It’s election season in Nigeria, and the volume of the debates online and offline are reaching a deafening pitch. Interestingly the focus of most of the campaigns and debates are not on the issues that will affect the future of our country. In 2015 – this is not good enough for a country with Nigeria’s aspirations. Therefore, today with this blog, we are calling you to action to join us in putting health and healthcare on the agenda in this election. The quality, access and effectiveness of our health and healthcare affects every one of us.
Previous attempts to address challenges in the health sector have been dominated by the provision of infrastructure in tertiary care facilities. While medical infrastructure and equipment are part of the problem, they are a small part of it. The heart of the challenge in providing for the health of the Nigerian people lies not in buildings and equipment but in building systems that ensure effective management of the human and other resources required to prevent ill health and ensure good quality clinical care provided in health facilities.
We propose 10 priorities for the health sector:
- Implement the National Health Act: Now that the Bill has been signed into law, implementation is a major challenge. How do the parties intend to address this, especially against the backdrop of shrinking oil revenue?
- Quick wins – Identifying specific health priorities and present accessible, measurable plans for responding to these: (e.g. Childhood immunisation, maternal care, access to emergency services, prevention and care of HIV&AIDS, environmental sanitation, etc). Build on the progress made in childhood immunization and maternal and child health. Put in place or strengthen specific, managed, and funded programmes to address these. The programmes should take into account the inequalities in health outcomes between different zones of the country and between the rural and urban populations.
- Drive improvement with data and put this data in the public domain. Nigerians have a right to a basic minimum level of health and healthcare and must learn to ask for this. The National Health Act makes provision for setting up, resourcing and sustaining an information management system for health and healthcare management data. How do the candidates and political parties intend to put these into place? Putting the quality indicators and targets for all the priority areas and all tertiary health facilities in the public domain and letting Nigerians judge on their delivery and performance is essential. Who will commit to doing this?
- Institute a management culture for our health sector: The entire health system is in dire need of bold, innovative and strategic management. It should not be taken for granted that good healthcare workers will be good managers of hospitals and the rest of the health sector. As a matter of urgency, government should assess, map and categorise existing health infrastructure and the existing resource. Through an open and transparent recruitment process, we should identify the appropriate expertise to manage health sector organisations from people with the appropriate management skills, develop the capacity of existing managers and establish clear referral pathways and systems. Put in place mechanisms enabling us to learn from successes and failures. Why was the response to Ebola successful? What did not work so well? How can we learn from it?
- Health financing: Commit to increasing the health sector’s budget to recommended spending levels (~4% in 2014 vs recommended 10%). Implement the Primary Health Care Fund as proposed in the National Health Act with strict regulatory oversight (as in PENCOM). Seek the appropriate expertise to drive the founding goals of the NHIS and set a target of covering 40% of the entire population in 4 years. All our budgetary provisions on healthcare projects and programmes should be made publicly available online and trackable.
- Quality at the heart of care: Put the quality of care provided to patients at the heart of the entire health system. Patients must not wait hours at hospitals and be talked to condescendingly. Clinical procedures must be explained in detail and our healthcare professionals must be courteous and professional. Commit to working with patients and professionals to agree a code of conduct that will be publicly displayed in all public hospitals. Government should strengthen the regulatory organizations (Nigerian Medical and Dental Council, the Nursing Council etc.) and provide access to complaints. Government will need to review the curriculum and modernize and ensure that our educational institutions at undergraduate and postgraduate level produce professionals that embrace the patient dignity and quality agenda.
- Focus on leadership and clinical competence: Government should actively identify Nigerians that are leaders and experts in healthcare, in every speciality, and attract them to come back and work in the public sector by providing appropriate incentives and conducive working and living environments. Change the ongoing debates about salaries by engaging with the trade unions across the health sector to focus on deliverables, in addition to remuneration.
- Private sector: A significant amount of individual and household expenditure on health in Nigeria is spent in the private sector for services of doubtful quality. Whoever wins the elections should support and encourage innovative private sector initiatives while strengthening the regulation of private sector providers by establishing clear and transparent accreditation systems (the National Health Act establishes a basis for this) and providing incentives for private facilities in under-served areas. Regulate informal “chemists” and other informal providers of care and use them better in the delivery of care in underserved areas.
- Health Education: Government should use innovative social marketing techniques to aggressively communicate health messages, create awareness of health facilities and discourage harmful practices.
- Specialist health provision: Building on work done previously, government should identify and resource 6 specialist care centres across the country, both in terms of expertise and equipment. while insisting that they all become financially independent in 4 years’ time by providing a dual track of payment – one for those that can afford to pay and a parallel fund for providing equivalent but subsidised care for the poor.
These are ambitious targets. We do not expect immediate success. Positive change is often painful and will face resistance and often resentment. But it cannot be business as usual. A healthy population is our greatest asset. Without good health, little else is possible. With a clear agenda, good leadership, a good implementation plan, and a good team with the requisite clinical and managerial skills these ambitious heath objectives can be achieved.
Finally, we need you to get involved as well. Join us in a pre-election Tweet-a-thon to ask candidates and parties once more to share their plans for health and healthcare in Nigeria. After our Tweet-a-thon, there is still more than a week left till the election. So, candidates and parties should use that time to tell us how they intend to rescue our health sector.
- @nighealthwatch on strikes in the health sector
- @HERFON2014 on the implementation of the national health act
- @WellbeingAfrica on maternal and child health
- @EVA_Nigeria on youth health
- @ARFHng on malaria
- @XPneumo on pneumonia
- @nigdiabetes on diabetes
- @tobaccoCtrl on tobacco related health issues
- @swankpharm on drugs
Follow and use the hashtag #Feb14Health, especially during the Nigeria Health Watch Pre-election Tweet-a-thon on Thursday, 5 February, from 12noon till 3pm.