Economic Burden of Diseases in Nigeria: Focus on Sickle Cell Disease

In 2015, United Nations member states unveiled 17 Sustainable Development Goals (SDGs) to be achieved in 2030. At the heart of these goals lies Universal Health Coverage (UHC). Achieving the goal of good health and well-being is cardinal to the success of many other SDGs. It was estimated that the global average expenditure required for sustainable health growth is $271 per capita (nearly N205,000 per capita). This figure is surely not within the reach of many Africans. According to the National Bureau of Statistics, as of November 2022, over 133 million Nigerians are multidimensionally poor.

In recognition of the importance of health in driving the growth of Nigeria, the total budgetary allocation to health has increased by about 339% since 2015. Yet, per capita expenditure for health is less than N6,000 as contained in Nigeria’s 2023 budget. This figure is grossly inadequate and does not reflect the economic realities of the health challenges facing the country. Poor public funding of health has consistently enhanced out-of-pocket health spending in the country. This poses a serious threat to our development. Out-of-pocket health expenditure promotes poverty, especially for low-income and middle-income families. To successfully negate out-of-pocket health expenditures, Nigeria’s health budget will have to be placed above the recommended 15% benchmark. It is pertinent to understand that revamping our healthcare delivery system through tolerable levels of out-of-pocket health expenditure is critical to better health coverage and poverty reduction.

A study conducted at the University of Nigeria Teaching Hospital Enugu, reported the average monthly cost of managing sickle cell disease as N76,711 per person. In Nigeria, there are over 150,000 sickle cell patients in the country. It is estimated that nearly N140 billion is spent annually on the management of sickle cell in Nigeria, most of which are out-of-pocket expenses. Hospital admissions, blood transfusion, drugs, and laboratory assessments account for most of the costs.

There is no universal cure for sickle cell disease yet. The use of stem cell therapy is mostly practised in developed Nations. Apart from the resource limitations surrounding the application of the therapy in developing nations like Nigeria, the high cost and challenges of getting matched donor further stalls the commonality of stem cell therapy in the country. Treatments are normally directed toward limiting the frequency of sickle cell disease Crisis, preventing infection, halting organ damage, and minimizing pain. If not properly controlled, regular sickle cell Crisis exerts unimaginable emotional and economic constraints on families. It is important to recall that about 70% of Nigerians were reported to live below $1 a day. Furthermore, low-income earners spend about 50% of their income on food. Thus, most low-income families cannot afford to save for out-of-pocket health spending. To further aggravate the situation, over 95% of Nigerians have no health insurance.

Nigeria’s minimum wage remains at N30,000. It is nearly impossible for a minimum wage family for cater to their child who suffers from sickle cell disease. Despite these challenges, some state governments, a significant number of medium and small-scale businesses are yet to adhere to the recommended meager minimum wage of N30,000. The catastrophic economic burden of managing sickle cell anemia affects families of all socio-economic strata. However, over 90% of the lowest socioeconomic quartile cannot endure the cost of managing this devastating health condition. People living with sickle cell disease need financial protection, especially the poorest. They buy medications from the same market and incur the same costs as the rich. We cannot continue to wait for government to do the needful in the area of healthcare.

 Special recognition and appreciation goes out to numerous NGOs rendering support to people living with Sickle Cell disease in Nigeria. Many of these NGOs are the hope of many families. However, we can’t leave it to them alone, we all need to reach out to that family member, friend, neighbor, colleague, or random patient that is suffering the pain in silence. Your simplistic generosity could save a life, improve the quality of life, and lessen economic & emotional strangulations experienced by the patients and their families. Here I need to mention one of such NGOs that is relentless in providing and supporting people living with Sickle cell disease in Nigeria.

Apart from regular awareness creation, distribution of drugs, and intermittent provision of health aids to numerous sickle cell patients and clinics, the Valuechain Sickle Cell Foundation helps low-income sickle cell patients and their families offset hospital bills.

One of such interventions was the one benefited by 28 year Miss Fatima Zubairu, a resident of Zaria, Kaduna State. She is a Sickle cell patient that was diagnosed with waist bone infection condition that requires hip replacement surgery at Ahmadu Bello University Teaching Hospital, Shika. The cost of the procedure was N2.5 million, out of which the family of Fatima was able to mobilise N1.5 million through public donation that lasted months before it caught the attention of the Foundation. The attention of Valuechain Sickle Cell Foundation was drawn by the devastation of the family for being unable to raise the remaining N1million. The Foundation, through one of its active Trustees, requested the Teaching Hospital to consider writing-off N500,000 for the patient, while the Foundation completes the remaining N500,000. This was how Fatima was able to get her hip replaced. The current National public health funding policy offers nearly nothing for sickle cell disease patients, especially the low-income group. It is imperative for us to support the activities of communities, societies, and foundations such as the Valuechain Sickle Cell Foundation to improve patients’ accessibility to healthcare irrespective of their socioeconomic status. Providing support to those in need of assistance has been shown to benefit both the helper and the recipient of the help.

Ibrahim Suleiman Ph.D is a lecturer
at the Faculty of Medical Sciences,
University of West Indies, Barbados
ibrahim.sulaiman@cavehill.uwi.edu