Editor’s Note: Dr. Benjamin C. N. Anyene passed away on December 29th 2019. He was a versatile and important part of the health reforms that defined the Nigerian health sector from the 2000s. In this Thought Leadership Piece, Health Systems and Policy expert Felix Abrahams Obi, who was one of Dr. Anyene’s mentees, highlights the incredible contributions that “Dr. Ben” as he fondly calls him, made to the foundational reforms that revived the Nigerian health sector. The Nigeria Health Watch team commiserates with the family and friends of Dr. Anyene, an Iroko in Nigeria’s health sector.
Nigeria entered the 21st century with a dismal health record. In the World Health Organisation (WHO) 2000 Report, our country was ranked 187th out of 191 countries, alongside war-torn countries with fragile health systems like Sierra Leone, Liberia and Somalia. The gains made in immunisation coverage in the 1990s had been reversed to about 13% and Nigeria recorded about the highest maternal mortality rate globally, 1170 deaths per 100,000 births, at the turn of the century. With the successful transition from military rule to civilian-led democracy, the appetite for transforming the health system was high against the backdrop of the poor health indices.
Dr Ben Anyene served as the Commissioner of Health in Anambra State between 2000 and 2003. His career turned in 2001 when he was appointed as Head of the Technical Committee and representative of State Commissioners of Health in the National Primary Health Care Development Agency (NPHCDA) Board, chaired by Prof. Olikoye Ransome Kuti.
Prof. Eyitayo Lambo then invited Dr. Ben to join the UK Department for International Development (DFID) Change Agents Programme (CAP) for Health Sector and Immunisation Reform in 2001, as part of the cohort selected from various parts of the country. The change agents were trained on WHO’s health system pillars and how to promote and advocate for reforms in the health sector. Dr. Ben and his CAP’s Policy and Governance Group members undertook a study tour of Ghana to learn how the Ghanaian health system functioned. Another team traveled to South Africa to understudy their approach to providing immunisation services.
The change agents reviewed their findings and brainstormed how to adapt them to reform the Nigerian health sector. They also reviewed the 1988 National Health Policy. Their analysis of Nigeria’s 1999 Constitution showed that health was not guaranteed as a right to citizens, and they set out to address this legislative gap. More importantly, the change agents knew it was important to have a comprehensive legal framework to back the reforms to be embarked in the health sector.
Dr. Ben and members of CAP’s Institutional Working Group (IWG) made a case for registering a local non-governmental organisation to continue the work. With DFID’s approval, they established the Health Reform Foundation of Nigeria (HERFON) in 2004, modelled after South Africa’s Health Systems Trust, with Dr. Ben serving as a member of the Technical Advisory Group.
Through his work with HERFON, Dr. Ben became one of the key actors that technically supported the implementation of Prof. Eyitayo Lambo’s flagship Health Sector Reform Programme (2004–2007) during the latter’s tenure as the Minister of Health. He was the lead consultant for the development of the 2004 Revised National Health Policy, and other sub-sectoral policies including the Blueprint for Revitalisation of Primary Health Care (2005), Public Private Partnership (2005), National Health Promotion Policy (2007), and Human Resources for Health (2008).
He was at the centre of HERFON’s efforts to reverse the widespread rejection of polio vaccines in Northern Nigeria and played critical roles in the development and implementation of a variety of policies, strategic plans and programmes towards achieving national health priorities over the past two decades. Dr. Ben was also one of the three Nigerians that developed the first draft of the National Health Bill which was submitted to the National Assembly in 2004 by President Olusegun Obasanjo. He advocated through the platform of HERFON and the Health Sector Reform Coalition (HSRC).
When President Goodluck Jonathan declined assent to the National Health Bill after the National Assembly passed it in 2011, Dr. Ben organised a series of consultative meetings with the leadership of health professional associations, Christian and Islamic religious bodies to address their concerns about the bill and worked assiduously to get their buy-in before the legislative process restarted in 2012. He also led HERFON’s efforts to engage major political parties to ensure that health was mainstreamed into their manifestos during each electoral cycle.
As Chair of HERFON’s Board of Trustees and HSRC, Dr. Ben led advocacy and engagements with the Senate and House Committees on Health leading to the passage of the bill by both arms of the National Assembly by August 2014, which was signed into law by President Goodluck Jonathan on October 31, 2014. He worked closely with the National Assembly to gazette the National Health Act (NHAct) and guided the Federal Ministry of Health (FMOH) to develop a roadmap for the operationalisation of the National Health Act (NHAct). The FMOH appointed him as a member of the NHAct Steering Committee in early 2015 and he also served as co-chair of the NHAct Leadership and Governance Technical Working Group.
The health community was shocked at the news of the sudden death of Dr. Ben in December 2019; he was 68 years old and had put in over 35 years of active service in the health sector. We lost a soft-spoken, wise and a courageous and father-figure and mentor. He used every opportunity to speak truth to power and sustained advocacy to ensure that allocations to the Basic Health Care Provision Fund (BHCPF) become statutory as enshrined in the law. He publicly expressed his frustrations with the slow pace of implementing the NHAct and didn’t realise his dream of having health facilities in the country obtain a Certificate of Standards following their comprehensive accreditation as laid out in the NHAct. He also invested his time and energy towards efforts to finance the local production of vaccines, which have yet to be realised.
It will be a befitting honour for stakeholders in the health sector to work with the Federal Ministry of Health to immortalise his name for his contributions in reforming Nigeria’s health sector.
Dr. Ben Anyene was married to Lady Ngozi K. Anyene, and they are blessed with four children. There is an online platform created to harmonise the sharing of memories, stories, experiences and pictures with Dr. (Sir) Benjamin C. N. Anyene. Kindly go to www.forevermissed.com/benanyene/about
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Author’s bio: Felix Abrahams Obi is a health systems and policy expert and a mentee of Dr. Ben Anyene. He is the Senior Program Officer cum Healthcare Financing Engagement Officer with Results for Development Institute (R4D) and has over 15 years of experience in the translation and use of research evidence to inform health policies and programmes.