
the country by raising the living standard of the people.
- More funds should be channeled into the health system
and out-of- pocket user fees abolished to enhance access
to health by our people.
- Social welfare issues should be taken more seriously by
our government, religious groups and NGO’s to
adequately save the lives of our people.
- Our health institutions should be equipped and staffed
with qualified highly motivated health professionals.
- There should be increased local funding from government
and well spirited wealthy co operate bodies and
individuals to our local NGO’s for optimal services.
- Our Educational Institutions should review their training
programmes to incorporate courses that should raise our
national values as this shall enhance the dignity of the
- NGO’s should intensify their activities in the rural areas in
order to help our people in the grass root have good
- More research work should be done in our areas to
discover other features of our poor state of health
It is believed that if the issues raised in the seminar are
considered and implemented, money shall no longer be
an obstacle to health in our communities and entire
Very Rev. Jerome Uche Nduka
Medical Laboratory Scientist,
STEWARD HEALTH FOUNDATION
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