On October 25, 2018, UN member countries unanimously agreed to the Declaration of Astana, a reaffirmation of the landmark Alma-Ata edict promulgated to strengthen primary health care systems globally. The Alma-Ata decree was in 1978, shortly after which Prof. Olikoye Ransome-Kuti became Nigeria’s health minister. During his tenure, Nigeria’s health care system received significant boost, making it a model for several African countries and other parts of the global south. While some critics may disagree, the current rotten state of our health sector effectuated by knaves and reprobates makes Prof. Ransome-Kuti’s health care system despite its flaws, oh so desirable at this point.

It is November 2018, and we all know that Nigeria’s health care system has virtually collapsed. However, to put things in proper perspective particularly for those who might for whatever reason be disillusioned, it is necessary to provide a few facts for reckoning. According to certain reports, Nigeria provides healthcare for only about 3% of its population with millions lacking access to essential health services. There is a high, albeit poorly documented prevalence of infectious and non-communicable diseases, high maternal/infant mortality rates, malnutrition and general low life expectancy (45 years for men and 49 years for women). Some infectious diseases that have been vanquished in other parts of the world are still endemic in Nigeria.
For instance, Nigeria is one of three Countries-Afghanistan and Pakistan still grappling with Polio.
Nigeria is reportedly the fourth most dangerous country in the world to give birth, ahead of only Sierra Leone, Central African Republic and Chad. Poor public health response, poor hygiene, inadequate safe water provisions, weak infrastructure, poor record keeping, insufficient personnel are some of the other problems plaguing the system. The country practically has no systems for disease prevention, public health enlightenment, mental, sexual and reproductive health. As a result, many
Nigerians die or are rendered morbid from preventable causes.

The essence of the Astana conference is simple- to reinforce the need for efficient primary health care globally. The participants very likely gleaned important lessons from attendance. Who were these participants and can it be taken for granted that they have the inclination or proper understanding of what it takes to translate this agreement into meaningful growth? More importantly, do they have a work plan or strategy? Are they committed to influencing change in the health sector? Admittedly, revamping Nigeria’s healthcare sector is an arduous task. There are however, simple, pragmatic steps that can be taken to realize these goals. Political will is necessary as every determinant; ranging from critical appointments, infrastructural development, capacity building, to enacting policies is hinged on
political decisions. In its absence however, it can be stimulated. It might be a little late in time to talk about electing visionary leaders. However, we have seen how social media activism has influenced political decisions in recent time, even in certain cases where the outrage was misguided. Nigerians should therefore, be enlightened and encouraged to engage with and advocate for achieving the goals
stipulated in Astana.

We need to prepare to task the next President to seek a reformer, in the ilk of
Ransome-Kuti who will make bold political choices for health across the entire country, rather than a vacillating, inept Professor with ‘glowing’ credentials. Other activists, academics, philantropists, members of press, patient advocates and health workers must not forget this commitment. The obligations of the government, ministry of health and other relevant authorities or partners are clear. If
these stakeholders have lost sight of these, patriotic experts need to update them periodically. These experts can disseminate sound information on social or other media platforms so everyone can be aware and propagate the information.
The need to empower individuals and communities cannot be overstated. The country has to prioritize the welfare and continued training of medical doctors and other healthcare workers. Nigerian trained medical doctors leave the country in droves and no one seems to care. This is the worst form of brain drain considering the resources that goes into training these doctors. Other sane countries want to
retain their talent, not flush them out. These doctors are needed to serve the country particularly the rural areas. With the right incentives, working conditions and career development opportunities, it can be expected that many more doctors will be encouraged to stay. Adequate funding for medical research, equipment and other amenities, bookkeeping and disease prevention schemes is necessary.

In addition, the country’s health insurance program needs to be improved. Countries like Kenya with laudable initiatives such as National Hospitals Insurance Fund designed to ensure health care for the impoverished may be emulated. We need national, state and local policies, as well as workable strategies to develop and maintain sustainable healthcare systems throughout the country. These
policies should ensure accessibility to quality healthcare, improve the health, overall wellbeing and longevity of Nigerians, while contributing meaningfully to the sustainable development of the country.

Dara Alegbeleye is a PhD student at University of Campinas Oluwatosin is a medical doctor at University College Hospital, Ibadan