By Peter Samuel
Professor Henry C. Uro-Chukwu is a physician, medical biochemist, food scientist and clinical nutritionist. He was trained in Nigeria, the United Kingdom and the United States of America.
He also invented a clinic called Nutri-Med Online Clinic to advance the place of nutrition in medicare across the world.
In this interview with Health and Science Africa (HSA), Prof. Uro-Chukwu, identified key challenges bedivilling Nigeria’s health sector, the top causes of deaths and ways to address them among others.
As a medical expert in community medicine and public health, what is your assessment of healthcare to people at the grassroots in Nigeria ?
I will like to answer this question by looking at the available indices from the public health and community medicine points of view.
The maternal mortality ratio in Nigeria in 2025 is 1, 047 per 100,000 live births, and this constitutes 28.3 percent of all estimated global maternal deaths, making Nigeria the worst country for a woman to give birth in the world.
The causes of these deaths are issues that can easily be taken care of if the healthcare systems are optimal and there are less deaths from obstetric bleeding, eclampsia, sepsis, obstructed labour and complications of abortion. The second index is to look at the rate children under five years die.
This again shows that one out of every eight children born in Nigeria die, while the infant mortality rate is 52.61, an insignificant less than 2 per cent reduction from the 2024 data.
The life expectancy in Nigeria in 2025 is 54.5 for males and 55.1 for females, and these figures are lower than countries in extreme poverty or war zones such as Chad, South Sudan and Central African Republic. In a country that is the sixth most populous in the world, this is not a good result.
The top 10 causes of death in Nigeria are things that can easily be addressed in a functional health system, and these are infectious diseases like HIV/ AIDS, diarrhoea and lower respiratory tract infections. Other major causes of death are neonatal disorders, cancers, diabetes mellitus and cardiovascular diseases.
Anaemia affects 71 per cent of children under five years, while 32 per cent of children 5 to 12 years are equally anaemic. If one adds this to the fact that only 39 percent of children 12 to 23 months are fully vaccinated, with the total number of children with malnutrition in Nigeria put at 5.4 million, out of which 1.8 million have severe acute malnutrition.
The percentage of the population using out of pocket expenditure to access healthcare services in Nigeria is 75 per cent, implying that health access is poor. With the ratio of doctor to population being 3.9 doctors to 10,000 people.
This is a far cry from the recommendation of the World Health Organization (WHO) of one doctor to 600 people. There is also insufficient number of hospitals as the current 17 healthcare facilities per 100,000 people falls grossly short of the WHO standard. Again, access to essential drugs is very far from the 80 per cent mark set by WHO.
So, a look at all the indices of sound health systems does not show that the health sector in Nigeria is optimal. The six pillars of health systems: human workforce, essential products, funding, infrastructure, service delivery and leadership/governance, need to be optimized for the desired results to be gotten.
What are the challenges being faced by medical experts in community medicine?
The challenges are not isolated, as same challenges affecting other specialities of medicine are all there too.
Remuneration and other welfare packages are very poor, healthcare facilities are not optimal, data generation and management, with which healthcare planning is based on, are most times spurious.
The skilled health workers that need to support the community physicians are not available. The primary healthcare system that should be the primary basis for community physicians has collapsed, hence all the six pillars of health systems are very weak.
There is also the issue of quackery and misinformation that is compounding the efforts of community physicians in lifestyle modifications and advocacy; and adulteration of consumables. There are also quite a number of others.
Can you give us the rate of unreached communities within Ebonyi State and the rest of South Eastern Nigeria vis-a-vis community medicine?
Unless a good survey is conducted, it is difficult to comment on this, but frankly, the health profile of Nigeria certainly has regional variations, with the states of Borno, Adamawa and Yobe worst hit.
For the South East, it has peculiar problems of highly adulterated foods and medications, coupled with lifestyles that seem to reinforce non-communicable diseases such as hypertension, diabetes mellitus and cancers. HIV/AIDs and other infections are equally high, with Imo, Enugu and Anambra having higher figures than Ebonyi.
The primary healthcare systems in the South Eastern states are suboptimal, and out-of-pocket expenditure that limits access and affordability to orthodox healthcare services is an issue of concern.
Again, their skilled health workforce is low, and with the level of poverty, severe acute malnutrition, infections and obstetric-related maternal deaths are of concern. So, the South Eastern states may have slightly better health indices, but certainly are within the negative range.
What strategies can be deployed to boost the activities and relevance of community medicine in South East Nigeria?
The best advocacy is for the South Eastern states to partner with the community gatekeepers to build strong primary health systems and lay less emphasis on teaching hospitals.
That way, strong primary and secondary healthcare systems that imbibe the six health system building blocks will catapult the positive health outcomes.
What are the commonest illnesses in the rural areas and how can they be tackled?
The topmost causes of death in Nigeria which are infectious diseases, include diarrhoea and lower respiratory tract infections. Others are obstetric bleeding, obstructed labour and complications of abortion. Children’s malnutrition, especially severe acute malnutrition, is also assuming a high proportion.
To take care of these diseases, we must ensure that communities key into the health insurance policy that addresses and captures the informal sector, and I have a blue print for this.
Secondly, doctors and other healthcare providers should be given mouth-watering remuneration and other welfare packages that will encourage them to render services in the rural communities, while essential medicines management needs to be reviewed comprehensively.
How can shortage of drugs be addressed in rural areas?
The simplest approach will be a private sector-driven supply chain system that is transparent, ensures availability and affordability through a closely monitored community health insurance policy.
What is your assessment of the attention given to general hospitals in the South East?
I think evidences emerging from Ebonyi and Abia states are very encouraging, where general hospital infrastructure are being prioritised while the remuneration and other welfare packages of the health workers have improved significantly.
Strong monitoring is needed and the implementation of community health insurance policy should be reinforced for these two states.
There should also be a conscious need to improve household income of the typical rural residents. The issues of fake drugs and adulteration of foods need to be addressed comprehensively and urgently. Other South Eastern and Nigerian States should adopt this.
What do you think is impeding the activities of health-related NGOs?
Most of the NGOs are waiting for external funding, because this has been the tradition, but with the recent Western policies, communities and the government at all levels should begin to support community-based NGOs to deliver on several aspects of the health system.
What should be done to boost public health in Ebonyi and the South East as a whole?
There should be community ownership, community legislations and community participatory approaches in all health issues and ensuring health-in-all programmes.
In other words, just like we have Environmental Impact Assessment in all programmes, all activities, whether religious, cultural, infrastructural, political meetings/activities, agricultural programmes, educational projects, and of course industrial/environmental programmes, must inculcate health impact. This is what Finland that has one of the best health systems is doing.
Why are Nigerians still dying of curable diseases despite the investments, previous and present administrations have put into the health sector?
Every investment should have monitoring and evaluation components right from the point of policy formulation to project implementations.
There should also be feedback from these stages to determine the continuation of such investment or its termination. This is a problem in Nigeria.
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