Setting Healthcare Agenda (3)

HEALTH CARE AGENDA 2019-2023

In this third and final sequel of advisory healthcare template for the incoming governments at federal and state levels, shared by some of Nigeria’s best brains in the health sector, including the Minister of Health, Prof. Isaac Adewole, World Bank experts, and other stakeholders in the sector, there seems to be a unanimous belief that the nation’s health outcome can rapidly improve and put healthcare on the global map if the recommendations are diligently implemented. Martins Ifijeh, who spoke to the experts, reports

Can the incoming governments provide better health outcomes for Nigerians?

During the campaign build up to the just concluded presidential, National Assembly and state elections, not many candidates showcased their healthcare agenda either in rallies or as a policy manual. Only few knew the importance of healthcare to the building of a country or a state which they hoped to govern or legislate over.

For the category of candidates who had a fair knowledge of how healthcare can alleviate poverty, improve human capital and cause economic progress for a nation or state, they still preferred to put healthcare at the lowest ebb of their campaigns because they know not many electorates are aware how much of a right government and the leaders owe them in terms of provision of healthcare.

Simply put, these candidates went for what the average Nigerians would expect from a typical politician – promise to build good roads, provide jobs, build bridges and skyscrapers, provide good schools, and all the tangible things that can be counted in terms of development.

To them, there would be no need to make healthcare a focus since it won’t be on the priority list when they get into office. They would rather channel their energies into infrastructural development, which to them is a visible sign of development.

But for the few who understood that to build a country or state with a viable economy and human capital there must be good healthcare, they made it a front burner. Such persons knew with a good healthcare outcome (which by the way they consider not tangible like building of bridges and buying sewing machines for indigent Nigerians), diseases and poverty will reduce, and it would tell on the economy positively. Unfortunately, only few of such candidates existed among the thousands who contested in the various levels of elections.

With the elections now over and various positions declared by the Independent National Electoral Commission (INEC), some of the best brains in the health sector believe sharing advisory templates on how best to boost the health sector will in no small measure aid governments in bringing dividends of democracy to their people. This, they say is also significant, especially for election winners who prior to now did not articulate plans for addressing healthcare under their purview.

The experts 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 may not reach its desired destination.
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.

Addressing Healthcare through Political Will

For the Senior Health Specialist, World Bank, Dr. Oluwole Odutolu, without political will, there is only little the advisory templates can do, as this represents a key driver to translating proposed models into actions.

He said in setting health agenda for Nigeria from 2019 to 2023, stakeholders should not forget the role of politics and its role in development, adding that many of the contributions already made in the healthcare series examines the technical issues for the next four years, but that political will is key to achieving the models.

He said: “Since health is part of our social existence, therefore there is the politics of health and health is political in many ways as its social determinants are amenable to political interventions and are thereby dependent on political action or inaction.

“For example, housing, income and employment are issues that dominate political life, but they are key determinants of health and wellbeing. Secondly, many of the major health inequalities are linked to issues outside the health sector and they require non-health sector policies to tackle them – water and sanitation, education, environment. Lastly, health is political because power is exercised over it as part of the wider economic, social and political systems.”

He said there were many lessons to be learnt from other countries who at one point or the other took political actions that have changed the face of healthcare in their countries.

He said for instance, the National Health Service of England and Wales was launched on July 5, 1948, and that it was a product of many years of deliberations and a purposeful action of the Labour Party under the Clement Attlee’s government. “But the hero was the then Minister of Health, Aneurin Bevan who decided that “the only thing to do was to create an entirely new hospital service, to take over the voluntary hospitals, and to take over the local government hospitals and to organise them as a single hospital service,” he said.

CCT Expansion in Nigeria Social Investment Programme

Reeling out some national templates that can be adopted in addressing healthcare issues in the country, he said stakeholders should expand the Conditional Cash Transfer (CCT) part of the Nigeria Social Investment Programme.

He said: “Learning from Brazil, the Social Investment Program can expand the conditional cash transfer part of the programme and condition the cash transfer to some key and important health indicators such as immunisation, skilled attended deliveries and post-natal care. Nigeria can grow the program to the large population that needs health care across the nation.”

Political Participation

He advised healthcare professionals to participate in politics, as well as engage politicians.

“With the piece of legislation in place, how does Nigeria develop the leadership at political, professional and administrative levels to drive forward the health agenda? Health professionals and those who care should not only participate in politics but should engage with the political class to raise politicians, who will listen, examine the issues and be convinced of their role. Nigeria needs political champions for health. It does not just happen. We as professionals need to engage, convey our messages in a clear language to the politicians, be effective and efficient.

He called on stakeholders to use political instrument to establish social contract with the citizens on the quality of healthcare that is affordable and responsive, adding that such policies must be people centered.

He called for transparent, efficient and accountability in the use of public resources for both domestic resources and contributions from development partners.

He said the primacy of politics in development cannot be contested as distribution of resources is under the control of politicians. “Secondly, there is the instrumentality of the law for civil actions and regulations of practice in health. I have pointedly cited several examples of how political mandates and actions have improved health and wellbeing of large populations globally and in certain countries. It should be noted that much of this good come from outside of the sector pointing to the fact that social determinants of health are amenable to political influence,” he stressed.

Increasing Finance and Continuity of Impact Programmes

If there is one man who is most qualified to share advices on how best to run the health sector, it is the current minister of health, Prof. Isaac Adewole who believes the foundation the ministry has laid on ground over the past three and half years is a booster to changing the narrative in the sector as new governments start this May.

To him, increase in financing, with continuity of high impact programmes, and accountability, would aid the incoming dispensation in bringing better health outcomes. He said going forward, public financing for health must continue to increase to enable government sustain the successes achieved so far, as well as reduce out of pocket expenditure.

Continuous Implementation of BHCPF

He said programmes such as the Basic Healthcare Provisions Fund (BHCPF) must be implemented in accordance with the implementation manual as it provides a pathway to achieving Universal Health Coverage (UHC), adding that accountability processes must continually be improved upon to ensure elimination of wastages and increased allocative efficiency.

Sharing this template exclusively with THISDAY, the minister said: “In addition, continuous engagement with states is important to ensure ownership and increased performance management of programs. There should be increase in the number of public private partnerships to complement government’s investments in healthcare. So far we have midwifed the Lagos University Teaching Hospital / Nigeria Sovereign Investment Authority (LUTH/NSIA) cancer centre and are working with AFREXIM to set up a multi specialty centre focusing on managing complex Non Communicable Diseases (NCDs).”

He said the Ministry of Health should continue to work with the Ministry of Budget and National Planning on approaches to harness the power of the young and strong population bulge to achieve demographic dividend, while paying attention to our population growth.

“There is need to continue to strengthen public health preparedness through increased vigilance at our entry ports and digitisation of yellow cards.

”The legislative frameworks, policies and programmes being implemented serve as a foundation for continuous improvement of the health sector with the resultant increase in health outcomes. This certainly would facilitate the attainment of UHC and have a knock on effect on increased productivity and economic growth.

Hope for Better Healthcare

Adewole, who has championed a number of firsts in the health sector since resumption in 2015 said he envisions a Nigeria with much better health outcomes and a healthier population able to contribute productively to the economy due to the clear understanding of the challenges and the belief in the foundation the ministry had laid on ground in this present dispensation.

He said in the last three and half years, the ministry has put in place necessary legislative frameworks, policies and strategic documents and implementation of programmes to set the nation on the right path.

Projections

“Specifically, I see a situation where Nigerians as of necessity, no longer travel out to treat cancer related cases as we now have eight cancer centres at different levels of completion. This should reduce the capital outflow estimated at over $1bn; I see a situation where Nigerians have access to basic services such as child and maternal care in functional facilities under the BHCPF. These facilities numbering over 10,000 are spread across every ward in Nigeria

“I see a situation where public health emergencies are rapidly detected and measures put in place to nip the spread, given the foundation we have laid at the Nigerian Center for Disease Control (NCDC). We want a situation where malnutrition becomes a thing of the past as we have obtained a $232m credit facility to rapidly address nutritional challenges in under five children. This has encouraged local production of Ready To Use Therapeutic Food (RUTF),” the minister projected.

He said he was optimistic that in the coming dispensation, every child will be vaccinated against preventable illnesses and can grow up to be net contributors to the economy, adding that this will be possible with the increase in government financing for vaccines and the $1.03bn additional grant resources GAVI gave Nigeria in response to the country’s commitment.

He said the ministry has also encouraged local production of vaccines, with May and Baker commencing vaccines production and improved supply chain storage with the establishment of two automated and ultra modern warehouses in Lagos and Abuja to store cold and dry commodities, noting that this cost us over $12m with storage capacity equivalent to the size of a standard football field.

To the minister, in the coming dispensation, health workers of all cadres will be proud of their jobs, have the right working environment to thrive and they will be able to treat patients with dignity.

Legislative Additions

Adewole said with the passage of the (NCDC Act and the National Tobacco Act, ground has been laid for the incoming government to flourish, emphasising that NCDC has the mandate to respond to the challenges of public health emergencies and enhance Nigeria’s preparedness and response to epidemics through prevention, detection, and control of communicable diseases.

He said: “We have increased the funding for the organisation through regular budgetary allocation and the BHCPF. In addition, we also obtained $90m credit facility from the World Bank to set up the Regional Disease Surveillance System Enhancement (REDISSE) in Nigeria.

“This not only strengthens our ability to deepen our national capacity to detect and respond to disease threats, but also enables us reinforce sustainable and effective regional collaboration and collective action and allows us to establish an efficient linkage of country human and animal health systems to a regional disease surveillance and response network. I am optimistic, that the impact of the NCDC would provide the basis for a healthier and more secure country.”

Policies and Strategies Awaiting Incoming Government

Adewole said with the development of the National Health Policy and the second National Strategic Health Development Plan (NSHDP II) under his watch as a minister, it has provided the opportunity to shape the thinking for the health sector, adding that both documents provide the underpinnings for Nigeria to achieve UHC.

“They were also both approved at the Federal Executive Council (FEC), which indicates federal government’s commitment to health. Drawing from the policy are several strategic documents that lend themselves to reducing inequalities to health care services and increasing health outcomes.”

Scorecard

He said in addition to the fight against HIV/AIDS, TB and Malaria, the government has also laid on ground mechanisms for the fight against polio eradication, as well as the implementation of the Saving One Million Lives Programme for Results (SOML P4R).

Adewole said: “By funding states based on results achieved, we are changing the narrative on healthcare to a focus on outcomes. We have disbursed over $259m to states in the last four years and seen improvements in governance and accountability mechanisms and also improvements in health outcomes.

“We have also made the implementation of the Nigeria State Health Investment Project (NSHDIP), which is a performance based financing health intervention designed to improve primary healthcare in the project states with a focus on maternal and child health services; strengthening participating institutions at federal, state and LGA levels; Strengthening information management; and capacity building. The project his being implemented in Adamawa, Ondo and Nasarawa States and has been extended to six States in the North East,” he added.

He said the ministry has begun the implementation of the 2015 National Tobacco Control (NTC) Act and has obtained approval for the upward review of tobacco and alcohol tax, adding that upgrading of tertiary health institutions, something to build on.

Encouraging Partnerships

Adewole said at the start of the current administration, they had a number of bad cases with development partners, explaining that infractions in the use of funds meant government had to refund $5.8m and $5.2m to Global Fund and GAVI respectively, with both agencies threatening to never work with Nigeria again.

”We repaid the monies, instituted a mechanism for increased accountability and transparency and publicly published our budget allocations. This helped engender trust with partners. As at today the Global Fund is back and has committed a grant of $660m to Nigeria for HIV/AIDS, TB and Malaria between 2018- 2020. Similarly GAVI has committed $1.03bn as grants to Nigeria over the next 10 years to fund immunisation.

“In 2018, the US government committed a grant of $288m for HIV/AIDS and health systems strengthening. A further $300m has been committed for 2019-2020. These grant donations are provided as commodities and support for health systems strengthening. Their support is a testament to the trust reposed in us having redeemed the image of the country,” he said.

He said with the templates already put on ground, the next dispensation will have a smooth ride and healthcare will be better off.

With the publication of these health advisory public templates by some of Nigeria’s best brains in the health sector as put together by THISDAY, time will tell if President Muhammadu Buhari, who just won his re-election, and the newly elected governors will pick up these public document and implement it right from the start of the next political dispensation on May 29, 2019.