Health Policy

Can this National Council on Health be the beginning of real change for the Nigerian Health Sector?

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Editor’s Note: In this week’s Thought Leadership Piece, Felix Abrahams Obi, a health system research and policy analysis expert with the Health Policy Research Group of the University of Nigeria, writes about the Emergency Session of the National Council on Health that recently held in Abuja.

A few hours after President Buhari launched the #ChangeBeginsWithMe campaign on Thursday, September 8, 2016 at the Presidential villa in Abuja, key partners within the health sector convened at the Conference Hall of the Federal Ministry of Foreign Affairs to hold an Emergency National Council on Health. The 58th National Council on Health (NCH) held earlier in March 2016 with the Sokoto State Government as hosts.

The 2014 National Health Act recognizes the NCH as the highest policy-making body within Nigerian health sector. The responsibilities of the NCH include the protection, promotion, improvement and maintenance of the health of the citizens of Nigeria and the formulation of policies. The Council is also tasked with ensuring the delivery of basic health services to the people of Nigeria. It is obvious that members of the NCH carry upon their shoulders the weighty responsibility of fixing Nigeria’s weak and dysfunctional health system. It also goes without saying that they should be accountable for their actions, because their decisions will have  an indelible impact on our health outcomes.

Attendees at the Emergency National Council on Health.

Attendees at the Emergency National Council on Health

Unlike the 610 delegates and representatives of 34 states in attendance at the 58th NCH that held in Sokoto, there were lots of empty seats at the 2016 Emergency NCH in Abuja. Notably absent at the ‘high table’ were the newly-appointed CEOs of the National Primary Health Care Development Agency (NPHCDA) and the National Health Insurance Scheme (NHIS); the two most important agencies for the issues on the table on the day. However, the  Permanent Secretary of the FMoH, the CEO of Nigerian Centre for Disease Control, and the Director of Planning, Research and Statistics were all present.

The meeting’s initial focus was to be the adoption of the 2016 National Health Policy. Minister of Health Prof Isaac Adewole, in his opening address, noted that an update on the government’s response to the recent cases of wild polio virus in Borno State, the persistent Lassa Fever outbreaks and the need to fast-track plans to achieve Universal Health Coverage, had later been included in the agenda.

He also said he would provide the Council details of the 100 days’ Rapid Results Initiative tagged ‘Better Health For All Programme’ (BH4A) which was launched on July 2016 to respond to critical health needs of Nigerians  and rebuild the citizens’ trust in the ability of the health system to deliver and respond to their health needs. As at the time of the meeting, the BH4A had already crossed the 52nd day of implementation, and I was for one keenly waiting to hear what progress had been made, including  how many PHCs had been revitalized out of the 101 targeted for this first phase. The programme is also supposed to inaugurate up to 30 Mutual Health Associations (MHAs) to disburse funds to health facilities for better access to health care, and provide 10,000 surgeries carried out in 46 tertiary hospitals for indigent Nigerians.

There were no updates on any of these components at the NCH meeting. Rather, the Minister, who had just attended the launch of the #ChangeBeginsWithMe Campaign, said in his speech that, “We have articulated a transparency and accountability plan to support these initiatives. We shall engage with all suitable communications media to provide Nigerians with information on our progress and challenges, and to query our work and receive responses as appropriate”. A visit to the official Twitter handle for Better Health for All (@BetterHealthNGR) as of Sept. 12, 2016, shows there have been no recent tweet updates on the implementation of the #BH4A programme since its official launch in July, save for retweets of posts by the Office of the Minister of Health (@Fmohnigeria) during the official launch of the Saving One Million Lives Program for Results (SOML PforR) that held on the 16th of August 2016 in Kaduna.

Minister of Health Isaac Adewole speaks at the National Council of Health

Minister of Health Isaac Adewole speaks at the National Council of Health

It is imperative that Nigerians continue to call for openness and transparency in the use of public resources by the government, and especially so in the health sector, which continues to be in dire need of reform.

The Council approved the newly developed 2016 National Health Policy (NHP) which replaces the 2004 National Health Policy. The FMOH should be commended for the fast pace at which the new policy was developed under the NHP Technical Review Working Group led by former Minister of Health Prof. Eyitayo Lambo.  Also noteworthy is the manner in which key stakeholders at the national and sub-national levels, including development partners, the private health sector, Academia and Civil Society Organisations (CSOs), were engaged during the policy development process. If successfully implemented, the 2016 NHP, themed “Promoting the Health of Nigerians to Accelerate Socioeconomic Development,” could help Nigeria to achieve Universal Health Coverage (UHC) and sustainable health development in the years to come. The 2016 NHP also incorporates the key provisions of the 2014 National Health Act as part of its policy thrust.

Implementing the 2016 NHP will require a well-articulated plan, and the FMOH shared with delegates at the NCH its roadmap for developing the 2nd National Strategic Health Development Plan (NSHDP II).  The NSHDP II is expected to provide the supporting framework for the successful implementation of the 2014 National Health Act. It will also serve as the over-arching investment case for Health and the Global Financing Facility launched in 2015 in Ethiopia during the Financing for Development conference. One of the critical steps the Ministry of Health should take is the evaluation of the implementation of the first NSHDP, to generate evidence that will inform the development of the NSHDP II document, which is expected to be adopted at the 59th NCH in Abia scheduled for November 2016.

These two documents – the National Health Policy and National Strategic Health Development Plan could turn out to be the foundations of a new dawn, one that will make emergency responses such as the 100 days’ Rapid Results Initiative unnecessary.

As part of the update on the operationalization of the National Health Act, the new DPRS Dr. Oyemakinde) made a presentation of the much-expected draft ‘Guidelines for the Administration, Disbursement, Monitoring and Fund Management of the Basic Health Care Provision Fund’.

BHPFThe BHCPF is to be used to pay for the provision of a Basic Minimum Package of Health Services (BMPHS), the funding of operational expenses of PHCs across Nigeria, and for funding the provision of Emergency Medical Treatment for the care of Road Traffic Injuries (RTIs) arising from ‘accident hot-spots’ across the country. According to draft guideline, the funds from the BHCPF will be disbursed to the states and LGAs through 3 major gateways, namely the NHIS, NPHCDA, and the Emergency Medical Treatment Gateways.

This presentation elicited feisty discussion among the delegates. Dr. Jide Idris, the Lagos State Commissioner of Health asked about the roles of State Governments and their State Health Insurance Agencies in the BHCP Fund management process. He also wanted to know how State Medical Ambulance Systems will be integrated into the Emergency Medical Treatment Gateway. The Niger State Commissioner of Health Dr. Mustapha Jibril, expressed concerns about the use of third party agents such as Health Maintenance Organizations (HMOs) which he felt may circumvent existing state structures. He also felt that the proposed composition of the Ministerial Fund Oversight Committee may not guarantee full representation of the 36 states. He suggested that at least one state from each of the six geopolitical zones could suffice.

Commissioners interact during the National Council on Health meeting

Commissioners interact during the National Council on Health meeting

The Commissioner of Health from Katsina State questioned the proposed plan to provide the Basic Minimum Package of Health Services (BMPHS) to only rural women, against the provisions of the NHAct which guarantees BMPHS to all Nigerians. Dr. Mike Egbo, a member of the Health Sector Reform Coalition who was arrested in 2014 over his advocacy efforts for the NHAct, wondered if the proposed governance structures in the draft BHCPF guidelines aligned with the provisions of the NHAct, so as to avoid setting up a parallel bureaucracy.

The absence of representatives of the NHIS at the meeting was glaring, as many of the states’ concerns were about the NHIS Gateway. Commissioners were also concerned that they only received the draft guidelines to review the night before, and were being expected to adopt it at the meeting. The Minister of Health moved for the adoption of the draft guidelines to facilitate the process of including the BHCPF in the 2017 budget, but eventually agreed to set-up a five-member Committee made of up Health Commissioners from Delta, Lagos, Borno, Niger and Anambra States to review the guidelines and make further recommendations at the 59th NCH in Abia in November. Their work will be critical in shaping the future of the guidelines.

It would be advisable for the Ministry of Health to share the gazette copy of the 2014 National Health Act and the draft BHCPF Guidelines through its official platforms (e.g. on their website)  for Nigerian citizens to understand the key provisions of the Act as well as the operation of the BHCPF. If this is done, it would align with the Adewole’s commitment to wider stakeholder engagement in the health policy process. “We need you to own and take the driver’s seat in fostering the implementation of the National Health Act 2014 and the National Health Policy 2016,” he said, “We need you to work together with us to strengthen our surveillance systems and ensure that our response remains timely and effective.”

We will wait till the 59th NCH in November to see the extent to which the Minister has kept his words to Nigerians. Involving Nigerian citizens in making decisions that impact on their health is an inalienable right, one which the 2014 National Health Act seeks to promote.

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