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Experts in Nigeria’s health sector have called for coordinated efforts in the implementation of the recently developed Nigeria Health Sector Renewal Investment Initiative (NHISRII).
The initiative, launched by the Coordinating Minister of Health and Social Welfare, Muhammad Pate, in December was part of the government’s strategy to achieve Universal Health Coverage (UHC) by 2030.
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Speaking during a panel session on Wednesday, experts from academia, the health sector, the ministry of health, and the government, noted that the coordination in implementing the strategies would determine the outcome of the initiative.
The experts spoke during a health professional association/CSO policy dialogue with Nigeria’s Health Sector Leadership, organised by the Nigerian Academy of Medicine (NAmed) in collaboration with the development Research and Projects Centre (dRPC).
The speakers included Akin Osibogun, a professor and council member of NAmed; Muhammad Sadiq, a sub committee chairperson of a now defunct Presidential Health Reform Committee and Olanrewaju Tejuoso, the Chairperson of the Senate Committee on health in the 8th National Assembly.
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Others included Salma Ibrahim, a Senior Special Adviser to President Bola Tinubu on Health; as well as Muyi Aina, the Executive Director, National Primary Healthcare Development Agency (NPHCDA). Mr Aina was represented by Ngozi Nwosu, a director at the health ministry.
Challenges
Speaking, Mr Tejuoso noted that Nigeria has always had excellent health policies in theory but they always meet their hurdles during implementation.
He said the National Health Act, 2014, was a wonderful piece of legislation whose implementation lingered for more than four years.
According to him, the implementation of the law, which includes the Basic Health Care Provision Fund (BHCPF), took deliberate efforts from the National Assembly even when the executive allegedly failed to include it in the budget.
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He said: “When I was in the Senate in 2015, I met so many beautiful policies in theory on ground. One of them is the Health Act, 2014. For about four years, it was never implemented but it was such a beautiful presentation. The most important part of it, which is financial, was the BHCPF and was supposed to be introduced to the country by the executive in their budget to the Senate and House of Representatives for us to appropriate. But to my surprise it was never presented in the budget proposals. So how do we want to make this theory become practical if we do not implement the financial aspect that would make it work. So we had to on our own in the senate enforce the BHCPF into the budget of that year 2018. And to our surprise again in two years, the money was allocated but never spent.”
Mr Tuejuoso acknowledged citizens’ scepticism in trusting the government to cater for them. To encourage citizens to key into the initiative, he suggested that the government build citizens’ confidence by providing them with free quality service before introducing a paid service afterwards.
That way, he noted that the government would be able to convince the citizens of a quality and effective service delivery, which they would be willing to pay for.
“Even Nigerians that want to receive medical service, have lost confidence in our medical delivery,” he said.
“So our main focus now is to ensure if we are going to give free service to Nigerians for at least six months. Let them enjoy the quality service that we are supposed to be giving. They don’t believe you can give it. So, it would be a challenge to make them pay. These are the practical things that we need to focus on immediately.
“For six months, we can afford it. So that we can regain the confidence of the populace so that we can now start asking them to pay whatever we agree is the amount.”
Mr Sadiq shared the same sentiment, noting that the initiative, which focuses on Primary Health Care (PHCs) centres, has the potential of turning around the sector if well implemented.
He pointed out that Nigeria has in the past had excellent intentions put into legislation but they’ve not been translated into reality.
“Anybody that reads this plan will have no doubt that the plan has left no ambiguity about focus on primary healthcare. So primary healthcare has become the central to whatever the government is going to do,” he said.
“This is about coordination, getting all actors working together in synergy…All of the things that I read in the sectoral renewal plan are all excellent. They’re all going in an excellent direction if they can be actualised.”
Addressing demand and supply side
On his part, Mr Osibogun, a professor, said the government can increase the public confidence in the health system by investing in the facilities and strengthening workers’ capacity to improve the quality of service.
He said Nigeria’s health challenge must address challenges from both the supply and demand side.
“I’ve looked at the Health Sector Reform Renewal Agenda. It captures some of the things that we need to do, looking at both the supply side and demand side,” he said.
The supply side being the improvement of facilities and strengthening the capacities of health workers and the demand side being mostly the decentralisation of facility financing.
He commended the strategy and noted it would be great if it was ‘faithfully’ implemented.
Highlighting the challenges faced by Nigeria’s health sector, Mr Osibogun said Sub Saharan Africa accounts for 13 per cent of global population, 24 per cent of global burden of disease but three per cent of global workforce.
Yet, he said Nigeria is witnessing an unmitigated migration of skilled manpower, which is further worsening the manpower challenge.
According to him, fixing the supply side in the sector could help curb the flight of skilled professionals.
“The supply side will improve the quality of the facilities, the quality of the environment and may contribute to being able to retain professionals because if a trained professional and you know what to do and you don’t have the tools, you get frustrated and you want to go somewhere else. So, we should be able to improve the supply side in terms of improving the facilities through decentralised facility financing which I saw in the plan,” he said.
“I commend that plan. But of course there are areas where plans can be improved upon. I saw the decentralised facility financing, which is good if it is faithfully implemented.”
On the demand side, he said the most important thing is the implementation of the National Health Insurance law, which he noted would take the burden of healthcare expenses from the hands of individuals.
“You must be able to remove financial barriers to access. I see that in the plan we are also talking about the vulnerable group fund, conditional cash transfer, all these will remove barriers to finance,” he said.
He said although Nigeria passed the National Health Insurance law in 1999 and started implementation in 2005, less than 10 per cent coverage has been recorded.
According to him, Nigeria is making sluggish incremental growth when it should be ‘leapfrogging’.
“Ghana and Rwanda started implementation in 2004. Ghana has 60 per cent coverage. Rwanda has 80 per cent coverage,” he noted.
“My own recommendation is that we should start thinking about a totally decentralised insurance programme, talking about community based insurance schemes which is the pattern that Rwanda has actually adopted.”
Planning for health sector
Speaking about the government’s plans, Ms Ibrahim, the president’s adviser, said the government has held several engagements with stakeholders in the legislature, government personnel and development partners to come up with certain priority areas.
“We also considered and recognised the work done by the Health Sector Reform Committee because the report had been submitted,” she said.
She listed the priority areas to include governance, leadership and institutional reforms; review of legislations to fasttrack the implementation of the National Health Act as well as funding for the health sector.
“We also talked about the need to increase and innovative approaches to generate more resources for health beyond the existing lines we have of generating resources,” she said.
She said the government is also looking into boosting local production of pharmaceutical products.
“We must begin to produce. Even assembling in Nigeria. This is the only way Nigeria can be self reliant and independent,” she said.
Ms Ibrahim also said the government plans to strengthen the health systems, saying that the COVID 19 pandemic exposed the weaknesses of Nigeria’s epidemic preparedness.
She said: “We’ve seen the weaknesses which were exposed during the COVID pandemic and which shows what we’ve not been doing. Our systems are very weak even in responding to the epidemic like cholera, lassa and so on. So much needs to be done to strengthen the emergency preparedness and response. And that is another area that was prioritised. We need to strengthen the institutions. Not only the national level but more needs to be done at the sub national level in terms of systems and capacities for them to be able to respond to epidemics or pandemic that comes up in the future.”
About NHISRII
Speaking about the initiative earlier, Executive Director, National Primary Healthcare Development Agency (NPHCDA), Muyi Aina, said the initiative is not just a blueprint to transform the health sector but a “shared commitment to a healthier and more prosperous Nigeria.”
Represented by Ms Nwosu, a director at the health ministry, Mr Aina said: “The strategic plan aims to save lives, reduce the physical and financial pain for all Nigerians and produce health for all of us, regardless of our socio-economic status by rapidly improving on our current dismal health indexes.”
He said the health sector renewal initiative is anchored on four pillars which include effective governance for the health sector, efficient, equitable and quality health system, unlocking the value chain as well as health security.
“It will be driven by a sector wide approach and a key enabler to always be adopting a more coordinated approach between the federal government, the state government and all development partners.
“Another enabler is financing. In terms of increased effectiveness of spending and aligning spending with strategic priorities as against just increasing the allocation of funds. This will also entail digitalisation of health systems to ensure evidence-based decision making, as well as institutional strengthening of the MDAs to institute performance based culture.”
The NPHCDA boss listed the indicators to measure performance include fewer deaths, improved quality of life and care, reduced financial strain and reduced risk factors for both communicable and non-communicable diseases.
“Improve reproductive maternal, newborn, child health, adolescent nutrition as well as improved access to health services, equity, early detection and response to disease outbreaks and local production of health products including vaccines and other drugs,” he added.
He said the government is also redesigning the main gateways of the Basic Healthcare Provision Fund as the foundational basis for this sector wide approach to ensure more equitable allocation of resources to the poorest and the most disadvantaged populations and mobilise additional development partner support for a more coordinated approach.
He noted that the government plans to double the number of fully functional primary health care facilities, receiving decentralised facility financing for infrastructure upgrades and operational costs to ensure delivery of high quality essential primary health care packages.
“Working with the states, the NPHCDA will focus on improving the functionality of primary health care services across the country. Starting with the existing 8809 fully functional facilities currently supported by the Basic Healthcare Provision Fund and gradually expanding to about 17,680 facilities over the next four years in the 36 states and the FCT.”
Qosim Suleiman is a reporter at Newslodgein partnership with Report for the World, which matches local newsrooms with talented emerging journalists to report on under-covered issues around the globe
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