Cardiovascular Journal of Africa: Vol 28 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017 58 AFRICA
service but willing to offer their services to those private centres
that are also beginning to develop cardiac programmes whenever
they organise such missions.
This state of affairs leaves a lot to be desired, because
practitioners require a minimum number of procedures to
maintain competence and may need to periodically visit
established centres outside the country to satisfy this requirement.
This does not augur well for the rapid development of paediatric
cardiac services in the country and creates some kind of
expensive but inefficient vicious circle. Urgent intervention in
terms of massive investment in the health sector and new ways
of healthcare financing will be required to break the vicious
circle. However, with many other competing needs in and outside
the health sector, this slow pace of development of paediatric
cardiac services may continue for some time.
The North-Eastern geopolitical zone is particularly badly
affected, with a severe dearth of paediatric cardiology services
and personnel, despite having 14% of the population of Nigera.12
This may be due to the fact that it is the zone that has been
particularly hit by insurgency activities in recent years. This
means that parents of affected children will have to defy many
odds to obtain the necessary care for their children.
The other two northern zones (North-West and North-
Central) also lag behind the south, especially the South-West,
in terms of paediatric cardiac infrastructure. This finding is in
tandem with a report of the paediatrician work force in Nigeria,
where more than two-thirds of paediatricians practice in the
South, with the lowest child:paediatrician ratio in the South-
West.13 This trend is also consistent with observations in other
aspects of socio-economic development, with the South-West
historically leading the pace in terms of Western education and
its attendant developments.
While detailed echocardiography is adequate to prepare
most patients for surgery, cardiac catheterisation is needed for
the anatomical and physiological assessment of patients with
CHD on whom echocardiographic evaluation is difficult.14 It is
also being increasingly used for minor interventions that were
hitherto surgically repaired. Only three out of the six available
catheterisation laboratories in the country provided services for
children during the study period, although more recently, three
additional catheterisation laboratories were either in installation
phase or were awaiting official opening of the centres. This again
highlights inadequacy of equipment for a large population.
The rudimentary paediatric cardiology and cardiac surgery
services in Nigeria are being provided mainly by government-
owned centres, no doubt because of the huge capital outlays
involved in setting one up. The government centres however
have their peculiar challenges, such as incessant industrial action,
frequent power interruption, unnecessary bureaucracy and
intra-institutional conflict, resulting in loss of public confidence.
One way of strengthening these centres might be regional
co-operation between centres by effective referrals to one or two
centres that perform open-heart surgery, considering the small
number of surgeries performed in the country. As the number
of surgeries outstrip the capacity of existing centre(s) to peform
open-heart surgery, other centres with adequate facilities can
be upgraded to referral centres. The sharing of facilities and
expertise ensures sustainability of the few available centres.
The small number of surgeries performed locally is the
underlying reason for the thriving medical tourism for open-
heart surgery outside Nigeria. The quest to seek medical care,
including paediatric cardiac care outside Nigeria where more
comprehensive cardiac services are readily available has not
only led to a lot of capital flight but has also provided little
opportunity for development of the fledgling cardiac services
in the country. It is estimated that Nigerians spend about $20
billion on health costs annually outside Nigeria.15 The solution
is the provision of cardiac services at standards close to or on
par with those outside the country to convince the populace to
patronise the services available in the country.
The cost of cardiac care is not cheap anywhere in the world.
In a single-centre study in Nigeria, the cost of open-heart surgery
was found to range between US$6 230 and US$11 200 in a country
where the GNI per capita income is US$2 760.16 A previous study
demonstrated the catastrophic health cost to families who pay out
of pocket for their children’s medical care.17 Although the cost of
cardiac surgeries/interventions in Nigeria is cheaper than in many
centres internationally, most Nigerian families cannot afford it. In
a bid to bridge this gap, some non-governmental organisations,
such as the Kanu Heart Foundation, Save a Child’s Heart
Nigeria, and a number of other faith-based and non-faith-based
organisations have provided full funding or have subsidised the
cost of surgeries abroad for a small number of affected children.
Conclusion
The available paediatric cardiac services in Nigeria are grossly
inadequate and poorly distributed to cater for the teeming
population. The use of periodic medical missions to accomplish
intervention in a few selected cases, while marginally reducing
the burden of children with uncorrected cardiac anomalies,
will only serve a short-term remediation of the problem.
Medium- and long-term approaches would be the upgrading of
existing centres, strengthening of referral systems, coupled with
the training and re-training of relevant personnel to man the
centres. There is a need for better public–private partnership. It
is important that efforts by government and non-governmental
organisations in providing funding for surgeries abroad be
continued until the cardiac services in the country are adequate
for the needs of Nigerian children with structural cardiac defects.
We acknowledge the contribution of Adebowale A Adeyemo in reading
through the manuscript.
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