Setting Healthcare Agenda for Nigeria (2)

Nigeria’s health sector can match that of other developed countries in the coming political dispensation if advises by the country’s best brains in the sector are followed. In this sequel, Martin’s Ifijeh, who spoke to high powered healthcare stakeholders shared their various advisory templates which if implemented, would put the country’s healthcare on the global map

With improved healthcare the future of the Nigerian child is guaranteed

A former Minister for Public Health, Ecuador, Carina Vance Mafla, in one of the Early Childhood Development programmes held in Columbia University, New York, United States, which THISDAY attended, emphasised that the level of development and economic strength of countries were no longer determined based on how much money they have in their reserves, or how many roads they have built or how much modern structures they have in place, but by how much the people were living in good health, as well as their level of human capital development.

What this means is that countries who are solely pushing for economic development without prioritising their healthcare and the human capital of their people have no business projecting to become developed nations, as only a healthy people can truly learn, then improve the economy of their nation.

This is one reason countries like Nigeria, despite their continuous push for a better economy, better security and a stronger nation, have made little progress because the core of the challenge has not been given priority.

For instance, a country which ritually proposes for a better economy every single year would not have over 11 million of its child population grow in malnutrition and by consequence have a reduced brain capacity. Such a country would not allow children who can change the country’s narrative for the better die before their fifth birthday because of lack of proper healthcare. It would also not allow youths who should contribute to the economy die due to pregnancy complications, Human Immuno-Virus (HIV), cholera, Lassa fever, and the likes.

Unfortunately, this has been the case with Nigeria since 1999 when the country returned to a democratic government; a scenario that portends stagnation and a clear danger to every leader that strives to govern the nation of over 200 million people.

But as the country again choose its leaders that would run the affairs of the nation and the various states for the next four years, best brains in the Nigerian health sector have volunteered to share advisory templates on how best to put the country on the global map and in a push towards becoming a developed nation.

They are unanimous in one thing: ‘To fix Nigeria, fix healthcare and improve the human capital of the people’. They believe that no matter what a new government does, if healthcare is not given the priority it deserves, the country will remain in stagnation.

But they are also quick to warn that these templates can only be feasible in the face of an enabling policy environment driven by committed leadership and a government that is sincere about its human capital agenda.
They are also of the opinion that Nigerians, armed with their Permanent Voters Cards (PVCs) should vote in leaders with interest in their health and human capital development, right from presidency up to their local government representatives.

National Nutrition Agenda
Ever wondered why some countries are developed and economically stable with everything working for them, while others continue to labour to gain the same established economy without success? Wonder no further. Some nations address the root cause of poor economy right from the childhood of their citizens through proper and adequate nutrition, while others focus on other areas that have no direct bearing on the mental and physical development of their young citizens.

This is because several studies, including a report by the American Society of Nutrition, have established a link between adequate nutrition before a child’s fifth birthday and the child’s high intelligent quotient and his ability to contribute meaningfully to the society around him.

The study shows that a well nourished under-five year old child would develop a high cognitive prowess and physical capacity to add to a country’s Gross Domestic Product (GDP) through proper learning and decision making abilities, while a malnourished child may grow up to become suboptimal adult with under-performing economic abilities later in life, which on the long run would affect the economic strength of the country negatively.

Tejuoso is Nigeria’s Chairman, Senate Committee on Health

For instance, global childhood development experts believed the economy of the United States continue to maintain consistency largely because chronic malnutrition, otherwise known as stunting, which alters the mental and physical health developmental process of children under five is hardly associated with the country, hence children grow into adults with full potential to learn and add their quota to the country’s economy.

But the same cannot be said of most developing countries, especially in Africa and Asia where over 90 per cent of the approximately 170 million stunted children of under five years come from.

While Asia accounts for 56 per cent of stunted children globally, Africa accounts for 36 per cent, according to the WHO; a fact which experts have used to argue that most Asian and African countries remain the less economically strong nations of the world because of chronic malnutrition.

Sadly in Africa, Nigeria, which prides itself as the giant of the continent has the highest burden of the condition with over 11 million children said to be stunted with little or no attention by stakeholders and the government to address the scourge.

Experts say with the level of stunting in the country, if not tackled as quickly as possible, Nigeria may never grow into a developed country as envisaged.

No wonder the Chairman, Senate Committee on Health, Dr. Lanre Tejuoso, in sharing his nutrition template with THISDAY, predicted an economic boom for the country in the incoming political year, if malnutrition is tackled head on across the country.

He said the future of the country lies in its children, and that malnutrition, over the years, has continued to hamper the the future, survival and development of these children.

Tejuoso, said, “We need to take the issue of malnutrition more seriously now. Malnutrition has a high economic and health cost and a return of $16 for every $1 invested. Making nutrition a priority requires more attention and more funding.

Thus, if Nigeria is to reverse the current trend of malnutrition, we need to consider a lot of things.

Strengthen Leadership and Accountability for Nutrition
For Tejuoso, who has championed a number of causes in the red chamber to ensure malnutrition is eradicated from Nigeria, nutrition is coordinated through the Ministry of Budget and National Planning and by the food and nutrition committees at state levels, but noted that there was inadequate capacity and leadership in these entities to effectively mobilize and coordinate nutrition actors around the national nutrition policy.
He said the incoming government should look towards the area of reform as this was needed in increasing the national and state leadership for nutrition.
“Such reform should aim for a unified coordination entity, placed in the right institution with enough capacity and power and a clear link with the National Council for Nutrition. A coordinated and multi-sectoral approach is needed for Nigeria to address all forms of malnutrition in an integrated manner across the life cycle,” he said.

Ensure Pre-visible and Sustained Funding
The senator said: “Addressing malnutrition in Nigeria requires long term significant investment of financial resources from both the federal and state levels of government. For this to happen, the government, through the National Council of Nutrition, needs to ensure line ministries whose actions impact on nutrition and states; have budget lines for nutrition; allocate and release adequate budget every year; and then use the funds to contribute to the implementation of the national strategy plan for Nutrition.

Strengthen System for Service Delivery of Nutrition Interventions
On his advisory template, Tejuoso calls on the incoming government to approve for full implementation of multi-sectoral strategic plan of action for food and nutrition in Nigeria at all levels.
He said: “For nutrition specific interventions to be delivered at scale, it is critical to ensure that they are mainstreamed in the health system with a strong community component and appropriately motivated and skilled personnel. The federal government recently included most of the nutrition commodities in the Essential Medicine Lists (EMLs) and launched the CHIPS initiative. These are promising steps, however, States especially those most affected by malnutrition, still need to adopt and quickly roll out the CHIPS programme and ensure that the nutrition commodities (Ready-to-use Therapeutic foods; vitamin A, iron folate, micronutrients powder, etc.) form part of their procurement planning and implementation,” he added.

Multi-Stakeholder Engagement and Partnerships
The senate committee chairman on health the new government should address the underlying causes of malnutrition with integrated, multisectoral programming that supports the overall health and wellbeing of families and communities.

He said the federal government, as well as states should collaborate with relevant stakeholders active in nutrition, including the civil society sector and community-based organisations for demand creation for nutrition services.

“Government should also partner with the private sector and businesses to support nutrition related interventions as part of efforts to prevent and treat under-nutrition, such as food fortification, agricultural value chain development, access to water, sanitation and hygiene etc.”

Nutrition Information System
“The nutrition information system must be in place across relevant ministries, departments and agencies to regularly collect, analyses and impact level indicators to assess the implementation of the national nutrition plan, track progress toward the reduction of all forms of malnutrition and guide the development of evidence based policies and strategies,” he said.

Strengthen Community Nutrition Services
Establish a mechanism to ensure access and delivery of nutrition services (both preventive and curative services) through the community platform.

He said the various governments at all levels should increase partnership and engagement with the gate keepers, option leaders, religious and traditional institutions as change agents using the social behavioral change communication strategies to influence community members to improve knowledge, attitude, beliefs, behaviors and practices that are favorable to improving nutrition outcomes of the citizens

He also said for Nigeria to be malnutrition-free post 2019, the government should make full appropriation for the funding of nutrition commodities for the millions of children suffering from acute malnutrition as a matter of urgency.

Pharma Sector Agenda

Nigeria’s pharmaceutical sector is one of the least harnessed areas of healthcare the Nigerian government is yet to fully tap into considering the return on investment this would bring into the country. Many have regarded it as a multi-billion dollar investment Nigeria hasn’t harnessed.

Sharing the pharmaceutical sector agenda for the incoming governments at all levels, the Director General, Chief Executive Officer, National Institute for Pharmaceutical Research and Development (NIPRD), Dr. Obi Peter Adigwe believes the sector has all it takes to address some of the healthcare challenges in the country, as well as boost Nigeria’s economy to a high margin if well harnessed.

Adigwe is a pharma sector expert and DG NIPRD

Local Production of Essential Medicines

Adigwe said on local production of essential medicines, the Nigeria’s National Drug Policy stipulates that the nation should aim to produce at least two thirds of its essential drug needs through local manufacturing of drugs and commodities, adding that unfortunately, this target has not been achieved.

“Currently, local manufacture of drugs produces only about a third of the nation’s drug requirements. There is now a desperate need for policy coherence if the country is to achieve this target. A robust and comprehensive incentive framework will also expedite local production of essential medicines.

“Recently, significant effort was made by government’s partnership with a local company, to improve local capacity in the local production of vaccines and biologicals.”

He said to build on this, the incoming government should have a proactive strategy which will be adopted to ensure that this development results in sustainable access to safe, affordable and high quality healthcare. He said research and development activities will need to be prioritised, especially with respect to capacity building, policymaking, data collation and the development of contextual partnerships that can expedite local production of products for diseases and conditions prevalent in our setting.

The DG said the National Institute for Pharmaceutical Research and Development has now begun to develop capacities and competencies to spearhead this.

Aggressive and Contextual Research and Development Strategy

Adigwe emphasised that an evidence based approach has been proven to be the most effective and efficient means of addressing the complexities that characterise healthcare provision, noting that currently, research and development agencies struggle with the funding inadequacies required to undertake statutory functions and responsibilities.

He said this was therefore of critical importance to develop sustainable funding strategies, emphasising that decisions in the healthcare setting should also be routinely underpinned by appropriate evidence generated by contextual research.

Government Patronage and Supportive Regulatory Regime

Adigwe said: “Although Executive Order number three section 4F specifically directs that locally produced drugs and medicaments are given priority in procurement of drugs by the public sector. There is little evidence to indicate that this is being faithfully implemented. Instituting a more robust and comprehensive monitoring mechanism which includes all relevant stakeholders will enable the achievement of this policy. Regulatory Agencies also need to be more responsive to the needs of the sector so as to improve the ease of doing business

Cover Leakages in National Drug Distribution System

Adigwe also pointed out that weaknesses and leakages in the national drug distribution architecture was one of the key reasons why there was now a widespread misuse and abuse of opioids and other substances with potential for abuse.

He said: “If left unchecked, the emergent drug abuse epidemic will result in detrimental effects for national healthcare, together with negative socioeconomic implications especially with respect to security and criminality. Government has now begun to develop a comprehensive National strategy to address this menace. It is however important that policies and initiatives that are instituted be underpinned by the relevant contextual evidence.”

Encourage Local Production of APIs and Excipients

Adigwe, who was the former executive secretary of PMGMAN, said currently, despite the significant potential, there was still no Active Pharmaceutical Ingredient (API) produced anywhere in Nigeria, noting that NIPRD has therefore started engaging key stakeholders in the Petroleum Upstream Industry to enable the local production of APIs and other relevant excipients.

“It is now of critical importance that other stakeholders dovetail their efforts with this initiative to help achieve this objective that will confirm Nigeria as the hub for pharmaceutical manufacturing on the continent,” he said.

Harness Value Chain Creation Potential

He called on the incoming government to harness the value chain creation potential of the country’s pharmaceutical sector. “There is evidence that suggests that the pharmaceutical sector is associated with some of the highest value addition chains, in terms of backwards integration and ancillary sector development. Research has shown that for every job created in the pharmaceutical manufacturing sector, between five to 10 corresponding jobs are created in the wider economy. If properly harnessed, this can catalyse relevant national development in various relevant areas such as employment generation, human capacity building and knowledge transfer.”

Harnessing Natural Resources with Ethnopharmaceutical Potential

Adigwe said “Close to 10,000 plants with ethno-medicinal and ethno-pharmaceutical potential have been documented in Nigeria. However, despite the significant potential benefit to national healthcare and socioeconomic development, not enough effort has been put in to harness these natural resources. On our part in NIPRD, we have now developed the Contextual Processing Protocol that aims at harnessing these natural resources for improved healthcare access, while at the same time improving socioeconomic indices such as job creation, income generation and capacity building for the state, stakeholders and participants.”

Industrial Harmony in the Healthcare Sector
The DG is also of the opinion that a significant amount of resources is wasted every year when healthcare professionals go on strike actions, adding that more importantly, access to medicines and healthcare greatly diminishes during these industrial actions.

He said: “All these contribute to a loss of confidence in the system. A proactive strategy needs to be developed to engage all key stakeholders in a bid to come to a lasting solution,” he advised.

Address Threat of Non Communicable Diseases
Adigwe believes Nigeria now has one of the highest obesity figures in this part of the world. This, he said was in turn spurring a growing incidence of non-communicable diseases, amidst the still significant communicable disease burden in the country.

“Unless a contextual national proactive strategy is developed and religiously implemented, this double disease burden can potentially worsen national healthcare together with associated human development indices. Effort should be made to enable the rapid development of innovative preventative Public Health strategies together with the relevant Medicines and Commodities component. Some areas of focus include nutrition, maternal and child health,” he said.

Sustainable Provision of Safe, Affordable High Quality Medicines

He also called for a robust and comprehensive framework requiring multi-stakeholder engagement and contribution, as this was necessary to enable expedited improvement of the quality of medicines available in Nigeria. This, he said includes better regulation and surveillance of imported products, alongside Good Manufacturing Practices (GMP) in medicines’ and commodities’ production.

Adigwe said if all these are judiciously implemented as the country moves into another political dispensation, Nigeria’s pharmaceutical sector will be the envy of many countries including developed nations.

Development Partners’ Expectations

The Co-chair, Health Development Partners Group, Dr. Chris Lewis said as the country moves into another political dispensation, the group would continue to push for a number of priorities they have been pushing for a number of years, which they believed would address healthcare issues in the country.

He said one of the areas is the Basic Healthcare Provisions Fund (BHCPF) which is critical in the provision of basic healthcare to Nigerians. “We pushed for it in the 2018 budget, and we will continue to push for its implementation even with the incoming administration.

“We will also continue to push for increase in health budget in both federal and state levels. For that to happen, there needs to be domestic mobilisation of resources as well as regular releases of health budgets which we are also advocating for.”

Lewis is an advocate for better healthcare
He said the other area they would continue to push for is that government improves the efficiency of health services, as well as the prioritisation of health budget towards the lower cost and high impact areas of healthcare, such as primary health care, among others.

National Template on Non Communicable Disease

As different experts continue to proffer advices on how best to run the health sector in the next political dispensation, a Public Health Physician and Health Systems Specialist, United States, Dr. Ekpenyong Ekanem says a comprehensive advisory templates will not be complete without an agenda for addressing non communicable disease, which is now on the rise on Nigeria.

He said for government to effectively fight NCDs, the new government should ensure a sustained funding of the one per cent consolidated revenue fund to enable it improve health coverage, adding that this in turn will help NCD epidemiology since many of which is handled at the primary health care center.

He said: “We should also ensure benefit packages at state level health insurance schemes are robust enough to cover the common neglected tropical diseases and NCDs, such as hypertension and non-complicated diabetes.

“We should also ensure we put in place functional primary healthcare centers which will improve service delivery at the grassroot level, and reduce burden of these illnesses,” he added.