Implementing the Basic Healthcare Provisions Fund

The launch of the Basic Healthcare Provisions Fund at the 2nd THISDAY Healthcare Policy Dialogue in Abuja last week has opened another vista for Nigeria’s health sector. Martins Ifijeh writes on the need for its implementation

When the then Senate Committee on Health in the 7th National Assembly, headed by the present Governor of Delta State, Senator Ifeanyi Okowa, passed the National Health Bill in 2014, which included the Basic Healthcare Provisions Fund (BHCPF), no one envisaged it was going to take another four years before the federal government considers its implementation.

This is despite the widespread belief that the implementation of the National Health Act 2014, as signed by former President Goodluck Jonathan would help in tackling most of the healthcare challenges currently faced by Nigerians.

This thinking made several groups, organisations, the present National Assembly and the federal government to unanimously agree to implement the Act, especially the BHCPF, which has been widely acknowledged in the healthcare community as one of the major panaceas to tackling many of the healthcare issues in the country.

The BHCPF is a fund allocation to cater for the basic healthcare needs of all Nigerians. This means at least one per cent of the Consolidated Revenue Fund in the 2018 national budget will be deployed for the revival of the health sector.

As part of efforts to achieve this, the Minister of Health, Professor Isaac Adewole and the Director General of the World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus launched the BHCPF at the 2nd THISDAY Healthcare Policy Dialogue in Abuja last week, tagged: ‘The Journey to Universal Health Coverage in Nigeria’.

The BHCPC, according to Adewole, will henceforth be known as ‘Huwe’; an Ebira word which means life. He said the word was derived after an extensive crowd sourcing campaign, adding that it was easy to recall and a short syllable that depicts good health in local parlance.

With a new logo to complement the name change, Adewole noted that the first phase of the programme would soon commence in Abia, Niger and Osun states.

The logo would be displayed at accredited facilities where citizens can access the basic minimum packages of health services.

He explained that the BHCPF was intended to ensure monies are disbursed, managed and accounted for in a transparent manner. “It will also 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 accreditation standards and operating protocols.

“The BHCPF will complement ongoing efforts of states and local governments to mobilise resources for health. It is not intended to provide excuses to underfund or deprioritise funding for healthcare services,” he noted.

According to him, “the BHCPF 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.”

On his part, Ghebreyesus, who was very pleased with the launch of the Fund, said the implementation of the BHCPF would go a long way in making the Nigerian Government’s ambition of reaching 100 million lives with basic healthcare package of services a reality.

He said that there were many steps on the road to Universal Health Coverage, adding that the key is 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 BHCPF.
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 are 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.

He 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.

He noted that the step taken by the Nigerian Government, if fully operational, will help reduce healthcare issues faced in the country.

He said no citizen should get sick and die just because they are poor, or because the services they need are too far away. “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 is 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,” he added.

On his part, the Chairman, Senate Committee on Health, Senator Lanre Tejuoso, said the minimum one per cent provision by the government as stipulated in the 2014 National Health Act will mean almost 60 billion naira will be set aside in the 2018 national budget for the BHCPF.

He 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.
“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 may not be release in totality, and expected to have a change in the health sector.

“So we in the 8th National 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

Tejuoso told THISDAY that the benefit attached to the implementation means primary health centres will be more funded and more functional. “It will also ensure basic drugs and commodities are available and accessible to Nigerians. More importantly, this will reduce mortality rates and high disease prevalence in the country.

“PHC is the closest to the communities, and lack of access for simple medical challenges has been the cause of many deaths in the country, especially in rural areas,” he added.

Governor Okowa, who chaired the Senate Committee on Health during the 7th National Assembly called on the federal government to embark on a high powered advocacy to states so that they can be supportive of the Huwe initiative, adding that a workable healthcare model is the one embraced at the local level, from the states down to the communities.

“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 changes 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,” he added.

The governor, said that the two health committees of the Senate and House of Representatives in his time did actually push the National Health Bill, which was later signed into law.
According to him, “seeing us talk about it today excites me. 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,” he added.