How can a country pass a law and almost four years later we are only now getting round to implementation? It is no secret that the 2019 elections are in the hearts and minds of most Nigerians, with many launching campaigns to lobby for issues dear to them. For those advocating for health, one of the biggest issues in view this year is the call for the Buhari Administration to implement the National Health Act (NHA) and to provide for the Basic Health Care Provision Fund (BHCPF) in the 2018 budget.
On the 12th of April 2018, almost every one of significance in the health sector in Nigeria gathered in Abuja for the 2nd THISDAY Healthcare Policy Dialogue. This included the Minister for Health, Prof. Isaac Adewole, the Director General of the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, and other high-level officials who gathered to launch the logo and beneficiary identification card for the BHCPF at the event. The theme for the conference organised by ThisDay was “The Journey To Universal Health Coverage in Nigeria”.
The BHCPF, or “Huwe”, an Ebira word meaning “Life” drawn from extensive crowdfunding, is a component of the NHA, designed to address critical health care service delivery and to access issues across the various cadres of Nigeria’s health system. The BHCPF contains the funding mechanism for the NHA. Advocates in the health space have been working to raise awareness about the importance of implementing the NHA, especially the implementation of the BHCPF.
The WHO DG spoke eloquently about the importance of Universal Health Coverage (UHC) for every country, at the event. “Health is a fundamental right that should be enjoyed by all people, not a privileged few,” he said, adding, “No one should fall sick and die because they are poor or do not have access to health services.” He urged Nigeria to find its own path to UHC. “There is no single path to UHC. All countries must find their way,” he said, pointing out that countries do not have a choice when it comes to investing in health. “The question is not whether countries can afford to invest in health. The question is whether countries can afford not to invest in health,” he added.
As he spoke, Nigerians listened. The policy dialogue brought together policymakers including members of the Federal Executive Council, parliamentarians, development partners, civil society organisations, private sector leaders, and media. They all listened. But is listening quietly enough? Can we all sit idly back and watch the government ignore the implementation of law passed? Can we afford not to invest in health?
The call for the implementation of the NHA may sound to the average Nigerian like politicking by a group of “health people” just looking to make their voices heard. The non-implementation of the NHA has far-reaching consequences for the everyday Nigerian. Dr. Jimlas Opeyemi Ogunsakin, a Health Systems Specialist with the BHCPF Committee, pointed out that “for the first time in the history of Nigeria, we have this massive social development program in the health sector outside of the normal budgetary allocation to health. This is going to be a very massive investment in health, especially covering the people at the local level, at the community level,” he said. “If this is implemented, it’s going to improve service delivery, both on the supply and demand side of healthcare, within the PHC system. It is going to be fabulous.”
How fabulous it will be, however, depends largely on if the Nigerian government follows through on its commitment to provide for the 1% of the Consolidated Revenue Fund (CRF) in the 2018 budget. There was palpable delight in the audience when Senator Lanre Tejuoso, the Chairman of the Senate Committee on Health, promised that he will push for the implementation of the 1% CRF before the next elections. Time will tell.
Incredibly, almost four years after becoming law and despite the affirmations above, the 1% CRF is not currently included in the 2018 Budget, according to the Honourable Minister of State for Budget and National Planning, Mrs. Zainab Ahmed. She told Nigeria Health Watch in an interview after the UHC Dialogue event that the Ministry is however committed to funding the 1% CRF. “The clamour for the 1% of the Consolidated Revenue Fund is something we are very committed to meeting,” she said, adding, “It is not included in the 2018 budget that is before the National Assembly, the simple reason being that there are several other commitments required in the same pattern, for education, for science and technology, and we have to put all of it together because the purse is the same. Education is as important as health is and we have to sit down and make sure that we have revenues that are increased and also increased on a sustainable basis, so this is something we are working towards. We are consciously increasing the spending on health, the budget, as well as the releases on health and we will attain that 1% very soon.”
In light of this, the question remains, Will the next round of elections elicit any major leaps forward for the Nigerian health sector? Is health an important enough election issue for people? Politicians are seeking votes, and if the push for the implementation of the NHA is not high on the agenda as an election issue, what would be their motivation to push for the full implementation of the BHCPF?
Nigerians might be asking why they should push for the BHCPF to be implemented. The truth is, it is common knowledge that if you enter almost any rural area, and even most urban areas in the country, you will easily find people who are sick or dying primarily because they are unable to afford or access healthcare. Every single day, Nigeria loses about 145 women of childbearing age. The NHA and BHCPF are meant to help address these problems.
Dr. Emmanuel Meribole, Secretary to the National Steering Committee., spoke to Nigeria Health Watch about the importance of the Fund to cover Nigerians. “The Basic Health Care Provision Fund is supposed to be the funding vehicle for the minimum package of basic health services for all Nigerians will target rural areas, the poor and the vulnerable,” he said. “As you can see from all the discourse today, the health indices are mainly contributed by the poor in the society, by those living in the rural areas, and particularly women, children and the elderly so what we intend to do with the BHCPF is to target women and children services such as antenatal care, post-natal care, deliveries, immunization, treatment of under 5’s, malaria for everybody and screening for diabetes and high blood pressure and family planning.”
The Honourable Minister of State for Budget and National Planning, in trying to explain the government’s non-implementation of the NHA pointed to the many challenges the government faces. “We’ve shown that we recognize that health is a sector that must have increased financing but let us not forget where we are coming from,” she said, adding, “We’re coming from an economic situation that is very challenging. This law was passed in 2014, a time when the oil price was 120 dollars. The crude oil price crashed to 30 dollars at some point, now it’s up to about 50-55 dollars. So, we are struggling to make sure the economy stays afloat and trying to meet the requirements of the different sectors of the economy. It’s a process and we are working in the right direction.” However, evidence from other countries such as Rwanda, Thailand, Malaysia etc has shown that political will rather than a country’s income is a bigger factor when it comes to implementing UHC.
As Nigerians concerned about the health sector, we should work tirelessly in the direction of better health access and health coverage for every Nigerian. As we step into the theatre of elections, we must insist that health be high on the agenda. We must insist that the government implement the laws of the land when it comes to our health rights. There is no better way to demonstrate it’s commitment to the health of Nigerians than by implementing the 1%.
I fully agree with the view that government does not only need to implement the !% BHCPF but government CAN indeed implement it if it finds the necessary political will. History teaches however that unless concerted pressure is brought to bear on it, government (in Nigeria) is very unlikely to act in the peoples interest. We have therefore no alternative but to keep campaigning until the goal is achieved. I hope the NMA steps up to the plate to help lead this cause!