A new year is here, the end of one decade and the beginning of another, depending on where you place your marker. The year that passed witnessed some incredible moments in Nigeria’s health sector, and as we begin 2020, it’s important to reflect on what went well in 2019, and what we must look to achieve in the next decade.
The final 2019 Top Ten Health Items in Nigeria was a compilation of ten significant news stories that defined Nigeria’s health sector in the past year. They cover a gamut of issues which, as advocates who want to see a better health sector, we have now and again brought to the limelight for discourse.
Probably most prominent in health sector conversations in 2019 was the issue of Universal Health Coverage (UHC). It was the theme selected by President Muhammadu Buhari as the focus for the National Institute of Policy and Strategic Studies’ (NIPSS) Senior Executive Course 41 (SEC 41). In January 2019 the President rolled out Nigeria’s Basic Health Care Provision Fund (BHCPF) and it went into the first stages of implementation. The President also launched the National Strategic Health Development Plan II at the same event, adding that both documents were geared towards achieving Universal Health Coverage. Premium Times reported that the Federal government earmarked N55.1 billion for the Consolidated Revenue Fund (CRF) to the basket fund of the BHCPF, while the Bill and Melinda Gates Foundation contributed $2 million, out of which $ 1.5 million has been released. The Global Financing Facility (GFF) also committed $20 million to the fund, and the Department for International Development (DFID) reportedly put in £50 million over the next five years.
Further pushing forward the UHC agenda, the Senate in April 2019 passed the National Health Insurance Bill. In August 2019 the Federal Government released N12 billion to three agencies for the implementation of Basic Health Care; The National Primary Health Care Development Agency (NPHCDA), the National Health Insurance Scheme (NHIS), and the Nigeria Centre for Disease Control (NCDC). Premium Times reported that a breakdown of the disbursement shows that 50 per cent (N6.5 billion) went to NHIS, the NPHCDA got 45 per cent (N5.8 billion) and the NCDC, 2.5 per cent (N327 Million).
For World UHC Day on December 12th, as part of the #Health4AllNaija campaign, the Nigeria Health Watch team visited Jiwa, a community on the outskirts of the Abuja Municipal Area Council, to learn what they understood about the BHCPF and if the Primary Health Centre in the community which was an accredited BHCPF facility was functioning accordingly. The event was sponsored by a grant from the UHC2030 Coalition and delivered in partnership with Centre for Family Health Initiatives (CFHI). In the NHW blog on the event, Programme Analyst Aloysius Chidebere Ugwu reflects that while the community was adequately sensitised about the benefits of the Fund, implementation in that community had hit a bottleneck due to the requirement to pay fees for blood tests. In 2020, how will the BHCPF train move forward?
Healthcare financing will probably always be a huge topic in Nigeria’s health sector. 2019 saw robust discussions around the role of the private sector in partnering with government to finance healthcare. What innovative models exist that can be replicated or contextualised for the Nigerian ecosystem? PharmAccess’ partnership with the Lagos State Government in relation to primary health care delivery seems to be a promising model. We of course cannot talk about health financing without mentioning the State health insurance laws that 31 States have signed and begun implementation. These laws will define health financing in Nigeria in this new decade, if implemented judiciously, and it is up to engaged citizens of each state to help hold their governments accountable to those laws.
The conversation around financing health cannot be complete without the donor partnerships that have for years fueled development work in Nigeria’s health sector. In January 2019 the Bill & Melinda Gates Foundation (BMGF) signed a $75m financing agreement with the Federal Government to support childhood immunisation in the country. In October 2019 Global Fund Partners pledged $14billion to tackle Malaria, AIDS and Tuberculosis. The funding from donors is critical but so is sustainability. With Sustainable Development Goals (SDGs) deadlines looming in 2030, what does Nigeria hope to achieve in the next decade in these critical development areas?
What is vision without leadership? In 2019 Nigeria’s health sector welcomed a new Captain, Dr Osagie Ehanire, as the new Minister of Health. Alongside him and functioning in the office of Minister of State for Health is Dr Adeleka Mamora. Dr Ehanire is not a new face in the health space and as he enters his first full year as Minister of Health, the sector will rely on his experience and expertise to drive the necessary changes and initiatives in the space. 2019 also saw the suspension of the Executive Secretary of the NHIS, Dr Usman Yusuf, and the re-appointment of the Director General of the NCDC, Dr. Chikwe Ihekweazu. The NCDC led the response to several infectious disease epidemics throughout 2019, including outbreaks of Cholera, meningitis and monkey pox. Strengthening surveillance and laboratory systems and building partnerships in the region also seemed to be key foci for NCDC in 2019. NCDC needs more funds appropriated, budgeted and released to achieve all they have set out for this year. The #PreventEpidemicsNaija project is advocating for increased funding for epidemic preparedness to protect Nigerians from infectious diseases.
A new Director General was also appointed at the National Agency for the Control of AIDS (NACA), Dr. Gambo Aliyu. NACA successfully completed the largest HIV/AIDS Survey in the world, the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), and the results were made public in 2019. The survey included approximately 168,100 participants, ages 15–64 years and children, ages 0–14 years, from the selected households, and helped characterize HIV incidence, prevalence, and viral load suppression. This has helped to redefine HIV/AIDS programming in Nigeria by providing critical and accurate data. The new clarity is set to help NACA’s team in their drive towards meeting the UN 90–90–90 goal for HIV/AIDS.
Leadership has always been a critical aspect of health care reform and delivery. Will 2020 and the next decade bring with it good governance, transparency and accountability?
In August 2019, Nigeria marked three years without a single polio infection, taking one more critical step towards a polio-free certification by the World Health Organisation (WHO), which is set to be announced in March this year. Nigeria was previously removed from the polio-endemic list in 2015, but in August 2016 two cases of polio emerged in the newly liberated areas of Borno which were previously under insurgency by the terrorist organization Boko Haram. If Nigeria maintains the status quo and current efforts, 2020 will go down in history as the year the country was declared polio-free, a huge feat to be sure on the journey towards polio eradication. So, what happens afterwards? How do we consolidate the lessons learned from ousting polio?
2019 was one year maternal health came to the forefront of public discourse. The sector witnessed incredible conversations and commitments towards making it safer and healthier for women to give birth in Nigeria. From the NPHCDA declaring a national emergency on maternal health and creating the National Emergency Maternal and Child Health Intervention Centre (NEMCHIC), to the development of initiatives meant to provide community focused healthcare access to women, such as the Gombe MNCH Project, to the #GivingBirthInNigeria project sponsored by MSD for Mothers and being implemented by a consortium of Africare, EpiAFRIC and Nigeria Health Watch, 2019 was indeed the year for women’s health to be central on the agenda. And for good reason, for when women are healthy, the whole society benefits.
The centrality of women’s health to Nigeria’s development indices cannot be overlooked. And in 2020, from family planning to sexual and reproductive health, to child nutrition, to immunisation, as a country Nigeria cannot afford to ignore its women and children. The vision for better maternal health in Nigeria was aptly surmised when MSD for Mothers Lead and Executive Director, Mary-Ann Etiebiet said at the 2019 Future of Health Conference, “Women should not die in childbirth. It should not happen, and we know what to do to prevent it. We all have a role to play, and one woman at a time, we can end maternal mortality.” We must carry this vision to reality, for our daughters, and theirs.
2020 is here, and many of us have worked on strategies to help us achieve our goals. We have made our resolutions, we have planned for the days ahead. We must remember that Nigeria’s health sector can only live up to the vision we collectively build, and the healthy tomorrow we want for all Nigerians must be birthed… today.
Here’s to another decade of making the vision of a great Nigerian health sector… a reality. Join us.
How do you plan to make Nigeria’s health sector great in the next decade? Share your insights with us on our social media platforms!
Leadership is the biggest log in the eyes of Nigeria health sector. Whatever little is budgeted, appropriated and released, the fund should be accurately allocated based on priorities. It is very sad that the government talks about basic health care when attention to water and sanitation is still a mirage. How will you control common infectious diseases when this area is not adequately addressed? If all the states capitals and major cities are covered with dirt, what will it be said of the rural stings? It is pathetic when government pay lips service to critical health financing with gold coated speeches but action-wise there is nothing insight. Addressing basic health care is the sure way to go.