Diabetes is a chronic disease where the body finds it difficult to control or regulate the amount of sugar in the blood (Scheffler 34). It has been cited as the most challenging modern health problem encountered. According to the 2016 statistics, the total world population with diabetes is estimated at 415 million, with 46% being undiagnosed (World Health Organization 27). There are more than 1.6 million people in Nigeria suffering from the condition. The management of diabetes Mellitus has always been a challenge to developing countries due to inadequate care providers. Diabetes-related morbidity continues to rise due to increase in population, migration, and decline in exercising and diet. For that reason, life expectancy in the region is averaged at 50 years (Scheffler 37). Before highlighting the ways to combat diabetes in Nigeria, the paper discusses the nature of Nigeria’s healthcare system and its response to diabetes. After that, the analysis employs the use of primary and secondary prevention methods. Lastly, the paper outlines independent recommendations on combatting diabetes in Nigeria.
Current Health System in Nigeria
The current economic recession in Nigeria has made it a massive challenge in the self-management of diabetes to the typical individual. The prices of diabetes supplies have skyrocketed by a whopping 150 % in the last eight months of 2016. There are the monthly costs of supplies:
- Insulin (Mixtard of 100 IU) $ 12 per vial
- Glucometer (Accu-chek) $ 19 per meter
- Syringes $ 6 per pack of 100 units
- Test strips $ 11 per pack
Meanwhile, the monthly income is averaged at $100 per month. There is a need for an increase in political obligations, crucial for tackling the growth of diabetes in Nigeria. More so, the development of national policy is essential for combating diabetes. This review provides a framework for integrating the care for diabetes into the primary healthcare system in Nigeria.
Leadership and Governance
Under President Muhammadu Buhari, the healthcare system does not perform optimally due to the below-par leadership and governance in the healthcare industry. The system is fragmented with poor management at the primary healthcare level. It is also characterized by weak coordination between departments. More so, politicians have failed to identify with non-communicable diseases. There is no specific legislation/advocacy to support ordinary people. Therefore, for proper management of non-communicable diseases, the Nigerian government needs to revamp the health sector by creating an efficient and functional governance system to bolster the service delivery quality. Coordination between the health ministry and hospitals within the 36 states will improve the provision of diabetes services. Lastly, a collaboration between the health ministry and finance, education, and information sectors is essential in combating healthcare.
Information Surveillance & Research
Currently, the Nigerian healthcare system is poorly developed, especially in the field of gathering intelligence. There is no adequate surveillance system. Medical intelligence and surveillance are essential in controlling and intervention of diabetes in the country (Scheffler 34). There is a need for adopting automated-based medical surveillance systems complementing the traditional manual pattern of documentation and retrieval. To achieve success in the modern era, a well-grounded routine structure should be put in place, and proper management of the systems should be established.
The migration of healthcare workers to other countries is the biggest challenge in NDC prevention and control. Unbearable work conditions and underpayment present enough reasons for workers to emigrate to Europe and North America. The physical shortage of practitioners worsens healthcare conditions due to brain drain and discouragement of aspiring health workers (World Health Organization 33). One factor that may enhance human resource facilitation is decentralizing health service into federal and state ward levels. Therefore, nurses, doctors, and other health officials should be assured of comfortable working conditions and improved payments.
Infrastructure, Medicines, and Technologies
The federal government is mostly charged with coordinating affairs in university hospitals and federal health centers. The state controls general hospitals, and the local government manages dispensaries. The three-tier government allocated 4.6 % of the GDP to healthcare (World Health Organization 34). When divided between three levels of governments, the federal government gets 1.5% of this amount. Despite this effort, there is substantial geographical inequality in terms of accessibility and quality of facilities, relative to demand. There is an insignificant venture in technology, healthcare plans, and education. The government spends over 70% of its budget in urban centers, where approximately 50% of the populace resides. It means that the remaining 50% fight for limited resources. Drug quality is controlled by NAFDAC (National Agency for Drug Administration and Control). Despite the bid to provide medicine, the methods for distribution and quality of drugs have been sub-standard due to the commercialization of drug manufacture and delivery (Chinenye et al., “Diabetes and Related Diseases” 96).
Financing and Service Delivery
Empirical evidence reveals the negative impact of commercialization in public health delivery. Insurance is only available in several instances. Therefore, it presents the ordinary person with a minimal chance of accessing insurance services. However, the government covers all expenses (including NDC) for children under five, disabled persons, and prison inmates.
Nigeria, being a donor-dependent country, makes its public health interventions challenging to implement. Funding is a paramount factor in providing critical public health services, with non-communicable diseases being at the forefront. Therefore, the government needs to come up with creative ways to provide funding (Scheffler 45). The federal and state governments should take responsibility for funding NDC programs.
Forms of Prevention
With over 1.6 Million people suffering from diabetes, a combination of primary and secondary prevention approaches should be employed (World Health Organization 45).
The most efficient way of combating diabetes is through primary interventions. These aim at preventing the disease before it occurs. The government implements it in a bid to improve healthcare at the grassroots. The basic principles supporting primary prevention at the macro-level include community involvement, intersectional alliance, a collaboration of healthcare programs, equity, and self-sufficiency. In comparison, secondary and tertiary healthcare systems are meant to complement the services rendered at the primary level (Chinenye et al., “Diabetes and Related Diseases” 96).
The main eligibility criteria for primary prevention are checking body mass index (not more than 24 kg/m2), age (25 years and older), and impaired glucose tolerance. It is unclear how to identify people at risk for diabetes; some of the most reliable methods include oral glucose tolerance tests, regular or opportunistic screening (World Health Organization 45). In Nigeria, a large percentage of the population rarely goes for regular checkups due to insurance unavailability. The way forward could be the improvement of maternal care. Continued screening of diabetes-prone populations and developing policies for early intervention to optimize glycemic control should also occur.
Other ways of primary prevention are lifestyle interventions. Over 60% of the population visiting practitioners result in written prescriptions. These include drug therapy and pharmaceutical interventions. Integration of lifestyle prevention into existing healthcare systems and diabetes programs play a huge role in detecting and preventing increased morbidity rates (Chinenye et al., “Diabetes Advocacy and Care” 145). Prevention may also include counseling, exercise, diabetes education, nutrition, and behavior modification. The aims of dietary treatment are:
- Attain optimum glucose concentrations;
- Attain optimum lipid concentrations;
- Ensure suitable energy and a reasonable weight is maintained;
- Improve health through balanced nutrition.
More so, government and non-governmental institutions should put more effort into creating awareness and facilitation of enhancements in disease inhibition and glycemic control in already affected areas.
Secondary prevention is the systematic detection of diabetes at its early stages and intervening before the full symptoms occur. Bringing diabetes care close to where people live will substantially reduce the disease burden on the general populace. Some of the essential interventions are classified depending on the category of evidence and type of diabetes:
- Type 1 diabetes (regular insulin injections);
- Type 2 diabetes (an oral blend of hypoglycemic agents and diet variation);
- Maintenance of healthy body and physical activity (Metformin (level 1 and level 3) is a drug that can be used by both overweight and non-overweight patients respectively (Chinenye et al., “Diabetes Advocacy and Care” 149));
- Prevention of chronic kidney disease (optimal glycemic control, especially for people with type 1 and type 2 diabetes).
Some of the ways that can be used by Nigerian healthcare professionals include:
- Appropriate research and exposure of secondary interventions, including managing disease registers by systematically modeling expected versus actual prevalence (Chinenye et al., “Diabetes and Related Diseases” 98). This ensures the identification of improvement.
- Secondly, systematic screening and control should be conducted among clinical commissioning groups’ populations (Chinenye et al., “Diabetes Advocacy and Care” 147).
- Systematic collaboration between local authorities and relevant partners will ensure secondary preventions form a large part of the public health broad strategy.
- Voluntary sector groups should be used to develop a joint strategic need assessment and wellbeing strategy. This method engages patients that may not be reached by mainstream health services.
Burdens of diabetes fall on local communities at the primary phase. Therefore, suitable programs should be set up in those instances (Chinenye et al., “Diabetes and Related Diseases”99). The following principles and recommendation should be put in place:
- Proper decentralization of physical and human resources to ultimately improve access to healthcare as well as endure the uptake of long-term treatments;
- Appropriateness of the model applied to serve the local situation and resources;
- Continuous diagnosis and education to be continuously conducted to root out the first phases of diabetes;
- Proper management and assessment of complications requiring a clearly defined protocol for diagnosis, evaluation, and treatment;
- Proper clinic records for all patients to be maintained. In fact, an automated system would be more reliable and efficient, especially in conducting the clinical review. (Chinenye et al., “Diabetes Advocacy and Care,” 148).
Another way of combating diabetes is through health advocacy. This approach involves a mix of individual and social activities intended to achieve political and health sustenance for diabetes (Chinenye et al., “Diabetes Advocacy and Care” 148). It produces tangible results because it targets decision-makers and influencers in the health ministry. Consequently, the key factor in advocacy in Nigeria includes the facilitation of diabetes care at both primary and secondary levels and mobilization of political will to increase funding on research and treatment of diabetes.
The paper highlights some of the problems and risk factors associated with diabetes in Nigeria. The critical part entails the recommendations on how the health system can control the spread of diabetes and ultimately improve the economy’s general health status. Strong political leadership is highlighted as the key to sustaining the welfare of the healthcare industry in Nigeria.
Chinenye, Sunday, Rosemary Ogu, and Ibitrokoemi Korubo. “Diabetes Advocacy and Care in Nigeria: A Review.” The Nigerian Health Journal, vol. 15, vol. 4, 2015, pp. 145-150.
Chinenye, Sunday, Reginald N. Oputa, and Richard I. Oko-Jaja. “Diabetes and Related Diseases in Nigeria: Need for Improved Primary Care in Rural Communities.” Res J. of Health Sci., vol. 2, no. 2, 2014, pp. 99-107.
Scheffler, Richard M. World Scientific Handbook of Global Health Economics and Public Policy: (A 3-Volume Set) (World Scientific Series in Global Health Economics and Public Policy). World Scientific Publishing Company, 2016.
World Health Organization. “Package of Essential Non-communicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings.” 2010, http://www.who.int/nmh/publications/essential_ncd_interventions_lr_settings.pdf. Accessed 7 April 2017.