What ‘social welfare’ in Nigeria’s new health ministry should mean

Prince Agwu who holds a doctorate in social policy, is a researcher at the Department of Social Work and the Health Policy Research Group, University of Nigeria, Nsukka, and a Commonwealth alumnus of the University of Dundee, Scotland; the African Section Editor of Social Work and Social Sciences Review, and the Communication Focal Person for the African Health Observatory Platform, Nigeria National Centre.

Over the years, my research has identified lapses within the psychosocial domains of Nigeria’s health system, which is because of the absence and lack of integration of social protection, social care, and social justice. My publications have pointed to examples of healthcare spaces around the world that are comprehensive, characterised by systems that address the clinical, psychosocial, and human rights needs of health service users. In contrast, Nigeria’s healthcare space has been largely dominated by the mainstream clinical practitioners like medical doctors, nurses, pharmacists, etc., while other categories of vital care (social and psychological) are neglected or undermined.

History of state of care in health facilities in Nigeria

The transition from pre-colonial to colonial era marked the dawn of modern medicine in Nigeria. Health facilities in the colonial era provided for somewhat comprehensive care, evidenced by the inclusion of ‘almoners’ (ex-nurses that provided social care services) in health facilities and the value placed on social care by the colonial Directors of Medical Services. This arrangement reflects the definition of health by the World Health Organisation, as not just the mere absence of disease.

It is a known fact that medical doctors, nurses, pharmacists, and other clinicians from the health sciences cannot guarantee the full reach of health. This is why the colonial health system had value for social and behavioural determinants of health and provided for the integration of psychosocial services in healthcare delivery.

Unfortunately, the post-colonial era began the dismantling of the psychosocial components of health, parochially viewing health through the lens of the presence and absence of disease, which only needs the expertise of professionals who can administer medicines and injectables and conduct surgical procedures. Recognising this, the National Association of Social Workers in Nigeria called for the establishment of hospital social services, which hitherto has remained suboptimal.

The continuous undermining of the psychosocial components of health in post-colonial health system in Nigeria has led to excessive monopolisation of health service users by clinicians, disregard for courses in social and behavioural sciences connected to health, and the patronage of spiritual providers and alternative medicine practitioners for psychological and behavioural health defects.

Perhaps, in recognition of a non-comprehensive postcolonial health system, the administration of President Bola Ahmed Tinubu thought it right to draw lessons from the colonial times when healthcare was comprehensive, by renaming the Federal Ministry of Health (FMoH) to capture ‘Social Welfare’. Despite this change, the postcolonial exclusion of the psychosocial components of health still thrives.

What we experience when health facilities are exclusively for mainstream clinicians

A study presented evidence of poor care provided for a female service user who was domestically abused by her husband and seeking help from the closest primary health facility. She was told by the community health extension worker on duty to go back home and become more submissive to the abusive partner, that way she would no longer be abused.

Studies have complained about the lack of social protection in health facilities, leading to fragrant abuse of the rights of service users. Service users in another study lamented the lack of reporting and feedback channels in health facilities, and in many cases, disgruntled and abused service users turn to divine providence or stay mute whenever they experience violations of their rights.

Recent evidence shows devastating effects of diverse health sector corrupt practices on the health system, affecting health providers, service users, and leading to wastage of the country’s lean resources on health. It is believed that these issues continue to survive and plague the health system because there is no embedded social care and justice system in health facilities. So, facility managers and health workers are often left to their discretion, with no one delegated to watch over their actions to ensure compliance to the demands of human rights and social justice.

More so, when the clinicians themselves face struggles that could affect work performance, they often have no system in place to provide support. In truth, Nigeria’s health system will continue to lose a lot of investments and be poorly ranked without an optimal psychosocial system in place.

We must embody the new addition of ‘social welfare’ to the health ministry

The website of the Federal Ministry of Health and Social Welfare is hitherto silent about a social service division that should be manned by a well-trained and qualified social service professional. Strategic health documents in the country, including the ‘Minimum Standards for Primary Healthcare Services’ are either silent or ‘reductionary’ or not emphatic in their descriptions of the psychosocial roles that should accompany healthcare.

Primary healthcare facilities do not have any of the social service professionals like social workers and psychologists attached to them, despite that primary healthcare is designed to serve the grassroots population who are in dire need of quality psychosocial services and is expected to provide mental health services. The employment of non-social workers and non-psychologists into social service roles at the secondary and tertiary levels of healthcare is an aberration and undermines the significance of psychosocial roles in healthcare. And lastly, the absence of standard operating procedures for social service roles in healthcare makes it difficult to comply with professional boundaries.

Correcting these anomalies and repositioning Nigeria’s healthcare system toward comprehensive care that would pay attention to the clinical, psychosocial, and human rights needs of health service users is an urgent health systems concern. This task rests on the shoulders of the Minister of Health and Social Welfare; the leadership of the primary healthcare development agencies at federal and state levels; legislative committees on health; the unions of social service professionals, and other stakeholders rooting for the delivery of comprehensive health services that will recognise and preserve the wholeness, rights, justice needs, and safety of health service users.