At THISDAY Healthcare Dialogue, Global Health Leaders Challenge Nigeria on Universal Coverage

• WHO, World Bank, UNFPA, USAID/HFG, govt officials, private sector in attendance
• Basic healthcare provision fund renamed Huwe

Iyobosa Uwugiaren, Senator Ireogbu, Damilola Oyedele, Olawale Ajimotokan and Paul Obi in Abuja

Participants at THISDAY Healthcare Policy Dialogue/Summit, which included global health leaders, have urged government at all levels in Nigeria to be more committed to Universal Health Coverage (UHC) – a scheme that has become a priority goal worldwide.

The Health Dialogue held on Thursday in Abuja was in conjunction with the Federal Ministry of Health. It attracted global health leaders, policy makers, health practitioners, parliamentarians, development partners, academic, civil society organizations, private sectors and the media.

Thursday Summit with the theme “The Journey to Universal Health Coverage in Nigeria,” was a follow up to the high-level policy dialogue on transforming the Nigeria healthcare sector through appropriate financing held earlier in the year by THISDAY.

The summit agreed that commitment to Universal Health Coverage was an important way to expand access to effective healthcare services, reduce financial hardship during illness, and improve health outcomes.

It discussed extensively Nigeria’s current health financing reform efforts towards UHC, the progress and challenges of the on-going reform efforts, and made strong call for political and technical support to advance progress towards UHC.

The summit noted that the overall objective of the High Level Forum on UHC was critically to assess the progress towards UHC in Nigeria through a review of the country status of implementation and sharing of global experiences.

Exploring the place of health as a driver of economic growth, the experts recognised that the future of Nigeria success depends on its ability to transform non-renewable, and often volatile natural capital into productive wealth by investing more in human capital.

Giving a keynote speech at the event, the Director General of the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, described lack of access to quality healthcare as an outrage, while commending THISDAY for its intervention to set the agenda on effective and efficient healthcare service delivery system.

Ghebreyesus explained that nations must do all they could to implement Universal Health Coverage for their citizens.

According to him, “The World Health Organisation was founded 70 years ago on the conviction that health is a human right to be enjoyed by all people, not a privilege for the few. Although much has changed in 70 years, that conviction hasn’t.

“The term ‘universal health coverage’ didn’t exist in 1948, but if it did, it would have been in our constitution. Universal health coverage means much more than just health insurance, and it means much more than just health care.

“It means ensuring people can get quality health services, where and when they need them, without suffering financial hardship. Or to put it in another way, no one should get sick and die just because they are poor, or because the services they need are too far away. ‘’

Explaining further that the scheme also includes the full spectrum of services, from disease prevention and health promotion to treatment, rehabilitation and palliative care, the Director-General of WHO revealed that today, more than half the world’s population lacks access to essential health services, and almost 100 million people are pushed into extreme poverty every year because of the costs of paying for care out of their own pockets.

He said: “This outrage must end. No one should have to choose between buying medicine and buying food for their family. No one should have to choose between death and poverty.

“There’s no single path to UHC. All countries must find their own way, in the context of their own social, political and economic circumstances. But the foundation everywhere must be a strong health system, based on primary care, with an emphasis on disease prevention and health promotion.

‘’Such health systems do not only provide the best health outcomes; they’re also the best defence against outbreaks and other health emergencies; in that sense, UHC and health security are truly two sides of the same coin.’’

While stating that there are many steps on the road to UHC, he said that the key was political commitment and for that reason, Nigeria’s Presidential Summit on universal health coverage in 2014 was a vital step.

“The National Health Act passed the same year lays a firm foundation for making UHC a reality, by guaranteeing a basic package of services. The government’s ambition to reach 100 million Nigerians with a basic package of primary healthcare services is truly admirable’’, he added.

He congratulated the government for its commitment to allocating at least 1% of consolidated revenue from the national budget to the Basic Healthcare Provision Fund.

The WHO boss stressed further that financial investments were required to build strong health systems that deliver quality services, adding that’s exactly what they are: investments, not costs. They’re investments in a safer, fairer and more prosperous future.

He said the question therefore was not whether countries can afford to invest in their health systems but whether they can afford not to. He said universal health coverage was not just an investment in a healthier future; it’s a down payment on a fairer, safer and more prosperous future.

Also in a goodwill message, the representative of the Global Financing Facility Secretariat For Every Woman Every Child (GFF), Mr. Luc Laviolette, said that the GFF was started in 2014 in recognition that a different financing model would be required in order to achieve the health related aspects of the Sustainable Development Goals (SDGs).

He said looking back at the global performance of the Millennium Development Goals (MDGs) related to health raises the alarm that a lot needed to be done and also a different financing model will be required.

He said: ‘’There is also a lot of Official Development Assistance (ODA) for health but when you look at it, there is a lot of gaps, which at the time stood at $33 billion annually and also, financial flows from the private sources into various franchise, agencies and directly to the households. These private flows far exceed the ODA.

‘’So it was to develop a model that focuses on all types of financing. First and foremost, increasing domestic resources, this is at the heart of what GFF is doing. We are extremely pleased to be able to support in this someway in Nigeria.

“The funds from the Trust Funds, which is established at the Secretariat with financing from a range of donors came from the private sector department. This is designed with the World Bank financing in your country. In Nigeria, all of this in the context of investment for development and there are multiple World Bank financed projects that are linked with the GFF financing.’’

On his part, the Health Advisor DFID and Co-Chair, Health-Developmenr Partners Group, Mr. Chris Lewis, said that Nigeria had both the second highest total maternal mortality and the second highest child deaths total in the world.

‘’We’ve struggled to improve health coverage over the past 25 years and we have a transition of the donors funding mechanism for these services transitioning out in the coming years’’, he said.

‘’So, welcome in this boat of ship of change that is ultimately required in this country. People need access to health services, including prevention, promotion and treatment which make efficient services to be effective without exposing the user to financial hardship. This is the very definition of universal health coverage.’’

FG Renames Basic Healthcare Provision Fund Huwe

The climax of the event was the launch and renaming of the Basic Health Care Provision Fund (BHCPF). It was renamed ‘’Huwe.’’

With a new logo, the federal government announced that the first phase of the programme would soon commence in Abia, Niger and Osun states.

The Minister of Health, Prof. Isaac Adewole, stated this while presenting the keynote address, saying the logo would be displayed at accredited facilities where citizens can access the basic minimum packages of health services.

According to the Minister, Huwe, an Ebira word, means life, and was derived after an extensive crowd sourcing campaign, for an easy to recall, short syllable word that depicts good health in a local language.

The BHCPF is intended to ensure monies are disbursed, managed and accounted for in a transparent manner, ensure that funds flow from source (at the federal level) to service delivery points, creating performance incentives for providers, increase service utilisation and health worker productivity, and monitor service delivery, including improvements in service delivery readiness in line with accreditations standards and operating protocols.

The Minister said BHCPF was intended to complement ongoing efforts of the States and Local Governments, to mobilise resources for health, and are not intended to provide excuses to underfund or deprioritise funding for health.

According to him, “The Basic Health Care Provision Fund provides the platform to expand high impact and life-saving interventions to all Nigerians.

“It guarantees an explicit package of services to be delivered at the facility level, through the NHIS and State Health Insurance Agencies (SSHIAs), and operational budgets to facilities to improve quality of service delivery based on a quality improvement plan with quantifiable outcome measures.

The National Primary Health Care Development Agency (NPHCDA) and the State Primary Health Care Development Agency (SPHCDA) will assess on an annual basis the improvements in quality of care based on a set of metrics.”

Adewole explained further that the BHCPF is in recognition of the fact that Nigeria’s future success depends on its ability, to transform non-renewable (and often volatile) natural capital into productive wealth by investing more in human capital.

He added, “Within the health sector, we now know, based on our research in the last few years of this administration, that targeted coverage expansion for high impact reproductive maternal, neonatal, and child health (RMNCH) interventions to underserved populations have an immediate impact on the health of women and children. Several programs piloted by Government and partners across the country have demonstrated these.”

While also contributing to the conversation, Zainab Ahmed, Minister of State for Budget and National Planning, said that in terms of monitoring and evaluation for the health sector, the federal government had taken into account the health strategies of the Ministry of Health to the Economy Recovery and Growth Plan (ERGP).

According to her, ‘’And we also identified specific key priorities actions that must be undertaken within the four years of the planned period. So in the ERGP, we seek to prioritise health and take actions according to the third pillar which is investing in our people.

‘’Specifically, the ERGP target vitalising primary healthcare systems and the roll out of universal health coverage and also strengthening of the delivery beyond PHC systems and partnering with the private sector in constructing mega health centres.

‘’All these are geared towards achieving the broad outcomes of improving the availability, accessibility, as well as the quality of health services in our country. Expanding health services to all local governments is an imperative that we have planned for. Also, providing and financing health services, preventing infant mortality and maternal mortality. We aspire to reach the basic goals.’’

She added that the federal government had planned to spend in areas where the outcomes will quickly pull us out of recession, saying in 2015, the federal government released N16 billion; in 2016, N28 billion; in 2017, N45 billion. She added that the trajectory was a positive one, promising to attain the 1% Consolidated Revenue in conjunction with the National Assembly.

The minister further explained: ‘’One other thing we are doing is to block the leakages in all the sectors, if you just keep releasing resources without monitoring the impact of the resources and blocking leakages, we still won’t have the impact. Nigeria as a country has one of the poorest health indicators, as a government we intend to improve significantly these indicators within the tenure of this administration. ‘’

Obaigbena: Why We Are Spearheading the Advocacy

Earlier, while kick-starting the policy dialogue, the Chairman, THISDAY/Arise News Channel, Mr. Nduka Obaigbena, emphasized the need to invest more in the health of Nigerians.

He said that the dialogue was to help shape policy towards human capital development, ensure that the nation cares for it citizens of the country and that every life matters.

According to him, “At THISDAY, we are just facilitators, bringing policy makers, experts, bankers and financiers together to ensure we can move towards a very healthy nation, and of course an educated nation.

Welcoming the participants, the Chairman said Nigeria needs enabling laws and financing.

In a communiqué after the dialogue, the summit resolved as follow:

* Commended THISDAY, Federal Ministry of Health, WHO, World Bank, UNFPA, USAID/HFG and Sterling Bank for jointly supporting the dialogue on UHC.

* Commended the efforts made by the government of Nigeria so far in this regard, and called for more budgetary allocation for funding of healthcare services in Nigeria towards attainment of UHC.

* Critically considered the progress and challenges of the ongoing reform efforts of government, especially the National Health Acts passed into law in 2014 which has laid a firm foundation for making UHC a reality, by guaranteeing the basic health package services, while commending President Muhammadu Buhari for formally launching the UHC and made a strong call for political and technical support at all levels to advance progress towards UHC through full implementation of the Basic Health Care Provision Fund (BHCPF) initiative as an opportunity for achieving UHC.

* It also agreed that the Basic Health Care Provision Fund, now known as HUWE will provide the platform to expand high impact and life-saving interventions to all Nigerians. It guarantees:

• An explicit package of services to be delivered at the facility level, through the NHIS and State Health Insurance Agencies (SSHIAs);

• Operational budgets to facilities to improve quality of service delivery based on a quality improvement plan with quantifiable outcome measures. The National Primary Health Care Development Agency (NPHCDA) and the State Primary Health Care Development Agency (SPHCDA) will assess on an annual basis, the improvements in quality of care based on a set of metrics.

* The dialogue called on government to focus on investment on the explicit package of services defined under the Huwe program.

* The dialogue called for a high level advocacy to the Nigeria Governors forum to mobilize enough funds for support of healthcare delivery at the State level.

* Called for the need to attach public health indicators to the budgetary requests; while expressing satisfaction on the quality of contributions from all stakeholders and was optimistic that the Federal Government will leverage on the outcomes of the dialogue to achieve Universal Health Coverage.

According to him, “The Basic Health Care Provision Fund provides the platform to expand high impact and life-saving interventions to all Nigerians.

“It guarantees an explicit package of services to be delivered at the facility level, through the NHIS and State Health Insurance Agencies (SSHIAs), and operational budgets to facilities to improve quality of service delivery based on a quality improvement plan with quantifiable outcome measures.

The dialogue was attended by eminent personalities, including the Governor of Delta State, Dr. Ifeanyi Okowa; Wife of the Senate President, Mrs. Toyin Saraki; Chairman Senate Committee on Health, Senator Lanre Tejuosho; the Minister of Health, Professor Isaac Adewole; Minister (State) Health, Dr. Osagie Ehanire; Minister for State Budget and National Planning, Zainab Ahmed; Director-General WHO, Tedros Adhanom Gbebreyesus; Country Director World Bank Nigeria, Rachid Benmasoud; Representative of Bill and Milinda Gate Foundation, Paulin Basinga; Representative of Sterling Bank; and CEO Dangote Foundation, Zouera Youssoufoa, among others.