Exploring the Political Economy of Health
As Nigerians go to the poll on March 11, 2023, to elect the Governors to pilot affairs in their various states, stakeholders at the Nigeria Health Watch (NHW), Future of Health Conference recently held in Abuja, have stressed on the importance of voting for a leader that would prioritise health financing as a means of investing the future of Nigerians. Sunday Ehigiator reports
As Nigerians wait the President-elect, Bola Ahmed Tinubu, to officially replace President Muhammadu Buhari come May 2023, following the outcome of the February 25, controversial presidential elections, political gladiators in their various states have intensified campaigns for who they believe has the best interest of the people at the state level at heart.
Private industry players, including those in the health sector, are also not left out at this critical stage of politicking, as they are all keen on asking the right questions from every candidate waiting to be elected as governor, so as to know their political agenda for the sectors they play.
For health sector players at the conference, they are convinced that there is no better time than during this political transition to remind political leaders that health is as critical to a nation’s development as the economy, infrastructure, security and other priority issues.
Hence, they say, health must take its rightful place of prominence in the political discourse, especially during political campaigns, as it affects every Nigerian, especially the less privileged.
This aptly informed the theme of the 8th edition of the Future of Health Conference, ‘The Political Economy of Health: Investing in the Future of Nigeria’.
The Opportunities
Delegates at the conference, including delegates from the public and private sectors including civil society organisations, national and subnational government representatives, private sector, academia, and multilateral organisations convened to discuss the political determinants of health that shape the distribution of resources; and the interplay between the political, social, and economic factors that shape individual and population health outcomes; and how to create a national health service that meets the needs of all Nigerians.
In her opening remarks, Managing Director of Nigeria Health Watch, Vivianne Ihekweazu said, “We understand the influence of political will and action on health; therefore, we chose the theme to redefine what the health agenda should be.
“This current political season affords us a window of opportunity to put health on the agenda of the political discourse”.
Considering that Nigeria’s health policies and strategies, especially at the state’s level have not changed much since colonial times, this season also offers the opportunity to strategically think about how best to deliver health and health care to Nigerians in various states.
Improved Health Budget
In his keynote address, Director General (DG) of, the Budget Office of the Federation, Ben Akabueze, represented by the Senior Technical Adviser to the DG, Professor Olumide Ayodele restated the Federal Government’s commitment to financing Universal Health Coverage (UHC) in Nigeria through the allocation of N1.1 trillion to the health sector in the proposed 2023 budget, representing a 33 per cent increase from the N823.5 billion allocated to the sector in 2022.
He said in recognition of the importance of health, as a key determinant of economic well-being and development, the government has accorded high priority to health investment financing over time in the budget, to meet health SDGs and achieve universal health coverage.
According to him, “the FG budget for the health sector has more than doubled over the past five years. Allocation to the sector was increased by 170 per cent from N305.1 billion in 2016 to N823.5 billion in 2022 and further by 33 per cent to N1.1 trillion in 2023. This figure is exclusive of health-related expenditure in other MDAs and grants which are health-heavy.
“Allocation to agriculture and WASH (Water, Sanitation and Hygiene) sectors follows a similar pattern. With this, you will see that the strategy of the government is to significantly increase allocation to the sector and also take into consideration the need to improve spending on agriculture, promote food security and nutrition, and increase allocation to the environment to improve sanitation, to increase allocation to water resources to ensure that we can promote the health of the people.
“If you allocate more resources to WASH sectors, you will be able to prevent the outbreak of diseases.
“A dedicated line was also created in the service-wide vault in the Federal Government budget for ease of administration. The line has consistently been funded as required and the government remains committed to contributing 2/3 of a total expenditure of $3 billion, from remains committed to contributing two-thirds of a total expenditure of $3 billion, from 2018 to 2028.
“In addition, the funds earmarked for the basic healthcare provision fund has been made in statutory transfer from 2021, for more effective implementation.”
He, therefore, noted that it was critical for governments at all levels to remember that providing effective health care services is their primary responsibility and primary health care services for Nigerians, particularly at the community level must be prioritised, in planning, funding and service delivery.
The Economy of Health
At the first panel session of the event titled, ‘The Economy of Health’, panelists spoke to salient issues surrounding national health development and the economic and political values attached to it.
They said Nigeria’s National Development Plan (NDP) 2021 to 2025, is designed to unlock the country’s potential in all sectors of the economy for sustainable, holistic and inclusive national development.
According to the Special Adviser to the Nigerian President on Finance and Economy, Dr Sarah Alade, “One of the four pillars of the Plan is to enable a healthier and more educated populace.”
She recommended that significant investment be devoted to the aggressive upgrade of health infrastructure in Nigeria. More importantly, technology should be leveraged to drive service delivery and data aggregation in the Nigerian health sector.
Building on the call for increased investment in Nigeria’s health sector, Professor of Health Economics and Policy and Pharmacoeconomics and Lancet Nigeria Commissioner, Professor Obinna Onwujekwe, observed that although health is an investment, with an often-overlooked connection to development, it is habitually perceived as consumer expenditure and not a contributor to social and economic development.
He advocated for multi-stakeholder collaborations for increased investment, as well as multi-stakeholder collaboration and political participation in health. There is no better example of this than the critical role played by the organised private sector in supporting Nigeria’s pandemic response. Private sector investments can further be harnessed to improve priority in the health sector.
Relating the importance of increased investments to critical health issues, the National President of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), Dr Habib Sadauki, said, “Health financing is a major determinant of the health of the people.”
He noted that maternal mortality, under-5 mortality, low contraceptive use, and malnutrition, among others, are strongly related to economic development. “Therefore, if Nigeria gets health financing right, it will improve human capital, which will, in turn, improve national socioeconomic and political development.”
In addition, the Founder of Flying Doctors Investment Company, Dr Ola Brown, noted that increased investment in healthcare can indeed solve all of Nigeria’s problems.
She said, “We need to look at Nigeria’s healthcare holistically, not just how to solve healthcare problems but also how to solve the country’s problems as a whole.”
Rounding up the discussion, Senior Health Specialist at the World Bank, Onoriode Ezire, highlighted the important contribution of healthcare investments in the economy.
He said “investment in health is directly related to the growth of the economy,” adding that an investment in health will contribute to reducing inequality and promote shared prosperity.
Politics and Health
Globally, from institutional strengthening geared towards achieving universal health coverage (UHC) to investments in health security and provision of family planning services, every positive health outcome was made possible because of strong political will.
However, it begins with creating an inclusive environment where citizens contribute to co-creating the health outcomes they desire and holding leaders accountable to their commitments, said the Country Director of Pathfinder International, Dr Amina Dorayi.
He added that citizen inclusion is a key factor that can either facilitate or deter progress in healthcare.
Executive Director, Chatham House Centre for Universal Health Coverage. Rob Yates spoke on the importance of using simplified languages for clarity purposes when speaking to political leaders about UHC financing.
According to him, citizens can only hold their leaders accountable if these issues are presented to them without any ambiguities, all “communication must be in simple language, devoid of too many technicalities.
“Clear communication will also help stimulate citizens to go beyond talking about the healthcare they want, to organising themselves at the community level to demand it.”
Executive Director of Enough is Enough Nigeria, Yemi Ademolekun, advocated for the media and civil society organisations to work effectively to mobilise citizens to engage in what’s important to them because “we must recognise that health is critical to both human and economic development in Nigeria”.
While Senior Economic Advisor at the United Nations Development Program (UNDP), Amarakoon Bandara, reiterated that health problems cannot be solved in isolation; they require the holistic involvement of government at all levels.
“There is therefore the need for continuous advocacy to governments at the subnational level to be more involved in delivering quality healthcare to their citizens.”
Political Leadership in Health
Given that Nigeria has a federal system, there is a clear need for political will to drive the implementation and domestication of federal health laws at the subnational level.
Speaking at the last panel session of the event, Honourable Commissioner for Health, Enugu State, Dr Obi Emmanuel, discussed the need to domesticate laws and policies like the National Health Act, National Strategic Health Development Plan, and the National Health Policy at the sub-national level.
“We should institute the rule to always plan, and then when we implement, always look at evaluating what we have implemented and then try again, because this is how others must have gotten it right,” he reiterated, speaking on ensuring effective implementation.
Honourable Commissioner for Health, Kaduna State, Dr Amina Baloni, spoke on the need to ensure adequate engagement with those who translate policies into action.
“This is to ensure that they understand the collective vision and buy into it. It is also essential for building leadership capacity at managerial, departmental and implementation levels, ensuring data is used and communicated and ensuring accountability at all levels.”
Honourable Commissioner for Health and Human Services, Ekiti State and Chairman of the Health Commissioners Forum, Dr Oyebanji Filani, said, in communicating with other social determinants of health stakeholders, he made sure to use narratives that painted a good picture of why health needed to be prioritised for each stakeholder even though the message was essentially the same.
“The narrative around the messaging had to reflect what mattered to them in a way that they found and figured out that health was a priority and needed to be given that approach”, he emphasised.
Lastly, former Commissioner for Health, Cross River State, Dr Betta Edu, stressed the need for health professionals to effectively communicate to politicians what increased investment in health would mean for UHC, economic growth and job creation.
According to her, health professionals need to step out of “our silos and think about healthcare the way politicians think about healthcare so that we can have the right framing to attract the right resources and the right interests for healthcare.”
CAPTION:
L/R: Honorable Commissioner for Health, Kaduna State, Dr Amina Baloni; Honourable Commissioner for Health, Enugu State, Dr Obi Ikechukwu Emmanuel; Managing Director, Nigeria Health Watch, Vivianne Ihekweazu; Former Commissioner for Health, Cross River State, Dr Betta Edu, and the Director of Programs, Nigeria Health Watch, Kemi Agbaoye, at the recently organised Nigeria Health Watch (NHW), Future of Health Conference in Abuja.
