...Increased treatment costs threatening healthcare delivery...Economic pressure straining family relationships, causing household conflicts - Experts...Say brain drain worsening situation lNote Nigerians in for long haul...Add social bonds need protection
The prevailing economic downturn in Nigeria is taking a significant toll on the physical and mental well-being of citizens.
Millions are fighting to break the cycle of poverty that is fueling ill health, which in turn is impeding their ability to fully participate in the economic and social activities.
The struggle to afford basic necessities like food, transportation, basic health care and shelter is causing the people much anxiety and stress.
The rising inflation and unemployment further worsen these concerns, leaving many people feeling helpless and hopeless about the future.
Worse still, the economic woes are straining public healthcare, reducing access to services and specialists.
Healthcare costs, including consultation fees, medications, and diagnostics, have become a burden, leading to delays in seeking medical attention, even for critical illnesses.
In many hospitals, cutbacks on resources and staff are leading to longer wait times and limited services, making essential healthcare more difficult to access.
The situation is significantly impacting health-seeking behaviour as people are resorting to less effective or risky alternatives like self-medication, home remedies, and consultation of traditional healers, ultimately delaying or denying proper diagnosis and treatment.
It is also no news that mental health challenges and illnesses are on the rise, no thanks to the socioeconomic and other psycho-social factors.
Health watchers say there is a dire need to focus more on the causes of metal health illnesses and the deficiencies of mental health care in Nigeria.
They said the struggle to balance health and finances underscored the urgent need for systemic changes.
Vanguard investigations show that the rising cost of living has forced many Nigerians to choose cheaper, less nutritious food options that are as high in processed ingredients and unhealthy fats, as they are low in fibre and essential nutrients.
These and other economic constraints are contributing to malnutrition, weakened immune systems, chronic diseases and increased susceptibility to adverse mental outcomes.
Increased treatment costs
For instance, Asthma patients struggle to afford essential inhalers and explore untested alternatives because inhaler costs have surged over 500 per cent in less than a year due to inflation and the departure of multinational firms.
The average cost of outpatient care for some of these chronic disorders at secondary care centres and private hospitals in Lagos range from around N100,000 to N500,000, with transportation costs adding an average of N10,000 to N50,000 per visit to these centres.
For some others, the cost of accessing treatment for even common ailments such as malaria and typhoid fever can represent a significant proportion of the average monthly income.
The average cost of treating depression in a hospital in Lagos can range from ¦ 50,000 per month for outpatient care, with medication costs averaging around another ¦ 50,000 per month, depending on the type of treatment, hospital, and individual needs.
The primary cost contributors include doctor consultations, medication, and necessary tests or therapies.
Public hospitals may offer lower costs but could have longer wait times and limited resources than private hospitals.
More findings highlight the significant financial strain faced by patients living with chronic disorders such as cancer, diabetes and high blood pressure.
The rising costs of medications, including anti-cancer and anti-diabetic drugs as well as anti-hypertensives, coupled with the expenses associated with regular check-ups and transportation, are constituting heavy burden on those affected.
Testimonials
Olamide, a 45-year-old street vendor is hypertensive. The single mother of three who lives in a Lagos slum is also diabetic.
Due to her poor and irregular income and the high cost of living, she often skips meals or opts for cheap, unhealthy street food. Her children are also showing signs of malnutrition, affecting their growth and development.
"The cost of my drugs runs into several thousands that I am in a constant struggle to gather. I often miss doctors' appointments due to high transportation costs.
"I need over N1,000 to board 'keke' to the General Hospital and back, I cannot afford that, and I cannot trek."
After Mustapha was diagnosed with kidney disease in 2023, he was forced to stop work as a subsistence farmer. The 55-year-old man in a rural setting in Lagos State developed the disease due to dehydration from working long hours in the sun.
"I have a wife and six children. Since I stopped farming due to this illness, my income has drastically reduced and is inconsistent, as a result of which my family's financial situation has worsened.
"The nearest hospital is far away, and the cost of my medication is a challenge, so traditional medicine has been my primary source of treatment. But it's ineffective, I'm not getting better, but I cannot afford the the hospital treatment," he lamented.
Forty-year-old Beatrice is an ulcer patient. As the breadwinner for her family of five, she takes on multiple jobs to make ends meet, but this has led to increased stress and irregular eating habits.
"I developed duodenal ulcers and I am struggling to balance work and treatment, but the rising cost of living in the country, and here in Lagos in particular, has made it difficult to afford healthy food and medication. I'm just taking my chances," Beatrice said.
Those who are impoverished frequently lack access to quality medical care, adequate nutrition, good social security and other basic health amenities.
The diverse ways economic hardship is fueling chronic illnesses in the country highlight the urgent need for interventions to address this growing crisis.
Multidimensional poverty
From the World Bank's 2023 estimates, Nigeria was the second-poorest country in the world after India, with an anticipated 87 million people, or 38.9 per cent of the population living below the poverty line.
Nigeria also ranked 75th out of 103 developing countries with a 38.8 per cent rate, and by the end of 2024, the country's poverty rate is expected to rise even more.
Malnutrition increases due to inflation in Nigeria and poses a serious threat to public health with children and pregnant women most affected.
According to UNICEF, the country loses 15 per cent of its Gross Domestic Product, GDP, annually to malnutrition.
In 2023, 29 per cent of children under the age of five in the country were underweight; 6.5 per cent wasted, and 31.5 per cent stunted.
Worse still, 45 per cent of all child fatalities under the age of five were directly or indirectly caused by malnutrition.
In 2022-2023, UNICEF anticipated that 511,890 pregnant and nursing women in Northwest and Northeast Nigeria would require nutrition interventions.
From the 2022 National Multidimensional Poverty Index, MPI, survey, 133 million Nigerians, or 63 per cent of the country's population, live in multidimensional poverty, which is defined as having more than 25 per cent of all potential deprivations.
Worse still, from the 2020 Human Poverty Index, HPI, less than 10 per cent of Nigerians have health insurance, thus the exorbitant cost of healthcare out-of-pocket is forcing many people into poverty and deeper hardship.
Significant part of the 63 per cent of the multi-dimensionally poor in the country, experience major impediments to getting vital healthcare, underscoring the holistic nature of this relationship.
Brain drain worsening situation
Experts are worried that Nigeria's healthcare system is on the brink due to the economic downturn.
Concurrently, the persistent exodus of healthcare professionals, aka "Japa" syndrome, has exacerbated the crisis, leaving hospitals understaffed and struggling to deliver quality care.
They warned of dire consequences as a result of the critical shortages in essential medical supplies and equipment across healthcare facilities, even as the resulting financial stress and uncertainty actively contribute to anxiety and depression, often leading to unhealthy coping mechanisms.
Public health experts say economic hardship is manifesting in various ways, including increased anxiety, depression, and feelings of despair.
They emphasised the need for increased awareness and government support to address these challenges, arguing that the affordability of medications remained critical to prevent loss of life and improve overall health outcomes.
Strained family relationships, household conflicts
A Clinical Psychologist and Medical Social Worker at the Lagos University Teaching Hospital, LUTH, Ms Titi Tade, cautioned that the economic pressure was straining family relationships, leading to domestic violence, increased tension and conflict within households.
She cautioned that individuals might become withdrawn or irritable as they grapple with the emotional and financial burden of their situation.
Tade, who is Training Director of the Suicide Research and Prevention Initiative of Nigeria, SURPIN, Nigeria's leading suicide prevention organisation, also observed a concerning rise in suicide attempts linked to the current economic situation, even as she emphasised the need for increased awareness and government support to address the emerging challenges.
"When individuals feel trapped in a cycle of financial struggle, it can lead to hopelessness and a sense of despair.
"Some individuals may turn to unhealthy coping mechanisms, such as excessive alcohol or drug use, to escape the emotional pain associated with economic hardship," she told Vanguard.
Furthermore, the expert described the spate of fatal stampedes that occurred in some parts of the country as a reflection of the situation in the country.
She added: "Inflation is increasing, unemployment is rising, people are doing businesses that are not able to thrive because the prices of everything have skyrocketed, and even those who want the products cannot afford to buy them.
"So, all of these just create a sense of hopelessness, and once you have a sense of hopelessness, then depression starts to hit you. It's going to affect your mood, and the way that you interact with people.
"So, I'm not comfortable with the fact that as a country, mental health is something that we shy away from. People don't want to talk about it. So, if somebody is struggling it would show.
"In fact, this whole period is enough to trigger somebody who has a predisposition to develop mental illness to manifest the illness. The people who are more likely to be depressed will definitely be pushed into depression.
"There's nobody to talk to, even the people you talk to normally, they themselves are struggling; anxiety, depression and substance abuse are the most serious things.
"You find out that a lot of people start using substances to cope - alcohol, marijuana, whatever - they start using it to cope, and when somebody's on a substance, there's a tendency to indulge, so there's bound to be an increase in drug usage across the country.
"What I'm saying is that this is something that may not come out of classic signs of depression, but they will definitely have periods of unhappiness, and helplessness.
Increased cases of depression, anxiety & substance abuse
Warning that there was bound to be an increase in depression, anxiety, and substance abuse, Tade also foresaw a link between the economic situation with domestic violence and family conflict.
"I talked about how for people who struggle to cope, there will be feelings of helplessness, feelings of hopelessness, and they lash out. There's definitely that irritability that will make them angry because they're not able to provide. They're not able to do things they want to do.
"Most likely, people on medication will abandon it if they have to choose between treatment and food. And so, some people that even come into the hospital may stop coming to the hospital and this will cause them to fall ill again because they can't afford their medication.
"That's one. Two, for people who may want to seek help or have financial struggles, there's no question about it, they will not seek help. But then, when you now have a situation where there is stigma around mental illness, it makes it a double-edged sword.
"One, money is preventing you from seeking help, and two, the stigma around the illness itself will not even allow you to ask for financial help.
Tade highlighted the financial strain on Nigerians by the rising cost of healthcare, leading to increased medication costs, coupled with transportation expenses, saying it was making it challenging for many to access and afford the care they need.
"If you have hypertension, if you have diabetes, you will ask for help. But if you have somebody with a mental illness, and if the illness has started, they might not even be in a position to ask for help because once the illness commences, they are definitely not going to be aware that they're ill."
Nigerians in for the long haul
On a way out of the quagmire, Tade stressed the need to move beyond individual solutions and focus on establishing family healthcare centres.
Recognizing the vulnerability of many Nigerians, she emphasised the importance of developing comprehensive social welfare programmes to provide support to those in need, and also critical need for enhanced mental health education to raise awareness and improve understanding of mental health conditions within the population.
"The reality is that we are in for the long haul. It's going to be a long-term thing. It may not be easy for all of us to be able to see the light at the end of the tunnel, but even though we can't see it, we need to be working on our goals. I think we need to do a lot more education within the community.
"We're a resilient country, we're resilient people, Nigerians generally are resilient, but we don't want to push that resilience to the end. We need to develop better coping skills and try to be resilient. People need to be intentional now about relaxing and about trying to focus on themselves.'
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Protect social bonds
"We actually need ways of coping, through resilience and peace. However, the current situation can break the social bond of any community and we can't afford that because those social bonds are some of the things that make us resilient, that give us the ability to cope.
"If you don't have your community to look up to, if you don't have anybody to look up to around you as a human being, how do you exist? So, it's very important that we don't allow the social bonds to be broken."
Poverty, Ill-health restricting health access
A health critic, Dele Ogunlade, noted that poverty and ill-health were closely related in Nigeria, saying "poverty harms people's health by restricting their access to the basic essentials of life.
With the World Health Organization's 1948 definition of health as a condition of whole physical, mental, and social well-being, the relationship between poverty and health is well-established.
"What I am saying in essence is that poor health is a cause of poverty as well as a result of it; poor health further imprisons populations in poverty.
"Millions of the world's poorest and most vulnerable individuals die and get weaker every year from preventable and often treatable diseases. To address poverty and bad health, the political and economic systems that uphold discrimination and poverty must be changed," Ogunlade remarked.
A Professor of Medicine at the College of Medicine University of Lagos, CMUL, and a Consultant Cardiologist to the Lagos University Teaching Hospital, LUTH, Prof Amam Mbakwem, said hypertension was a significant issue in Nigeria.
Decrying out-of-pocket payments, even as she called for the total execution of the Universal Health Coverage programme, Mbakwem stated that hospitalization for cardiac problems such as heart failure in Nigeria, carried a heavy financial cost, with up to 60 per cent of uninsured patients facing destitution due to catastrophic medical expenses.
"In our setting, high blood pressure continues to be the most frequent risk factor for heart failure. About 19 per cent of deaths occur in the first year and are on the rise; the majority of deaths happen within three months after admission.
"Approximately 50 per cent of our heart failure patients experience psychological anguish, 28 per cent have low self-esteem, 25 per cent have poor quality of life, and roughly two thirds are sad.
"The World Health Organisation, WHO, states that the out-of-pocket cost of healthcare, particularly for cardiovascular illness, has reached catastrophic proportions. As a result, some families have become poor while trying to pay for cardiovascular care.
"A policy to lower the cost of drugs to manage the main risk factors, such as diabetes and hypertension, ought to exist," she noted.
On his part, a Consultant nephrologist, Dr Akinsiku Oladipupo, decried the growing incidence of kidney diseases in the community, calling for proper management of diabetes and high blood pressure cases.
Oladipupo, who is the Medical Director at Doren Specialist Hospital, said globally, diabetes, accounts for about 40 per cent of kidney disease cases, while hypertension accounts for about 33 per cent.
"Kidney disease is a silent killer, but most patients do not have direct manifestation or any directly significant or specific symptom initially. But what happens over time is that they have non-specific symptoms.
"When you see individuals always going to the hospital, and are always complaining of feeling unwell, feeling tired, having malaise, getting tired easily, such individuals might be suffering from kidney disease and we just need to check."
