- In an online report published on World Mental Health Day, media organisation Al Jazeera drew bleak conclusions about the state of mental health care in Nigeria.
- It focused on among other areas the number of hospitals, staffing and funding.
- While there is little doubt that mental illness is poorly resourced in Nigeria as in many other countries, accurate information about the depth of the challenge can only strengthen the public debate around solutions
In an online report with the headline 'Nigeria has a mental health problem', the broadcaster made several claims. In July 2019, Al Jazeera also reported that Nigeria had a “mental health crisis”.
In an effort to improve the accuracy of public debate on mental health in Nigeria, often an under-reported topic, we checked the accuracy of a number of claims made in the most recent report.
Al Jazeera attributed this statistic to the World Health Organization, estimating the share at “some 50 million people”.
Africa Check contacted Al Jazeera for the source of the report’s claims, and were told that it was against Al Jazeera’s policy “to provide external organisations detailed breakdowns of its public and proprietary sources”.
“The information is factually correct, and you are welcome to independently verify it,” the report’s author said. We turned to the WHO, which also raises awareness on mental health internationally.
|What is mental illness?|
Mental illness, sometimes referred to as mental disorders, “comprise a broad range of problems, with different symptoms,” the WHO says. But they are generally characterised by some combination of abnormal thoughts, emotions, behaviour, and relationships with others.
Examples include depression, schizophrenia, intellectual disabilities, and disorders due to drug use. Most of these disorders can be treated, the international health agency says.
For data on Nigeria, Dr Mark van Ommeren, the mental health coordinator at the global health agency, referred us to the WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences & Drug & Alcohol Abuse at the University of Ibadan.
Prof Oye Gureje, who is the director of the centre, told Africa Check that the largest nationally representative study on mental health in Nigeria was published in 2004.
Titled Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys, it was carried out in five of Nigeria’s six geopolitical zones in 2002.
In a sample of 6,667 people aged over 18, it was found that one in eight Nigerians had had a mental illness in their lifetime. The most common were depression and anxiety disorders.
There is no newer data from the WHO to show that one in four Nigerians have suffered from a mental illness.
We were unsuccessful in finding an official definition of a neuropsychiatric hospital. Peter Ajiboye, professor of psychiatry at the University of Ilorin Teaching Hospital, told Africa Check that a neuropsychiatric hospital can manage both behavioural and some nervous disorders, such as epilepsy.
“More psychiatric hospitals are now using the name neuropsychiatric hospitals. This is a way of fighting the stigma that comes with the word psychiatric hospital,” he said.
There are eight federal neuropsychiatric hospitals in Nigeria, according to the health ministry. This number is accurate, Emeka Akpa, the administrative head of the Nigerian Medical Association, told Africa Check.
But there are three other state-run neuropsychiatric hospitals in Nigeria, Dr Joyce Omoaregba, a senior consultant at Edo state’s Federal Neuropsychiatric Hospital and secretary-general of the Association of Psychiatrists in Nigeria, told Africa Check.
These are in Port Harcourt, Ondo state and Anambra state.
Al Jazeera said this was according to the WHO. Country-level estimates on depression rates can be found in the health agency’s 2016 Global Health Estimates. The most recent data is from 2015, Allison Brunier, a WHO spokesperson, told Africa Check.
For depressive disorders, Nigeria does have the continent’s highest number of cases, at 7,079,815. But as a share of the population, at least 24 other countries in Africa have a higher rate of depression than Nigeria’s 3.9%.
The top five are Cape Verde (4.9%), Lesotho (4.8%), Botswana (4.7%), Ethiopia (4.7%) and South Africa (4.6%). Some 47 African countries are covered by the data.
READ: Do 1-in-5 Nigerian adults suffer from long-term depression? World Bank revises brief
The frequency of suicide is the number of suicide cases in a year and is measured per 100,000 of the population, Dr Joyce Omoaregba, a senior consultant at Edo state’s Federal Neuropsychiatric Hospital told Africa Check.
The WHO has previously told Africa Check that for comparisons between countries, age-standardised rates are the most appropriate. (Note: The organisation does not release rankings and cautions against this partly due to concerns over data accuracy.) The health agency’s most recent data shows that Nigeria’s age-standardised suicide death rate was 17.3 suicides per 100,000 people in 2016. This places the country 15th in the world.
The South American country Guyana has the highest frequency of suicide in the world, at 30.2 suicides per 100,000 people.
READ: Nigeria ranked ‘15th in the world’ for suicide – but Lesotho tops African list
In a 2013 national policy document on mental health services, Nigeria’s health ministry also made this claim.
According to the Association of Psychiatrists in Nigeria, there are 250 psychiatrists registered to it, and 200 psychiatry trainees. All psychiatrists working in Nigeria must also be listed with the association, secretary-general Joyce Omoaregba told Africa Check. Despite some Nigerian psychiatrists moving to other countries, their estimate still holds, he said.
Mental health professionals in Nigeria face several challenges leading many to leave the country, according to Gabriel Onyeama, an associate professor of psychiatry at the University of Nigeria.
These include poor physical environments and weak conditions of service. In addition to improving these, the government should train more professionals, Onyeama said.
This estimate is from a WHO survey, Prof Oye Gureje told Africa Check. He is director of the WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences & Drug & Alcohol Abuse at the University of Ibadan.
It was from a study on mental health published in 2004. “It is a finding showing that those with severe forms of anxiety and depression and substance abuse rarely get any treatment for their conditions,” Gureje said.
“Other studies show that probably a higher proportion of those with psychosis get treatment, but mainly from traditional and faith healers – and that the treatment is often inappropriate and inhumane.”
In a November 2019 report international advocacy organisation Human Rights Watch highlighted the mistreatment of people with mental health conditions in Nigeria.
According to the 2018 appropriation bill released by the national assembly, Yaba Psychiatric Hospital in Lagos was allocated N3.3 billion, or $10.7 million at the official exchange rate. (Note: The hospital is also known as the Federal Neuropsychiatric Hospital.)
Another N134 million was set aside for ongoing construction and other projects.
There is however no detail in the 2018 budget implementation report from the national budget office on how much eventually reached the hospital. The hospital’s management also declined to share this information when contacted.
In Nigeria’s approved 2018 budget of N9.12 trillion, some N356.45 billion was allocated to the health ministry.
This works out to 3.91% of the allocated budget, according to documents from the country’s budget office.
In previous years the budget share was higher. In 2015, the health share was 4.24% of the budget, in 2016 it was 4.1% and in 2017 4.17% - or N304 billion.
Drawing attention to the number of doctors from Nigeria leaving for other countries, Al Jazeera said the country was losing at least 12 doctors every week to the United Kingdom, citing data from the UK’s General Medical Council.
The General Medical Council is responsible for registering doctors and setting professional standards for all doctors working or training in the UK. Its registry does not make explicit whether doctors are from a country other than the UK or when they arrived in the UK, but does record the “place they were awarded their main medical degree”.
On 7 November 2019, there were 310,527 doctors in the register, a 10.9% increase from the 280,000 doctors listed when we last checked on 25 April 2018.
The number of doctors whose primary medical qualifications were obtained from Nigeria rose by 1,742 – from 5,250 to 6,974 in those 18 months. This means that on average 22 Nigeria-trained doctors were added to the doctors’ registry every week, higher than Al Jazeera’s figure.
The physician-to-patient ratio is a “flawed metric” due to the difficulty of approximating the number of patients at any given time, Prof Lukoye Atwoli told Africa Check in June 2018. At the time, he was dean of the School of Medicine at Kenya’s Moi University. Due to this difficulty, most reports will use the doctor-population ratio as a proxy for coverage.
The Medical and Dental Council of Nigeria regulates the practice of medicine, dentistry and alternative medicine in Nigeria. For over a year, Africa Check has unsuccessfully requested data on the number of doctors in its register.
Nigeria’s population is also controversial, with the last published official estimate showing a population of 193 million in 2016. The UN’s population division estimates the population as 200.9 million as at 1 July 2019.
In April 2019, the president of the Nigeria Medical Association, Dr Adedayo Faduyile, was widely quoted as saying “40,000 doctors were taking care of 200 million people”.
Fayudile told Africa Check that every doctor in Nigeria is a member of the organisation. Using his figure, the doctor-to-population ratio is between 1:4,800 and 1:5,000, depending on which of the two population estimates is used.
Nigeria's doctor-to-population ratio is widely cited, and is often compared to the WHO’s “recommended ratio”. As we explained in May 2019, this “recommended” ratio is nonexistent.
Dr Mathieu Boniol, a WHO statistician, has previously told Africa Check that the agency has not prescribed any ideal ratio of any kind of healthcare worker to a population.
The WHO might have published some estimates for research and comparison purposes, but “a country’s number of healthcare workers should be adapted to its needs and the characteristics of its national health labour market”, Boniol said.