Nigeria, Plagued by Deadly Diseases, Is Working to Mend Its Health-Care System

LAGOS, Nigeria —  Hardly a week goes by without reports in the newspapers of outbreaks of diseases among Nigeria’s 100 million people--yellow fever, measles, meningitis, tetanus, cholera, polio, guinea worm and others.

Hundreds of thousands die each year as a result of infectious disease, malnutrition, poor sanitation and the lack of medical care.

“The majority of our people do not have access to health care,” said Dr. Olikoye Ransome-Kuti, the minister in charge of health for Africa’s most populous nation.

His task is to improve the health of Nigeria at a time when the once-wealthy oil giant has been forced to drastically cut spending.

Ransome-Kuti’s approach to an array of problems is nothing short of a complete reform of the health care system and his program has won praise from the World Health Organization in Geneva.

“Our priority is to establish a basic primary health care system,” he said in an interview. “If we can put that in place, at least 50% to 60% of our health problems will be solved.”

Previous administrations spent millions of dollars on large modern hospitals for the major urban areas, but most never were completed because of financial mismanagement and the country’s falling oil revenues, Ransome-Kuti said.

Nigeria has joined a growing number of developing countries that are switching from large hospitals to a decentralized network of small health centers in rural and urban areas. The centers focus on preventive measures to control diseases before they require expensive hospitalization or reach epidemic proportions.

The new program stresses mass immunization campaigns, oral rehydration therapy for diarrhea, Africa’s largest child-killer, and nutrition, hygiene and family planning education. It also seeks to provide cleaner water and human waste disposal systems.

Nigeria’s predominantly rural population is highly susceptible to outbreaks of measles, typhoid, cholera and other diseases largely caused by a lack of clean drinking water and poor hygiene. Many villagers are suspicious of modern medicine, preferring to visit traditional healers whose treatments may aggravate health problems.

The World Health Organization in Geneva once assailed Nigeria’s health policies but now applauds them.

“Nigeria has a head start,” said the organization’s representative here, Samuel Brew-Graves. “It has the leadership and the know-how and is applying it.”

About a third of the nation’s local government areas have been given about $100,000 each to set up community health centers. Ultimately, all 304 local areas are to be included in the program.

Both rural and urban areas suffer from a high infant mortality rate--150 per 1,000 live births in rural areas. Three in 10 children die before age 5 in the urban areas, said a 1987 Health Ministry report.

As many as 2,000 Nigerian children die daily due to malnutrition, chronic undernourishment and related health problems.

Urban hospitals are run-down and ill-equipped to deal with the cities’ burgeoning populations. Basic drugs are in short supply, and the country’s lack of hard currency has made it difficult to buy spare parts for medical equipment.

Another major problem is the low morale of doctors in the civil service. Many doctors in urban areas moonlight illegally to supplement their meager salaries. Others remain unemployed rather than work in the rural areas, most of which lack even rudimentary health facilities or basic amenities for doctors’ families.

Ransome-Kuti said last year that he might be forced to import doctors from Cuba and still is keeping that idea alive, despite protests from the Nigerian Medical Assn.