International Journal of Development and Sustainability Online ISSN: 2186-8662 – www.isdsnet.com/ijds Volume 1 Number 2 (2012): Pages 437-447 ISDS Article ID: IJDS12081202 Austerity and the challenges of health for all in Nigeria Ogundana Folakemi * Department of Sociology, Ekiti State University, Ado-Ekiti, Nigeria Abstract The economic downturn experienced by Nigeria and many sub-Saharan African countries led to the adoption of austerity to restore the country’s economy since the 1980s. Since austerity emphasizes privatization and commercialization, instead of restoration, it had, however, impacted especially the Nigerian health sector negatively. Nigeria has indeed continued to bear witness to some of the worst health and healthcare statistics in the world. Evidence from key health indicators in Nigeria also clearly shows that the country’s health situation has experienced massive deterioration. Given the above, the paper argues that austerity constitutes a major impediment to the attainment of a good state of health as well as effective and viable healthcare delivery to all in Nigeria. The paper, therefore suggests: (1) reframing and recognizing health as a human right issue; (2) integration of indigenous medicine into the Nigerian national health delivery systems; (3) recognition of State investment in social services as quite necessary and important such that budget allocation to health is increased as ways forward. Keywords: Austerity, Health and Healthcare Copyright © 2012 by the Author(s) - Published by ISDS LLC, Japan International Society for Development and Sustainability (ISDS) Cite this paper as: Folakemi, O. (2012), “Austerity and the challenges of health for all in Nigeria”, International Journal of Development and Sustainability, Vol. 1 No. 2, pp. 437–447. * Corresponding author. E-mail address: [email protected] International Journal of Development and Sustainability Vol.1 No.2 (2012): 437–447 1. Introduction Agriculture was the mainstay of the Nigerian economy at independence. It provided gainful employment and satisfactory livelihood to over 90% of the country’s population (NDHS, 2008). The country, at this period depended almost entirely on agricultural production for food and agro-industrial raw materials for foreign exchange earnings through commodity trade. However, with the discovery of oil in the 70s, the dominant role of agriculture began to give way to petroleum exports. This particularly translated to relative buoyant economy during the first two post-independence decades such that public spending in all sectors grew rapidly in the 60s and 70s. For instance, curative health expenditure rose by 2,850% from the N4.4million in the 70/74 fiscal year to 114million in 77/78. Expenditures in other related services, which enhanced health such as water supply, housing, education and sports, equally witnessed remarkable growth within the same period (Zwingina, 1992). This state was, however, short-lived especially because the 80s ushered in an era of economic crisis. Indeed, the dramatic fall in oil export revenues resulting from the boycott of the Nigerian oil in the world market in 1978 led to economic recession and deterioration. By 1980s, Nigeria had entered an era of ‘oil doom” and serious economic crisis. For instance, there was a dramatic fall in the country’s revenue from a peak ofUS$10billion in 1979 to about US$5.161billion in 1982. The GDP also fell by 2% in 1982 and 4.4% in 1983. The consequences of these include declining growth, increasing unemployment, galloping inflation, poverty, worsening balance of payment conditions, heavy debt burden and increasing unsustainable fiscal deficits among others (Olukoshi, 1990). To reverse the Nigeria worsening economic fortunes, the IMF-inspired austerity was adopted under the Economic Stabilization Act in 1982. The Act provided the blue print for the “tougher” austerity subsequently introduced through Structural Adjustment Programmes (SAP) in 1986. Although austerity is a set of economic reform measures designed to achieve economic recovery and growth, its adoption had particularly left both the state and the people worse off. It further threw millions of Nigerians into poverty while those already poor went below poverty line. Evidences provided by UNDP (2000) and many other sources indicate that the incidence, depth and severity of poverty have been growing over the years. The Nigeria Office of Statistics and UNDP, for instance, show that in 1980, poverty level was 27.2%. By 1996, it had risen to 70.2%. Although, the level remained at 70.2% between 2000 -2003, some 87.5 million people were living below the poverty line of US$1 a day while 90.8% of the population or 112million people, lived on less than US$2 a day. Indeed, Nigeria was estimated to have the third largest population of the poor in the world during this period. The National policy on poverty eradication of the federal government of Nigeria also shows that while the depth and severity of poverty were 0.160 and 0.080 respectively in 1980, it increased to 0.358 and 0.207 in 1996. These had more than doubled in 2003. Also, Nigeria’s per capital income of US$260 in 2000 is not only much less but just one-third of its level of US$780 in 1980 (World Bank, 2003; AFRODAD, 2005). Moreover, since the introduction of austerity measure, unemployment and job security have equally been on the rise in Nigeria. As massive job losses occur in both the private and public sectors of the economy by 438 ISDS www.isdsnet.com International Journal of Development and Sustainability Vol.1 No.2 (2012): 437–447 day, it is increasingly difficult to absorb hundreds of thousands of graduates from Nigerian tertiary institutions. 2. Theoretical context This paper is anchored on a class of economic theories known as neoliberalism, which is a conservative policy aimed at enforcing stringent budget discipline on nations. The two major tenets of neoliberalism (www.wordiq.com/definition/neoliberalism) are: That close economic contact between the industrialized and the developing nations of the world is the best way to accelerate the transfer of technology which is germane in making poor economies rich. Hence, all barriers to international/globalised free trade should be eliminated as fast as possible. That governments in general lack the capacity to run large industrial and commercial enterprises. Thus, (except for key obligations such as those relating to income distribution, public- good/infrastructure, administration of justice and a few others), governments should hands off and privatise. As a political-economic philosophy, neoliberalism had major implications for government policies beginning in the 70s and increasing in prominence since 1980s. It de-emphasizes or rejects positive government intervention in the economy. Rather, it focuses on achieving progress and even social justice by encouraging free market methods and less restricted operations of business and “development”. The promoters of neoliberalism argue that the net gains for all under free trade and capitalism will outweigh the costs in all, or almost all cases (www.wordiq.com/definition/neoliberalism). 3. The problem Nigeria has continuously adopted most of the internationally recognized health interventions to address the various problems of her health system and burden of diseases. These include eradication of small pox in 1970; expanded programme on immunization (EPI) in 1975; Primary Healthcare (PHC) in 1988; the Millenium Development Goals (MDGs) in 2001 and; Polio Eradication Initiative (PEI) in 2003 (HERFON, 2006). Nonetheless, the Nigerian health situation is far from desirable. Indeed, Nigeria had continued to bear witness to some of the worst health and healthcare statistics in the world. Evidence from key health indicators in the country clearly suggests that Nigeria’s health situation have experienced massive deterioration. For instance, life expectancy at birth had remained low (HERFON, 2006, PRB, 2009). Mortality is high, with the majority of it due to infectious diseases and complications of pregnancy and child birth (HERFON, 2006; NDHS, 2008). Quite worrisome is the burden of a combination of new diseases and re- emerging old ones such as malaria, HIV/AIDS and Tuberculosis, which put the life of millions of Nigerians in serious jeopardy. There had also been significant shift in the types of predominant diseases from infectious ones to cardiovascular and degenerative diseases and cancer which currently accounts for a significant proportion of all deaths in the country. With respect to the Nigerian Health situation, therefore, the World ISDS www.isdsnet.com 439 International Journal of Development and Sustainability Vol.1 No.2 (2012): 437–447 Health Organisation (WHO) ranked the Nigerian health system as 187th of the 191 countries evaluated in 2000. Besides, Nigeria is not only lagging behind in all Millenium Development Goals (MDGs), it is also close to the bottom of virtually every development index (HERFON, 2006; Hadi, 2007). Since health is a state of complete, physical, mental and social well being of an individual (WHO, 1981), it is quite important in the development of every society. The importance of health as a developmental issue is better understood in terms of the components of good health which include freedom from pain, discomfort, boredom and stress; absence of illness, infirmity and diseases; balanced nutrition; qualitative and quantitative housing; water supply; good working and living conditions; education that