Do fewer than 20% of Nigerians have access to oral health care services?

Nigeria's health minister has claimed that at least eight in every 10 people in the country of an estimated 193 million lack access to oral health care services. What data is available shows a dire situation but is unfortunately too sparse to prove or disprove the figure.

Do fewer than 20% of Nigerians have access to oral health care services?

The country’s health minister, Professor Isaac Adewole, claimed so at an event to mark the 2016 National Oral Health Week in Abuja.

Given that Nigeria’s bureau of statistics estimated the country’s population at 193 million in 2016, this means more than 150 million Nigerians would be affected. (Note: The estimate is based on Nigeria’s 2006 census which could be an overcount due to issues such as political interference.)

Health centres inactive or running skeletal services

A dental assistant at work in the ECWA Evangel Hospital in Jos, Nigeria, in May 2006. Photo: Mike Blyth
A dental assistant at work in the ECWA Evangel Hospital in Jos, Nigeria, in May 2006. Photo: Mike Blyth

Neither the minister nor his media aide, Boade Akinola, have yet responded to our request for the data on which Adewole based his claim.

Professor of community dentistry at the University of Lagos, Oyinkansola Sofola, told Africa Check that Nigeria’s last comprehensive National Oral Health Count was done 20 years ago.

The minimum standards for primary health care in Nigeria require that each facility contain an oral care section with basic dental care facilities and consumables. In the absence of a dentist, a general duty doctor has to be available to diagnose and treat dental health problems where possible. The doctor is expected to refer cases to higher public hospitals where necessary.

The facility should furthermore have a nurse or midwife, preferably trained in dental health, available to provide basic treatment.

The system looks good on paper but in reality, few primary health care centres in Nigeria are working properly.

The minister’s aide told Africa Check that “there are about 30,000 primary health care centres in Nigeria and only about 20% of them are functional”. This state of affairs was revealed by an investigation carried out by the Public Private Development Centre, an NGO which monitors public procurement processes in Nigeria.

In 2015, the centre randomly sampled 40 out of 89 primary health care contracts that were awarded to public hospitals – which also provide primary healthcare – in 7 states the year before. It reported that majority of the hospitals were either inactive or running skeletal services.

The head of a parliamentary committee on health services, Chike Okafor, said at a public hearing that “most centres lack drug supplies, basic health infrastructure and cannot boast of a good number of medical personnel”.

Public services not free

Even when a public health institution is functional, its services are not free. Fees differ from state to state and local government to local government. (Note: Nigeria’s statistics bureau revealed in 2012 that about 112 million Nigerians were impoverished out of its estimated 2011 population of 167 million. This represented 67.1% of the country’s population, or two in every three Nigerians.)

“People only see their dentists when something is terribly wrong. The economic [cost] of a mere toothache could be great,” the head of the Nigeria Dental Association, Dr Olabode Ijarogbe, told Africa Check.

In 2012, Nigeria developed a National Oral Health Policy, which included plans to provide ideal oral health care to more than half of the country’s residents. This would happen through awareness about oral health, strategic research, workforce development and coordination of oral health activities. The provisions of the policy also included the upgrade of dental practices and integration of oral health into national health programmes.

But as far as the dental association’s vice president can tell “that policy has not quite taken off”. Dr M.O. Ashiwaju told Africa Check: “The implementation level has been very low.”

Where are the dentists?

Even if the health centres were all operational, would there be enough dental personnel to go round?

Ashiwaju told Africa Check that “[fewer] than 5,000 registered dentists are serving Nigeria’s teeming population”.

Using last year’s population estimate of 193 million, the dentist-population ratio comes to 1 dentist for every 38,600 people. This compares to 1 to 2,000 in most developed countries, according to the World Health Organization.

Nigerian dentist Dr Lawal Bakare led an attempt to break the Guinness World Record for the most people brushing their teeth at the same time. A reported 201,000 school kids from all over Lagos State participated.

Bakare told Africa Check that “given the weakness of data management in Nigeria, we may not be able to speak with a level of absoluteness. I would say that the minister tried to show the burden of dental health in Nigeria and what we can confidently say is that it very very high; we might even be underestimating it.”

Conclusion: The health minister’s claim is unproven

Nigeria’s health minister claimed more than 80% of the population do not have access to oral health care services but did not provide evidence to back up the figure.

What data is available paints a gloomy picture for oral health care in the country, however.

To start with, many of the primary healthcare centres that are supposed to provide the first line of basic oral health care, are either inoperative or not fully functional. Furthermore, the country has few dentists to cater for the entire population. And in cases where services are available, people may not be able to afford it since visits to primary healthcare centres in Nigeria are charged for.

Nigerian-based researchers and dentists therefore suggest that the minister’s claim is reflective of the situation on the ground. However, due to lack of conclusive facts and figures the claim that “fewer than 20% of Nigerians have access to oral health care services” is unproven.

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