RECENTERING HEALTH AS SOCIAL WELFARE

Nigeria needs a health sector fashioned as a social welfare rather than an epicenter of policy, argues Paul A. Obi

“Pioneering spirit should continue, not to conquer the planet or space… but rather to improve the quality of life and health…”

–          Bertrand Piccard

Explorer, Psychiatrist & Clean Technology Pioneer

For too long, the tragedy of policies and their implementation in Nigeria stemmed from their inability to connect policy initiation to derivable outcomes, leading to inertia about potential benefits to citizens and target users. Even as welfare is a central thematic focus by the framers of the Nigerian 1999 Constitution, the health component of such social welfare has not been extensively and broadly recentered, repurposed or reconnected to the centrality of the constitutional requirement for welfare as state policy. For the most part, health care service delivery has been reduced to the tokenism of talk shops in Abuja and policy cottage industry for pseudo-health related non-governmental organisations that littered all around. But the challenge of delivering health care to the poor, rural communities and the have-nots should ordinarily go beyond the ideals of policy, to improving life and situating health at the centre of government welfare intervention to care for those who the real essence of government and governance is critically meant for.

The pragmatism of ensuring health becomes a social welfare package for the citizens does not come easy. It requires painstaking efforts geared towards changing the direction of policy – from time wasting formalities to actually providing the needed and practical succour, services and actionable plans for those struggling to escape the poverty net or those entrenched deep in its squalor. In that sense, the complete package of government agenda on health is that which combines policy, initiation, infrastructural development, implementation, healthcare commodity provision and even free healthcare itself as an amalgam of social welfare as the end-game. As President Bola Ahmed Tinubu’s administration braces up to this important task with Prof Muhammad Ali Pate on the saddle as the Coordinating Minister of Health and Social Welfare, there is therefore ample opportunity to stir the health sector more from policy-centric to social welfare centric as the basis of any transformational agenda within the sector.

As the minister himself, recently acknowledged, “the health sector is undergoing transformation” in which, Pate said is encapsulated by four pillars, that include: improving health sector governance, scaling up population healthcare outcomes, unlocking healthcare value chain and ensuring health security among the populace. If the implementation of these four pillars is to be sustained to achievable outcomes, they should be conceptualized as deliverable social welfare packages by the federal government. Of course, the challenges of ensuring that the 36 states of the federation and the Federal Capital Territory (FCT) key in is onerous. But the ability of the central government in Abuja to set a template using its 30 teaching hospitals, 22 federal medical centers, 21 specialty hospitals, five major agencies and 16 regulatory agencies and simulating same with the 36 states is important to ensuring that healthcare goes beyond policy and number of infrastructure to a social welfare package that improves and better the quality of material lives of the citizens.

To discreetly respond to the above health needs and how to retool the required health services as social welfare, two factors must be taken into account: one) the potency and efficiency of the primary healthcare sector, and two) the calculus of health economics. Starting with the first, as the former Executive Director of the National Primary Health Care Development Agency (NPHCDA), Pate is a great fit to revitalize the primary healthcare sector as a conduit to transform health from the overt fixation on policy to social welfare. Here, primary healthcare centers – including those built by NPHCDA and state governments would have to be reinvigorated from mere elementary check-up centers for Malaria, Fever and Catarrh to real avenues for better health. Again, the best way to address this challenge is to redirect the influx of medical doctors from urban centers to rural communities through improved conditions of service. While our tertiary health institutions like teaching hospitals should remain as centers of research; our primary health facilities must have to be upgraded infrastructure wise.

Beyond the expected focus on primary healthcare, what the federal government does with healthcare in the urban and semi-urban centers matters a lot to addressing the accessibility gap and the growing cases of avoidance of public health facilities across the metropolis around the country. One of the challenges that characterized public health facilities in urban centers deals with the issue of trust of services. Citizens in need of clinical health services often posed questions like whether they would receive the best form of medical attention in such facilities? What will be the attitude of health workers and care providers in public hospitals? What level of promptness and response mechanism is in place to attend to patients in critical situations or those that require intensive care unit (ICU) services? The federal government in conjunction with the 36 states must provide answers to these salient questions as a way forward to a new deal in the nation’s health sector.

Another profound challenge or puzzle that the minister, the Minister of State for Health, Dr Tunji Alausa, experts and professionals and the government generally need to resolve is the calculus of health economics required to reset Nigeria’s health sector from policy-centric to social welfare package. Here, maybe, the government would have to return to earlier policies initiated then by former Minister of Health, Prof. Eyitayo Lambo focusing on scaling up health economics in the country. The most critical issue to resolve here is how does the federal government drastically reduce or erase out-of-pocket spending for low-income earners and the poor generally. As the federal government navigates several pathways to stem out the prevailing economic hardship, inflation and high cost of living, it is pertinent to ensure that money and cash is not further taken away from low-income earners seeking for better health and life. If our healthcare service delivery is to be re-enacted as a social welfare, fashioning out that no mother, child or a poor man pays for healthcare services in any of the tertiary, secondary or primary services is a sure way for redistribution of income in economic terms. The middle class, bourgeois and plutocrats could be compelled to pay, but not the poor. 

From the foregoing, healthcare funding and financing becomes an important factor not just for the federal government, but also the states and international funders as well. In fact, at the recent Legislative Summit on Health, Pate himself put it aptly about this challenge and how to address it. The minister observed that, “many Nigerians rely on public facilities, private facilities, sometimes do not seek medical care at all due to affordability issues,” stressing further that, “Public health spending is approximately $13-14 per person, with total health spending at $85, most of which is out-of-pocket. This is insufficient, especially when compared to countries like Ethiopia and Bangladesh, which achieve better health outcomes with similar or lesser spending. “There is significant fragmentation across federal, state, and local levels, with each operating independently rather than as a cohesive national health system. “Many primary healthcare centres and hospitals are underfunded and lack essential resources and trained personnel,” Pate stated.

The overall aspiration and expectations of citizens from the government is that when they are sick or their health takes a downturn, the government as a welfare interventionist will be readily available to offer help and assist, and provide better health and life. Yes, tremendous efforts are being made, and with the prevailing innovations by Pate and the rest of the team to revamp the Nigerian health sector far from nebulous policies to actionable outcomes is a strategic way to go. Still, how that evolved matters as well. But a more resounding way to respond to the health sector challenges and appreciable outcomes lies in retooling and recentering the sector more as a social welfare. Thus, disentangling the many difficulties, challenges and problems associated with the Nigerian health sector through actions directed towards health as social welfare will bring applause than the long stay on policy. For now, Nigeria needs a health sector fashioned as a social welfare rather than an epicenter of policy. The new name of the ministry should also be reflected in its tact, plans and actions. 

Obi is a lecturer, journalist and researcher based in Abuja

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