At 2nd THISDAY Healthcare Policy Dialogue, Leaders Task Nigeria on Universal Coverage

• WHO, World Bank, UNFPA, USAID/HFG, top government officials, lawmakers, private sector in attendance

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

A cross section of experts and leaders from the healthcare, public and private sectors, the legislature, multilateral development partners, civil society organisations and the media, Thursday converged on Abuja for the second THISDAY healthcare policy dialogue where they all urged governments at all levels in Nigeria to be more committed to the adoption of Universal Health Coverage (UHC), saying the scheme had become a priority goal worldwide.

The speakers at the dialogue also agreed that UCH was an important way to expand access to effective healthcare services, reduce financial hardship during illness, and improve health outcomes.
As a follow up to the previous high-level policy dialogue on transforming the Nigeria healthcare sector through appropriate financing held on March 6 by THISDAY with the theme, “Health Financing in Nigeria for Universal Health Coverage Policy Dialogue/Summit,” Thursday’s event was held at Transcorp Hilton Hotel, with the theme, “The Journey to Universal Health Coverage in Nigeria.”

The dialogue was sponsored by the Federal Ministry of Health, World Bank, World Health Organisation (WHO), UNFPA, USAID/HFG, Private Sector Health Alliance (PSHA) and Sterling Bank.
The dialogue, which extensively discussed Nigeria’s current healthcare financing reforms towards UHC, the progress and impediments to the reform, called for political and technical support to advance the progress towards UHC.

Experts at the event agreed that the overall objective of the high level forum on UHC was critical to assessing the progress in the march towards universal coverage in Nigeria through a review of the country status on implementation and sharing of global experiences.
The dialogue was attended by eminent personalities including the Director-General, WHO, Dr. Tedros Adhanom Ghebreyesus; Delta State Governor, Dr. Ifeanyi Okowa; Minister of Health, Prof. Isaac Adewole; Minister of State for Health, Dr. Osagie Ehanire; Minister of State, Budget and National Planning, Mrs. Zainab Ahmed; Chairman, Senate Committee on Health, Senator Lanre Tejuosho; wife of the Senate President and Founder/President of the Well Being Foundation, Mrs. Toyin Saraki; Country Director, World Bank, Mr. Rachid Benmassoud; representative of the Bill and Melinda Gates Foundation, Paulin Basinga; representative of Sterling Bank; and CEO, Dangote Foundation, Zouera Youssoufoa, among others.

Exploring the place of health as a driver of economic growth, the experts stressed that the future of Nigeria’s success depends on its ability to transform non-renewable, and often volatile natural capital into productive wealth by investing more in the country’s human capital resources.
Giving a keynote speech at the event, the Director-General of WHO, Ghebreyesus, described the lack of access to quality healthcare as an outrage, while commending THISDAY for its intervention to set the agenda on an effective and efficient healthcare service delivery system.
Ghebreyesus explained that nations must do all they can to implement and achieve 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 healthcare.

“It means ensuring people can get quality health services, where and when they need them, without suffering financial hardship. Or to put it 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 WHO DG revealed that today, more than half of 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 cost of paying for health service 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 were many steps on the road to UHC, he said 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 one per cent of consolidated revenue from the national budget to the Basic Healthcare Provision Fund.
The WHO boss, however, stressed that financial investments were required to build strong health systems that deliver qualitative services, adding that 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, saying universal health coverage was not just an investment in a healthier future but 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 to achieving 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, it set the alarm that a lot needed to be done and also, a different financing model will be required.
According to him, “There is also a lot of Official Development Assistance (ODA) for health but when you look at it, there are 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.”
On his part, the Health Advisor, UK Department for International Development (DFID) and Co-Chair, Health-Development Partners Group, Mr. Chris Lewis, said that Nigeria had both the second highest maternal mortality and the second highest child death rate in the world.

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

The climax of the event was the launch and renaming of the Basic Health Care Provision Fund (BHCPF) by the health minister, who said the fund will now be known as “Huwe”.
With a new logo to complement the name change, Adewole, who presented the keynote address, noted that the first phase of the programme would soon commence in Abia, Niger and Osun States.
He added that the logo would be displayed at accredited facilities where citizens can access the basic minimum packages of health services.

According to him, Huwe is an Ebira word, meaning life and was derived after an extensive crowd sourcing campaign. He said it was easy to recall and a short syllable that depicts good health in local parlance.
He explained that the BHCPF was 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, increasing service utilisation and health worker productivity, and monitoring service delivery, including improvements in service delivery readiness in line with accreditations standards and operating protocols.

The minister said the BHCPF will complement ongoing efforts of the state and local governments to mobilise resources for health, and is not intended to provide excuses to underfund or deprioritise funding for healthcare services.
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 the 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 was introduced 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 programmes piloted by government and partners across the country have demonstrated this.”

The Founder/President of the Well Being Foundation, Mrs. Saraki, in her remarks, before the launch of the Huwe card, said easy access to healthcare should be a priority for Africa and Nigeria.
She echoed the position of Dr. Ghebreyesus that Universal Health Coverage was a social imperative, an investment which must be made for the people.
Saraki recalled that during her tenure as First Lady of Kwara State, community health was the lynchpin of development, making sure that no citizen was more than five minutes away from quality, affordable healthcare.

“Putting people first is the right and smart investment to make for our people,” she said.
The Delta State governor, while congratulating THISDAY for organising the dialogue, urged the federal government to take the advocacy to the state governors, saying since 2014 when the Health Act was passed into law, it looked like Nigeria fell asleep.
“But it appears too that THISDAY working with the Ministry of Health has brought this alive,” the governor stated.

“I believe that there is a lot to be done, but very importantly, the governors need to be carried along. It is going to be a tough process trying to convince them at this time, but we can do it together and I believe that advocacy is very important and it requires a lot of pleading.
“I believe that when they start, they will be able to surmount the difficulties. We have difficulties but we are moving fast and we believe that in another three years, there will be a lot of change in our state because this is a foremost programme that we have and we are very confident that we will be able to surmount the challenges and we will make it,” he added.

The governor, who was the Chairman, Senate Committee on Health when the Act was passed in the 7th National Assembly, said that the two health committees of the Senate and House of Representatives did actually push the National Health Bill, which was later signed into law.
According to him, “Seeing us talk about it today, I am truly very excited, I have been very worried that in the last three years, nothing has been done.

“In my state, by the special grace of God, we have already passed the Delta State Contributory Health Commission Law, which establishes a mandatory health insurance scheme for all citizens.
“We passed it as early as February 2016 and since January 2017, we started the processes. The governance processes are fully on board, a lot of people are enrolling and more importantly, the public service has fully keyed into it and that is a big plus for us because that has been the challenge.’’

Also speaking at the event, the Chairman of the Senate Committee on Health, Senator Lanre Tejuosho, conveyed the commitment of the 8th National Assembly to the implementation of the National Health Act, which recommends that one per cent of the Consolidated Revenue Fund be deployed in the revival of the health sector.

Tejuosho said the one per cent had already been included in the 2018 budget for the sector, adding that the lawmakers would push for its full release.
He said: “The one per cent is more crucial to Nigeria than even the capital budget allocation for the health sector, because the capital budget may not be released in totality, but this one per cent, once it is in the budget, must be released just like the two per cent released to the education sector.
“There is no way we can continue doing the same things every year, introducing budget allocations, which we may not release in totality, and expect to have a change in the health sector.”

He commended Okowa for ensuring the passage of the National Health Act when he was in the National Assembly, adding: “I tell my colleagues, that we have enough theory on the ground. But we need to make sure that this becomes a reality, and the people of Nigeria see it working in the health sector.
“So we in the 8th Assembly, the health committees, are focusing on the implementation of the one per cent guaranteed by the National Health Act and its inclusion in the 2018 budget, being the last budget before the next election.”

He further disclosed that as part of efforts to ensure the development of the sector at the state level, the Legislative Network for Universal Health Coverage was launched in December to enhance communication among the lawmakers at the federal and state levels.
In its contribution to the dialogue, the Dangote Foundation announced that it was currently spearheading an innovation, which would see the private sector contribute one per cent of its profit after tax to the revitalisation and development of the health sector.

The CEO of the Foundation, Ms. Zouera Youssoufou, speaking as a panelist at the dialogue, said the President of Dangote Group, Alhaji Aliko Dangote, had floated the idea at the last meeting of the National Economic Council (NEC) and was committed to implementing it.
“One of the ideas that Alhaji Aliko Dangote floated at the last National Economic Council that we had, was to see how we can get the private sector to commit one per cent of its profit after tax, which would go to supporting the BHCPF.
“This is because in every country that we have looked at, government cannot do it alone, we need private sector contributions.

“So, he is committed to doing this himself, he has been floating the idea with his peers, and the goal is to see how we can raise money from the private sector to support what we are doing on the government side.
“We completely believe in public-private partnerships, we believe that we cannot do everything by ourselves. On every single programme, we work through the federal or state governments, where we work,” she said.

Youssoufou said the foundation considers itself a development partner, and was already working in the primary healthcare sector, particularly in Northern Nigeria.
During the panel session, a panel of experts advocated increased private sector financing of basic healthcare in Nigeria.
The Country Director, Bill and Melinda Gates Foundation Paulin Basinga lamented that a key missing component of the health sector in Nigeria was that 75 per cent of public health is funded by households while government at federal and state levels only account for 13 per cent.

Dr. Basinga proposed that in order to plug the funding gap, Nigeria (the government and others) needs to invest more than $1 per capita, which is approximately what the BHCPF can finance, to reach between $30 – $40 per capita as recommended by WHO in order to deliver a basic package of services to address common diseases and health problems, and achieve universal health coverage.
She said it is important for the legislature and executive to work closely, and the release and execution of the allocated funds has to be perfect to make primary health care delivery achievable.
“There will be a paradigm change if one per cent of Nigeria’s Consolidated Revenue Fund is channelled into healthcare and we need continuous budgeting to attain that.

“It is important that the legislature and executive must work closely and the executive has to be perfect to make private healthcare delivery achievable.
“We will need more than $1 per capital, probably between $30 and $40 per capital to be able to deliver those services. To get innovative healthcare you need very strong private healthcare where the execution must be perfect,” Basinga said.

The country Director, World Bank Nigeria, Rachid Benmassoud, lauded the healthcare policy dialogue, noting that it was held at a very critical time when Nigeria was facing a lot of challenges.
He also called for the involvement of the private sector, which he noted was very vibrant in Nigeria, in the drive and implementation of UCH.

Benmassoud said a healthy nation will be a recipe for economic and social development.
“I am pleased that there is an encouraging coalition on the health sector in Nigeria. I think implementing the national health plan will be an embracing step towards universal healthcare. Nigeria has a vibrant private sector and it is important to harness it. The World Bank is pleased that healthcare focuses on mother and children,” he said.
A representative of UNFRA, Eugene Kogili, wanted Nigeria to emulate other countries that tend to invest in vulnerable people including children, mothers and adolescents.
Kogili, who stood in for Diene Kieta on the panel, said that UNFRA had observed that other countries that had made reproductive, maternal and child and adolescent care the fulcrum of their investments, were getting high returns.

He said from previous research, investments of N1 million in reproductive, maternal and the new born care would create a return on investments of N20 million, 20 times the amount invested and of more benefit than investment in infrastructure that only delivers three times the amount invested.
“Most countries tend to invest in children, mothers, and adolescents. But then we have also realised that it is not all mothers and children that are served as they are left behind because of their geographical location.
“We must ensure that healthcare targets those rural areas left behind by making them the target in the first part before any other person.
“Now we have to know that there are two ways of funding which will come through government via taxation and insurance schemes – basic health or private insurance or community based insurance.
“For you to succeed, we have to move money from private hands to the public side. What has worked in most countries is that public money is mandatory and is applied to business. But it has to be managed by government,” Kogili said.

On his part, Isiye Ndombi of UNICEF advocated that Nigeria step out of the shadows and take a cue from Thailand, which stepped forward since it suffered a recession in the first quarter of 2013 and has continued to improve in spite of going through eight governments.
Speaking in relation to the level of spending by donor agencies, the Mission Director, USAID, Stephen Haykin, advised Nigeria to fund opportunities that work and in the broader area of the economy, adding that government should support groups that spread the risk.

“We need private foundations to come forward and make contributions in support of universal health coverage in the mold of the Bill and Melinda Gates Foundation,” Hawkin said.
While also contributing to the conversation, the Minister of State for Budget and National Planning, Mrs. Ahmed, said that in terms of the major functions of her ministry in the area of monitoring and evaluation of the health sector, the federal government had consciously taken into account the health strategies of the health ministry in the Economic Recovery and Growth Plan (ERGP).
According to her, “We also identified specific key priority 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 in accordance with the third pillar, which is investing in our people.
“Specifically, the ERGP target is on vitalising primary healthcare systems and the roll out of universal health coverage. It also aims to strengthen the delivery beyond PHC (primary healthcare) systems and partner 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, we aim to provide and finance health services, prevent infant mortality and maternal mortality. We aspire to reach the basic goals.’’
She said the federal government had spent in areas where the outcomes quickly pulled the country out of the recession, noting that in 2015, the federal government released N16 billion, in 2016 it released 28 billion, in 2017 it released N45 billion to the healthcare sector.

She said that the trajectory was a positive one and promised that the government would implement the one per cent financing from the Consolidated Revenue Fund in conjunction with the National Assembly.
In his opening remark, the Chairman of THISDAY/ARISE Global TV, Mr. Nduka Obaigbena, emphasised the need to invest more in the health of Nigerians.
He said that the dialogue was to help shape policy towards human capital development and ensure that the nation cares for the citizens of the country because 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, Obaigbena said Nigeria needs the enabling laws and financing for the health sector, noting that this can be achieved with the collaborative effort of the public and private sectors.
In a communiqué after the event, the summit resolved as follow:
• Commended THISDAY, Federal Ministry of Health, WHO, the 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 allocations for funding healthcare services in Nigeria towards the attainment of UHC.
• Critically considered the progress and challenges of the ongoing reform efforts of government, especially the National Health Act passed into law in 2014, which has laid a firm foundation for making UHC a reality by guaranteeing basic health package services, while commending President Muhammadu Buhari for formally launching the UHC.
• Called for political and technical support at all levels to advance progress towards UHC through the full implementation of the Basic Health Care Provision Fund (BHCPF) initiative as an opportunity for achieving UHC.

• 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.
• The BHCPF guarantees an explicit package of services to be delivered at the facility level through the NHIS and State Health Insurance Agencies (SHIAs); operational budgets to facilities to improve the 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 the quality of care based on a set of metrics.

• Called on government to focus on investment on the explicit package of services defined under the Huwe programme.
• Called for a high level advocacy for the Nigerian Governors’ Forum (NGF) to mobilise enough funds for the 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. Participants were optimistic that the federal government will leverage on the outcomes of the dialogue to achieve Universal Health Coverage.