Every new year comes with high expectations, with the hopes of new opportunities to make a difference in the Nigerian health sector and new energy to carry on ongoing projects. 2018 is here, and with it comes a whole new year of possibilities for the Nigerian health sector. Last week, Nigeria Health Watch summarised some of the key themes that dominated the health sector in 2017, a few will continue into this year.
As 2018 kicks off, we asked various organisations in the Nigerian health space to share their key priorities with us as they strategise for 2018. We reached out to government and non-government organisations, as well as development partners to find out how they plan move their agendas in the Nigerian health sector forward in 2018. This will enable Nigerians to better understand what to hold their public officials accountable right for, from the start of the year. We also wanted to articulate key issues that we believe should be at the forefront of every Nigerian’s mind, as the country enters a critical year for governance en-route to the 2019 presidential elections.
1.) Making progress towards Universal Health Coverage (UHC):
This is the big one – the momentum towards the implementation of a comprehensive government-led Universal Health Coverage strategy has been growing since 2015. UHC should be at the forefront of every health-conscious Nigeria’s mind as a strategy that provides them and their neighbour better quality and affordable access to quality healthcare, avoiding significant out-of-pocket expenditure.
For Charles Usie, Country Representative for Christian Aid UK Nigeria (CAid), Community-Based Health Insurance schemes are critical mechanisms to progress towards UHC in Nigeria, and will be a key focus of the CAid team in 2018. “As long as majority or poor ordinary Nigerians continue to pay for health services out of pocket, we will not be able to justify the mortality and morbidity rates in Nigeria,” he said.
Dr. Sunday Udo, Chief Executive Officer TY Danjuma Foundation, mentioned that a lack of National Health Insurance Scheme (NHIS) coverage nationally as well as inadequate human resources for health are issues the foundation will prioritize this year. “One of the key challenges is a shortage in the quality, quantity and mix of health care workers in Nigeria… NHIS coverage is still far below expectation.” For UHC to work, resources must be available, both in manpower and equipment.
In 2018, citizens should also pay attention to new state health insurance laws, which states started putting in place after the National Health Act was signed into law in 2014. Signing a State Health Insurance Scheme into law is one of the requirements states must meet if they are to access the national basic healthcare provision fund provided for in the National Health Act. If your state has signed into law a health insurance scheme, now is the time to push for implementation. If your state has not signed a health insurance scheme into law, what is holding your state back? So far, 14 states have signed health insurance schemes into law. They are; Lagos, Oyo, Ekiti, Delta, Bayelsa, Cross River, Akwa Ibom, Kwara, Abia, Adamawa, Kano, Anambra, Sokoto, and Enugu state.
In addition to holding states accountable, Nigerians should not wait! If one can afford it, it is better to purchase health insurance for yourselves and families than to pay out-of-pocket. The NHIS’s website has a breakdown of different types of health insurance schemes available. Approach any of the HMO’s listed and choose your plan!
In 2018 the main demand for health advocates is that the Buhari Administration should include in the 2018 budget the 1% Basic Healthcare Provision Fund (BHPF) stipulated in the National Health Act that was passed by former President Goodluck Jonathan in 2014. The 1% BHPF is meant to help address several deficits in primary health care service delivery that will ultimately support the goal of UHC. Nigerians should also demand that their states and Local Government Areas (LGAs) meet the requirements of accessing the BHPF. States are required to provide 25% counterpart funding as well as set up primary health care and State Health Insurance Bills in order to access the fund.
Dr. Paulin Basinga, Nigeria Country Director for the Bill & Melinda Gates Foundation, noted that supporting health financing is high in the foundation’s priorities for 2018. “A significant part of our work will include partnering with the government on the issue of health financing as it pertains to strategic purchasing of healthcare commodities, transition away from donor financing etc,”. He further noted that “In 2018 we will focus specifically on working with the government to enable the launch of a functioning Basic Healthcare Provision Fund, as mandated by the National Health Act, with a particular emphasis on strong implementation starting in the three pilot states—with the potential to scale up in the coming years.”
2.) Achieving Polio Elimination:
The re-appearance of polio in Nigeria in 2016, after the country was declared polio-free in 2014 resulted in a more determined and proactive response by the National Primary Health Care Development Agency (NPHCDA) officials and development partners. Nigeria is one of the last three countries in the world still battling polio and 2018 presents an incredible opportunity for the country to finally and completely eliminate this disease. Dr. Paulin Basinga, Nigeria Country Director for the Bill & Melinda Gates Foundation (BMGF), listed polio eradication and routine immunization as two key priorities for the Foundation in 2018. “We will support the government’s continued efforts to maintain a strong polio program alongside international partners, to ensure children are immunized against the disease, and that we remain vigilant. Success will mean that, in 2020, Nigeria can achieve WHO certification for having eradicated the disease,” he said.
The urgency for polio eradication and adequate government funding for routine immuniziation cannot be understated, especially given that Nigeria may have limited access to vaccine finance in the future. Dr. Basinga also noted that “At the same time, Nigeria’s “Middle Income Country” status means that in the coming years it will become ineligible for financial support for vaccines from Gavi, The Vaccine Alliance”.
3.) Prioritising Nutrition:
It is time to put nutrition firmly on the agenda! With 1,000 children dying in Nigeria every day of malnutrition, it is clear that as a country we are failing the next generation in the most basic aspects of feeding. Every Nigerian should push their state to ensure that funding nutrition is included in states budgets, and ultimately ensure the funds are released as quickly as possible. In 2017 the Buhari Administration launched its nation-wide school feeding programme.
Are you aware of this programme in your state and if it is working in the schools in your community? Finally, awareness about proper nutrition is key for families and communities in order to reduce the burden of malnutrition in the country. We can do more with the little we have.
4.) Owning our HIV Care & Treatment Programme:
Nigeria carries the second largest burden of HIV on the continent, and in 2017 – we crossed the threshold of having one million people on treatment. The majority of those on treatment are being taken care of by donor funds, primarily the US Government through the PEPFAR Fund. This means that government funding for HIV care & treatment is very low. According to Dr. Sani Aliyu, Director General, National Agency for the Control of AIDs (NACA), his top priority for 2018 is to determine the number of people actually infected in Nigeria by carrying out a “Population-based HIV prevalence survey at sub-national level”. Once this is achieved, we must plan to take ownership for the care and treatment of Nigerians living with HIV. We cannot continue to rely on donors for this.
5.) Assuring our health security:
2017 saw a large number of disease outbreaks across the country. Every Nigerian has a role in prevention by ensuring that safe and hygienic practices become a part of your lifestyle. The Chief Executive Officer for the Nigeria Centre for Disease Control, Dr. Chikwe Ihekweazu, stated that improving and digitalising disease surveillance is one of his priorities for 2018. “At NCDC our priorities for 2018 include implementing electronic, case-based surveillance for six priority epidemic prone diseases – Measles, meningitis, cholera, yellow fever, Lassa fever, and monkeypox, from all 774 LGAs in Nigeria,” he said. While we hope that outbreaks are kept to a minimum this year, a robust surveillance system and functional Emergency Operations Centre (EOC) and laboratories, once in place, should allow the government to respond quicker to outbreaks when they do occur. Should this not happen, we must hold our government officials accountable.
As 2018 begins in earnest, we know that there will be many issues that will demand our time and resources, but we must continue to ensure that health is at the forefront of Nigeria’s socio-political agenda if we are to make considerable progress in our nation’s health outcomes, in a way that we can all look back at the year 2018 and say “Progress was made!”
I share the optimism that the recognition of the ability and investment in Universal Health Coverage is generating in our country towards making 2018 a memorable year for health. Only last Tuesday (9 January 2018), the Hon. Minister of Health, Professor Isaac Adewole, delivered a very inspiring lecture at the University of Port Harcourt as a keynote address at the celebration of the 85th birthday anniversary of Emeritus Professor Kelsey Harrison. The title of the lecture was NIGERIAN HEALTH SYSTEM: IN PURSUIT OF AN EQUITY AGENDA and within it, the Hon. Minister advocated the strengthening of service delivery that would guarantee the purchase of a DEFINED (emphasis mine) set of services for the rural population. This BASIC MINIMUM PACKAGE OF HEALTH SERVICES would cover antenatal care, delivery and neonatal care, interventions for children <5, malaria and non-communicable diseases and interventions for family planning.
I was happy the minister appeared to have done his home work well. For if truly we can evolve a system that would effectively address these items though UHC, our health system would have gone a long way in addressing our basic health needs.
But then, will the momentum being generated now escape our nation's propensity for not seeing anything good through? Remember Olikoye Ransome Kuti and you will recollect that we had come quite close to getting it right long before this time.
The private sector is an important partner in the healthcare scheme in Nigeria. The present scheme of the NHIS offers abysmally low reward for the private provider thereby removing any incentive to invest in the healthcare program. This explains the current lack of interest on the part of providers who believe that the benefit of the scheme favours only the middleman while the providers can barely maintain their services at the required standard. A revision of the schemes fee pattern to make it more finacially rewarding to the private providers will certainly improve the quality and attraction of the NHIS for both the patient and the private provider. No one will invest in a scheme where he/she cannot make ends to meet, as the present scheme operates. DR? I. D. ONYIAH, FRCS. 11/1/2018.