Intensive care is a specialized medical care for people who have life-threatening illnesses. This care usually occurs in a specialized location in a hospital called the Intensive Care Unit (ICU).
Examples of cases that require ICU include patients with serious infections affecting a single or several organ systems of the body, people who find it difficult to breathe and require mechanical ventilation, people who are involved in accidents with serious injuries, and hypertensive emergencies.
Professionals critical to the ICU’s functioning include physicians known as
Intensivists, critical care nurses, respiratory therapists, and speech-language therapists. Nigeria currently has over 30 ICUs, most located in teaching hospitals. Although South-Western Nigeria, particularly Lagos, has made giant strides in improving ICU care, there remains a significant imbalance between the available workforce, the number of ICU beds per 100,000 residents, equipment and facilities, and funding. The mortality rates from ICU admissions are remarkably high. In a retrospective research study in 2022 by Eya et al. on Admission and Mortality Patterns in Intensive Care Delivery at the Enugu State University Teaching Hospital, the mortality rate during the study period was 34.1 percent. Similarly, in a 5-year retrospective research study at the Lagos University Teaching Hospital by Poluyi et al. in 2016, the mortality rate was 61.4 percent.
These figures highlight Nigeria’s urgent need for improved ICU facilities and healthcare policies.
A recent research study of ICUs in Sub-Saharan Africa by Osinaike et al. showed that there was a total of 385 ICU beds in Nigeria as of 2019, roughly translating to a ratio of about 0.19 beds per 100,000 population. Meanwhile, Ghana has about 0.5 ICU beds per 100,000 people. Ethiopia has about 0.3 per 100,000 population. South Africa has 8.9 beds per 100,000 population and appears to lead the pack in Africa. On the other hand, according to statista.com, the United States of America (USA) has 34.7 ICU beds per 100,000 population, while Germany, in Europe, has 29.2 beds per 100,000 population. This demonstrates the need for Nigeria, a country with a population of over 200 million people, to deploy funding and resources for emergency preparedness, e.g., the COVID-19 pandemic, and reduce mortality from life-threatening illnesses at the ICU.
It is a pressing reality that Nigeria is grappling with a severe shortage of trained ICU physicians.
The few that are available are predominantly concentrated in urban centers. This is due primarily to the brain drain of medical professionals to Western countries, where they are better appreciated and rewarded. It is high time a state of emergency was declared in the health sector and policies were swiftly implemented to ensure that more physicians are trained and retained in the country.
The exodus of physicians can be significantly reduced if they are adequately remunerated relative to their colleagues in other parts of the world. According to the Nigerian Association of Resident Doctors, 6 out of 10 physicians in Nigeria plan to emigrate to a foreign country.
Moreover, between 2016 and 2018, 9000 physicians emigrated to the UK, Canada, and the United States. The Minister of Health and Social Welfare, Muhammad Ali Pate, disclosed that about 16,000 doctors left the country in the last five years. Nigeria has about 55,000 licensed doctors left to serve a population of over 200 million. How can we improve ICU care if most doctors are fleeing the country? Urgent intervention is not just a necessity but a moral imperative. The COVID-19 pandemic has starkly underscored the need for pandemic preparedness to manage life-threatening presentations.
The ICU requires both basic and advanced hemodynamic monitoring equipment. During the recent COVID-19 pandemic, there was a paucity of mechanical ventilators worldwide, and many patients died even in developed countries because their resources were overwhelmed by the relatively high morbidity of respiratory illnesses. It was indeed a miracle that the COVID-19 pandemic largely evaded Africa. It is best left to our imagination the level of widespread panic and perhaps ‘dead bodies on the street’ of Nigeria, as warned by Melinda Gates. In addition, Thisday newspaper recently reported that Nigeria spends between 1.5 billion and 2 million annually on medical tourism. Again, it is pertinent to suggest here that patriotic government officials should instead find ways of building world-class facilities in Nigeria, including ICUs, and importing foreign physicians to work in these facilities along with Nigerian physicians so that in the long run, there will be a geometric improvement in the standard of healthcare offered to the average Nigerian resident.
In April 2001, the African Union resolved to dedicate at least 15 percent of its annual budget to the healthcare sector. While Nigeria is still at well less than 10 percent, South Africa has already met its agreed proportion of the budget allocated to health. The new National Health Insurance Act (NHIA) was signed into law in 2022. It replaced the failed National Health Insurance Scheme (NHIS) of 1999. One can only hope that the government would ensure adequate funding for NHIA so that the average citizen can access health services.
The potential of improved ICU care is not just about increasing the life expectancy of Nigerians from 52.68 years (2021) to at least greater than 70 years. It holds the promise of economic growth and a boost in national productivity. With improved healthcare, people will no longer have to die needlessly, and they will be alive to contribute their own quota to the economy. This is a vision of a healthier, more prosperous Nigeria that is within our reach, and it’s a vision that can inspire us all to work towards a better future.
I firmly believe that Nigeria has the potential to compete favorably with the rest of the world, particularly South Africa, Europe, and North America, in terms of healthcare. However, this can only be realized if the Nigerian government steps up, demonstrates patriotism and dedication, and action are crucial in this journey towards a healthier Nigeria, and it’s a responsibility that we all share.
Dr. Charles Oluwarotimi Poluyi (MD, MPH) is a resident physician (internal medicine) in the United States of America, a public health professional, and a physician-researcher in medicine and public health sciences.
cpoluyi@bhmcny.org
Dr. Oluwasegun Matthew Akinti Brookdale University Hospital, Brooklyn NY drsegunakinti@gmail.com
