The saying that “life begins at forty” is used to denote the belief that one can still record their best success at that age.
It’s a time when many people begin to prepare to exit their young adulthood, with middle ages staring them in the face.
But with Nigeria ranked at 190 out of 193 countries of the world with an average life expectancy of 54.80 years, thus if truly life begins at 40, then Nigerians may just have 15 years to live.
Longevity refers to the characteristics of the relatively long lifespan of some members of a population. Maximum lifespan is the age at death for the longest-lived individual of a species. Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age, and other demographic factors like gender.
The most used measure is life expectancy at birth (LEB). The combination of high infant mortality and deaths in young adulthood from accidents, epidemics, plagues, wars, and childbirth, before modern medicine was widely available, significantly lowers LEB.
The Global Health Observatory indexed several indicators that determine life expectancy rate which include: children aged <5 years sleeping under insecticide-treated nets (Health Inequality Monitor), deaths per 1000 live births, the estimated malaria mortality rate (per 100 000 population), health service provision (IHR SPAR), accessibility of a functional healthcare facility in communities, maternal mortality ratio (per 100 000 live births), medical doctors (per 10 000 population) and mortality rate attributed to exposure to unsafe WASH services (per 100 000 population).
Life expectancy at birth in Nigeria is among the lowest in Africa as well as in the world. An average Nigerian is not expected to live beyond his or her 55th birthday. The countries with the lowest life expectancy are:
Central African Republic (53.345 years)
Chad (54.458 years)
Lesotho (54.366 years)
Nigeria (54.808 years)
Sierra Leone (54.81 years)
Somalia (57.5 years)
Ivory Coast (57.844 years)
South Sudan (57.948 years)
Guinea Bissau (58.444 years)
Equatorial Guinea (58.878 years)
Currently, 51.2 percent of the population of Nigeria resides in urban settlements (102,805,995 people in 2019). Through primary health centres (PHCs) and public health posts, accessible health services are extended to underserved communities. However, many of these facilities in rural communities are not functioning as they should, thereby exposing 48.8 percent of the population to various degrees of health challenges.
To control the spread of disease and reduce the growing rates of mortality due to the lack of functional health facilities, special attention needs to be given to healthcare infrastructure in rural areas.
The inability of the government to provide conducive healthcare amenities in rural and remote communities is a barrier to the realisation of health equity.
For most Nigerians, public health facility is the first point of contact for health care since it is presumed to be affordable. At this level you, expect short-term, uncomplicated health issues to be resolved. Poor health infrastructure funding has been linked to low life expectancy. Nigeria remains the second largest contributor to maternal child mortality globally, with 917 maternal deaths per 100,000 live births.
Osun state covers approximately 14,875 square kilometres and lies between longitude 4 degrees 00”E and latitude 05 degrees 55N”.
Osun state shares a boundary with Ogun state, Kwara state, Oyo state, and Ondo state towards the South, North, West and East respectively. Accessibility to basic healthcare facilities has broadly been identified as a major indicator of socio-economic development and the existing spatial pattern of distribution of PHCs plays a very prominent role in the metrics used in evaluating the level of efficiency or the existing level of provision of service in these facilities within the state.
Oja Tuntun is a community along Ibokun – Osogbo Road in Obokun LGA of Osun state. Ibokun is about 25km and 34 minutes journey from Osogbo, the state capital.
Oja Tuntun (Oja Titun) Health Post was commissioned on 17th February 1999. In the health system, the health post is the first institutional contact point for health care service delivery in rural areas or underserved communities.
In addition to providing health services, the health post also monitors the activities of Female Community Health Volunteers (FCHVs) and centers for community-based activities such as outreach clinics (ORC), extended immunisation clinics (EPI Clinics) and community health sensitisation.
I arrived at Oja Tuntun as early as 9 am and on the ground is the health worker attached to the health post. She received me warmly. But the state of the health facility was rather appalling.
Mrs. Arije Oluronke, a health technician/assistant was transferred in 2018 and has been the only staff working at Oja Tuntun health post in the last 4 years.
She said the community has over 100 residents and is surrounded by 5 other communities that also visit to the facility for anti-malarial drugs.
The health post because of the poor condition of the infrastructure here cannot offer more than to give malarial drugs to walk-in patients.
The level of literacy in this community is very low and that played out in their act of rejecting a medical card. “If you asked them to register to collect a treatment card, they will refuse and want to have access to drugs when needed,” Mrs Arije said This made it difficult to create a proper health record for them.
Residents must trek about 7 km to either Ibokun town or Egbeda in Boripe LG to access health care services. Many pregnant women registered for their antenatal in neighboring PHC and some as far as Osogbo, the state capital. In a case of an emergency, patients will have to walk in pain and agony before they could access healthcare services.
Over time, lives have been lost in the community when treatment is not administered on time even from minor infections arising from untreated water-borne diseases as the community is also faced with a lack of clean water. It is clear that this facility lacks the basic kits for treatment.
Pa Rufai Akanbi, the Baale of Oja Tuntun got emotional as he showered praises and prayers on Mrs. Arije. He said sometimes, she uses her personal money for the procurement of drugs and first aid materials.
He described her as a woman very diligent in her work, but her effort is not appreciated and no motivation from the government in terms of the provision of equipment to discharge her duty. He took us down memory lane when the health post was commissioned.
He said, “the government has not done well by not prioritising our welfare in this community, if not they would not have watched it turn to this deplorable state.”
I moved from Oja Tuntun in Obokun LG to Egbeda in Boripe LG where they have a Millennium Development Goals (MDGs) Primary Healthcare Centre built in 2011. The facility provides services such as antenatal, immunisation, baby delivery, and health education to the communities and outpatients. Mrs. Makanjuola, the community health officer transferred to this facility from Iree in 2017 divulged.
The signpost has been removed and placed somewhere within the facility which made it difficult to locate the PHC. The removal was not intentional, over time the iron bar has become weak from rusting and no effort has been made to erect it back in a conspicuous place.
The experience here is similar to that of Oja Tuntun, many of the wards and labour rooms are not in tidy conditions.
The facility is best described as one which has been left over time unused but that is not the case, lack of capacity and adequate personnel is responsible for its poor state which is a pointer to the poor maintenance. Sometimes, hiring another pair of hands is the best action to take when there are no additional hours in the day to get all of your tasks done.
With proper staffing levels, patients’ needs would be met. Inadequate staff or qualified personnel to carry out designated duties will lead to the inability to meet performance criteria. There is a correlation between the availability of health workers and the provision of healthcare services of acceptable quality. Consequences of inadequate labour include missed care, job stress, potential failure to rescue, and dissatisfaction.
My tour of the facility revealed that some of the rooms are abandoned and the PHC is not operating in its full capacity.
It is recommended that to meet the UNHCR standards the following workload indicators of staffing need includes in a PHC, Laboratory Technician, Outreach Workers, Midwives, Community Health Officer (CHO), Community Health Extension Workers (CHEWs), Junior Community Health Extension Workers (JCHEWs), and Cleaners.
The WHO have said scaling up primary health care interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
The policy use case of LEB shows that life expectancy is one of the factors in measuring the Human Development Index (HDI) of each nation along with adult literacy, education, and standard of living. Life expectancy is also used in describing the physical quality of life of an area or, for an individual when the value of a life settlement is determined a life insurance policy is sold for a cash asset. Disparities in life expectancy are often cited as demonstrating the need for better medical care or increased social support.
Nigeria’s weak healthcare infrastructure and financing system are significant drivers of poor health outcomes and service delivery. It is not enough for the government to build health posts and PHCs; set standards and measures in place must be duly maintained to ensure that they evolve from just paper to reality.
The federal government should adequately fund the PHCs to ensure the availability and retention of adequate qualified health personnel in the right mix to discharge healthcare services in remote and rural communities.
[This piece was supported by the Africa Data Hub Community Journalism Fellowship].