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Hospital in a rural community in Niger State, Nigeria (c) Isaac Anyaogu

With broken healthcare, Nigeria joins 49 others in pledging to end health system emissions  

One month after resident doctors in public hospitals across Nigeria called off a nine-week strike over poor pay, Nigeria has joined 49 others at the ongoing COP 26 Climate summit in the UK in pledging to cut greenhouse-gas emissions across its health systems, a move that sounds hollow in a country doctors still conduct surgeries using candlelight.

Experts say the healthcare industry contributes about 4-5 percent of greenhouse gas emissions globally. These countries have committed to lowering their emissions of carbon dioxide, the main greenhouse gas that is warming the world, across their health systems. 14 countries have pledged to reach net-zero carbon dioxide emissions before 2030. This appears like a strange company for a country whose president goes for medical checkups abroad.

“Resilience of health systems is incredibly important. It is also true that as part of a green recovery from COVID-19, we need to recognize the role of health systems as emitters accounting for 4-5 percent of global emissions,” said Dr. Rachel Levine, US assistant secretary for health.

According to Dr. Levine, as part of COP 26 health programs, countries were asked to commit to publishing a plan sending out how they would develop their health systems, to minimize carbon emissions and air pollution, based on a baseline assessment of the health systems greenhouse gas emissions.

In a country where public hospitals lack stable electricity and doctors’ strike are just suspended until the next one, where drugs are available based on the goodwill of donors, and where salaries of lawmakers are prioritized over funding primary healthcare centers, it is uncertain how the country can mobilize the financing required to upgrade its creaking healthcare.

Nigeria’s President  Muhammadu Buhari has visited hospitals in the United Kingdom seven times since he was sworn into office on May 29, 2015, and has spent over 200 days in London hospitals for medical treatment.

It took a pandemic for the Secretary to the Nigerian government Boss Mustapha to notice the pitiful state of Nigeria’s public hospitals. Appointed to head the government’s COVID-19 task force, Mr. Mustapha was forced to confront the reality of hospitals without power to store vaccines or paracetamol to administer to patients reacting to the AstraZeneca vaccine.

“I can tell you for sure, I never knew that our entire healthcare infrastructure was in the state in which it is. Until I was appointed to do this work,” he said.

While Nigeria has the highest number of poor people in the world, the lifestyle of its leaders often belies this fact as they commute to hospitals in the UK and the United States to treat a cold.

Nigeria allocates less than 5 percent of its federal budget to the health sector, of these over 60 percent often goes to paying salaries. With over 400, 000 cancer patients according to data from the Global burden of disease, Nigeria has less than 10 radiotherapy machines.

Nigeria and other African Union member states met in Abuja, in April 2001 and committed to allocating 15 percent of their government budgets to health. This commitment is called the ‘Abuja Declaration’ and African governments reference it in health sector goals and policy documents.

However, according to an analysis of the Federal Ministry of Health and its agencies' budgets between 2001 and 2021by the nonprofit Partnership for Advocacy in Child and Family Health (PACFaH), Nigeria had neglected to follow through on its promise, oftentimes barely reaching a third of the pledged target under the Abuja Declaration.

Nigeria’s medical doctors are fleeing the country with a desperation that borders on mania.  In the past three years, estimates show that over 2,000 medical doctors have left the country. There is approximately 1 doctor for every 6,000 Nigerians against the WHO recommendation of a 1:600 ratio.

Against this backdrop, the country’s pledge to cut greenhouse gas emissions in the health sector by 2050 which will require building new and greener facilities at the same time as expanding health care coverage to millions sound like a pipe dream.

In an interview with Akin Abayomi, commissioner of health in the country’s commercial capital, Lagos, he said the state government is constructing new hospitals that will be eco-friendly and retooling the current primary healthcare centers in partnership with the private sector.

“We are embarking on this as part of our One Health Paradigm that will ensure Lagosians live in a healthy environment and eat good food and are not stressed out by the environment,” said Abayomi.

However, Lagos isn’t always the best benchmark for Nigerian reality. Seven nairas out of every ten spent in Nigeria is consumed in Lagos even though it is only home to 10 percent of the country’s 200m people.

Yet, the healthcare industry is a major driver of greenhouse emissions especially in the developed world and poor countries like Nigeria will depend massively on financing from rich nations to make a dent in their emissions pledge. Beyond making pledges, there’s little in the form of policy and coherent plans that could guide Nigeria to meeting this target.

Gordon Brown, former prime minister of the United Kingdom said climate change could consume more lives in years to come than Covid-19 did.

“We need to have a system of global burden-sharing where the richest countries that are responsible for the historic emissions and have the wealth and the capacity to pay, make good on the funding that is necessary for mitigation, adaptation and that includes the adaptation of healthcare systems particularity in the poorest parts of the world,” said Brown.

He warned that “If we don’t reach the target that we have set of $100bn a year in climate finance, for developing countries, then we will deprive them of the opportunity not only to build coastal defenses, renewable industries but to build the healthcare systems that are necessary for resilience.”

Rachel Levine said greenhouse gas emission emissions are predicted to increase as health systems develop and demographics changes increase healthcare demand.

“Health systems also contribute to air pollution which is a critical driver of premature deaths and hospital emissions,” Levine said.

Levine said high emission countries must do more, and reduce emissions more quickly and while health sector emissions are lower, in low and middle-income countries, these are projected to increase at rates that will make Paris Agreement targets difficult to meet.

At the COP 26 Summit, pledges have come from high-income countries including the United States, Britain, and Germany, as well as several low- and middle-income countries that are already among the most vulnerable to the effects of climate change, such as the Bahamas, Fiji, and the Maldives.

Many of the pledges represent initial commitments that will need to be bolstered with more specific details on how the goals might be achieved.

Carrying out these commitments will require countries to significantly retool their health systems, to make them more efficient using clean energy.

This story was originally published in Business Day on November 9, 2021. It was produced as part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews' Earth Journalism Network and the Stanley Center for Peace and Security.