Ensuring Universal Health Coverage in Gombe

 During his inauguration as the fourth executive Governor of Gombe State on May 29, 2019, Alhaji Muhammad Inuwa Yahaya vowed to provide an enabling and conducive environment aimed at strengthening good governance by pursuing meaningful and mutually beneficial policies, programmes and projects towards enhancing the wellness, wellbeing and socio-economic status of the state and the citizenry. Segun Awofadeji reports that three years down the line, the governor has initiated Universal Health coverage in the state using Primary Health Care as the corner stone to increase efficient, qualitative and affordable healthcare facilities and services as well as ensure availability of essential drugs, vaccine and immunisation across the 11 Local Government Areas of the state

Three years after his inauguration, landmark and remarkable achievements have been recorded placing Gombe state popularly called “Sahel in the Savannah” in a position of light and as one of the fasted growing states, not just in the Northeast sub – region, entire Northern extraction but Nigeria in general.

While campaigning for the governorship seat on the platform of the All Progressives Congress(APC), Muhammad Inuwa Yahaya discovered with concern that majority of people in the local government  areas of the state did not have access to quality health services due to inadequate infrastructure, absence of basic medical equipment and manpower. 
Governor Yahaya at the  time promised to among others to proactively implement strategies to achieve Universal Health coverage in the state using Primary Health Care as the corner stone to increase efficient, qualitative and affordable healthcare facilities and services as well as ensure availability of essential drugs, vaccine and immunisation across the 11 Local Government Areas of the state. 
And in his inaugural speech, the governor lamented that “Our healthcare delivery system is in a pitiable condition. We would, therefore, commence building of additional healthcare institutions, provision of medical facilities, equipment, training and retraining of healthcare personnel for better service delivery across the state.”

Apparently worried by the decay and poorly functional health system owing to years of neglect of this very important sector by past administrations, the Muhammadu Inuwa Yahaya-led new government upon assuming office also declared a state of emergency in the sector and set up a comprehensive agenda for the holistic overhaul of the system.   

The Gombe State Commissioner of Health,  Dr. Habu Dahiru described the approach adopted by the administration  towards revamping the health sector as broad-based and multi-disciplinary. 
“The health sector is one area where the governor covertly declared a state of emergency, and he did so because when he came into office the sector was literally gasping for breath but mid way into his tenure the situation is far much better now and I think you have seen it for yourselves”. 
To undertake any critical sector of the state for development like the health sector with the intent on making meaningful impact on the lives of the benefiaries in the respective communities across the state, funding remains key and it is in realisation of this fact that the Inuwa Yahaya administration considered it expedient to increase the budgetary allocation to the Primary Healthcare Development Agency by 49 per cent in 3020 and 30 per cent in 2021. 
Through the Primary Health Care Development Agency, at least one Primary health centre in each of the 114 wards in the state was either consructed or rehabilitated to deliver quality healthcare services to the people at the grassroot level and to guarantee effective service delivery, each of the  PHCs have been provided with a motorised borehole and solar power.
At an interactive session between state governors and high level Gavi delegation on Zero- Dose Children,  PHC Coordination and COVID-19 response in Nigeria, held at the Banquet Hall of the Presidential Villa,  Abuja, Governor Muhammadu Inuwa Yahaya says his administration revitalised and strengthened the Primary Health Centres (PHCs) in Gombe State in order to reduce the burden on secondary health facilities and ensure easy access to quality healthcare by all and sundry. 
Gavi, the Vaccine Alliance,  is an independent public-private partnership and multilateral funding mechanism that aims to expand global access to and use of vaccines, particularly among vulnerable children. 
Governor Inuwa commented on his administration’s efforts at strengthening the health system and ensuring PHC autonomy through its Equity Fund in addition to the ongoing Basic Healthcare Provision Fund(BHCPF), which is a federal and state funded initiative. 
He told the gathering that Gombe has enacted a law recently that earmarked not less than one per cent of the state’s and local government’s consolidated revenue as equity fund. 
“This fund alongside the BHCPF is being used to enroll poor and vulnerables in our communities to access health care at their ward level PHC. This has created a sustained source of funding to the PHCs enabling them to conduct their activities without hindrance, including the conduct of regular outreaches to underserved communities”. 
He revealed that over 40,000 poor and vulnerables, including internally displaced persons from the insurgency-wrecked neighbouring states have so far been fully covered under the state health insurance scheme, known as GoHealth. 
“Our recent investment that saw the complete revitalisation of 1 PHC in every ward has greatly improved the confidence of the people in our public health system; and as such with the commencement of the formal sector programme, we have witnessed the selection of public PHCs as their primary providers despite having the option to select private facilities by the formal sector employees”. 
He contended  that public trust is a key driver of uptake of essential health services including immunisation, noting that if adequate investment is made to improve the standard of the public health facilities and provide them with basic equipment and manpower, people will continue to have trust in the public heath system. 
To ensure quality service delivery of the PHCS across the state, Doctors, Nurses and other medical staff are posted to all the 114 Primary Health Centres. 
THISDAY checks revealed thatgovernment embarked on the upgrading of the state specialist hospital including the installation of relevant equipment that were hitherto lacking such as Xrays and Ultrasound machines, ECG, Echo, Endoscopy and equipping of the dialysis centre constructed by the past administration but left unequipped. In addition to that, one general hospital in each of the three senatorial zones is upgraded so as to make available to the people specialized services and reduce the burden on the state specialist hospital. 
The general hospital in Kumo is being completely reconstructed while that of Kaltungo and Bajoga are undergoing a state-of-the-art transformation. 
Other Cottage hospitals/health clinics are also gradually being renovated and upgraded such as Cottage hospitals in Mallam Sidi, Bojude, Kuri and General Hospital in Nafada. The government has also embarked on ensuring the construction of a cottage hospital in Filiya, Shongom LGA, the only LGA without any secondary health facility in the state. Still, government established a 12-bed Intensive Care Unit (ICU) at the SSH Gombe. 

Also to ensure the realisation of the Universal Health coverage in the state Governor Inuwa Yahaya provided counterpart funding to the tune of N605 million to NSHIP project, and to strengthen primary Healthcare, the government introduced the Gombe state Contributory Health Scheme (GO-Health) which uses the sector wide approach to healthcare financing. 
To ensure the effective coordination of health personnel, facilities and service delivery, the government, for the first time in the history of the state, established the Hospital Services Management Board and appointed credible, experienced and dedicated personnel to serve on the board, while remodelling of the State Specialist Hospital Gombe, General Hospitals Bajoga, and  Kaltungo are testaments to the effort of the Inuwa Government to transform the health sector for the benefit of the people.
Other major strides recorded by the Inuwa Yahaya administration during the period under review include ensuring the commencement of housemanship at the specialist hospital where at least 30 young doctors have been engaged to undergo their internship training. This was a strategic move considering the fact that the housemanship quarters located at the specialist hospital was abandoned for over 20 years. Its construction started in 1999 and all previous governments abandoned the project. 
The successful completion of the quarters in addition to the employment of specialist consultants enabled the state to secure accreditation to commence this programme. With this singular achievement, it means having at least 30 doctors every year undergo their training at the hospital thereby boosting the human resource availability at the facility. 
Also, employment of Consultants and Senior Registrars is also significant. For the first time in the history of the state, there are close to 20 specialist consultants working at the state specialist hospital. Before the coming of this administration, there were only 2-3 consultants. This was made possible because of the governor’s approval of the upward review of consultant’s salary in the state. This has made consultants in the state to earn more than their colleagues at the Federal Teaching Hospital. This has greatly resulted in drawing specialists to the state civil service. 
 Government also secured accreditation to commence residency training in Obstetrics/Gynecology and Family Medicine. Securing this accreditation would not have been possible if the necessary infrastructure, equipment and consultants are not available. With this now, the state will attract doctors from all over the country to come for specialist training in these fields of medicine thereby significantly increasing the available manpower to provide services. 
 The deployment of 147 nurses/midwives to all the 114 renovated PHCS in the state has been quite revolutionary in the state. This move has made available at least 1 nurse/midwife at all the PHCS located in the various wards of the state and drastically reduced the referral rate from the PHCS and reduced the incidence of maternal deaths associated with pregnancy and childhood morbidity/mortality. 
While commending the efforts of the Inuwa Yahaya – administration in transforming the state’s health sector in  the last three years, Muhammad Hassan of Gombe State University declared that “if there is one area one could vividly see the exemplary demonstration of political will and determination to provide the necessary strategic direction and oversight is the governor’s ability to take the centre stage whenever issues related to governance and leadership in the health system is concerned”.
Governor Inuwa Yahaya while summarising his achievements so far  in the health sector during the launching of a mobile application technology for Gombe State Contributory Healthcare Management Agency (GoHealth) in the state recently, said that “On our assumption of office, we declared a state of emergency in the health sector. Over the past three years, we recorded tremendous achievements across all areas of the health ecosystem. These include the establishment of the Gombe State Contributory Healthcare Management Agency, the settlement of all outstanding counterpart obligations and earmarking not less than one per cent of our consolidated revenue of the state and local governments as equity fund to complement the BHCPF in order to extend coverage of this laudable intervention to more vulnerable persons in our communities”. 
He launched the mobile app during a stakeholders engagement meeting on Basic Healthcare Provision Fund (BHCPF) organised by GoHealth in collaboration with the German International Cooporation GIZ, Legislative Initiative for Sustainable Development ( LISDEL) and Saif Advocacy Foundation.  The Governor maintained that the launch of the mobile application is in line with his administration’s aspiration towards providing quality and affordable healthcare services for the people through GoHealth. 
He declared that “”You will recall that on the 18th of March, 2021, I officially flagged off enrolment into the Basic Health Care Provision Fund (BHCPF) at Daban Fulani in Kwami Local Government Area. It is gladdening to see that the agency thereafter successfully enrolled over 25,000 poor and vulnerable across all the 114 wards of the state who have been accessing the Basic Minimum Package of Health Services at our revitalized primary healthcare centers since the 1st day of July, 2021”. 
He maintained that the participation of Gombe State in the BHCPF was made possible because of his administration’s commitment towards revamping the health care delivery system following years of neglect by the past administrations. 

Quote“To undertake any critical sector of the state for development like the health sector with the intent on making meaningful impact on the lives of the benefiaries in the respective communities across the state, funding remains key”