Nigeria’s Poor Implementation of Health Pledges

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Isaac Adewole

Time and time again, the Nigerian Government has shown that it is good at making commitments at global forums on behalf of the country but ends up not implementing them. Martins Ifijeh examines some of such pledges tied to the health sector that never saw the light of day

If world powers and developed nations are chosen based on the promises and commitments leaders of such countries made on global or regional gatherings, then be rest assured Nigeria should be the greatest country in the world following it’s antecedents in this area. In fact, United States, Germany and China would have been queuing behind Nigeria economically and in many other areas.

But words without actions, and promise-and-fail attitude do not make powerful nations, reasons Nigeria is still a third world country despite being blessed with enormous natural resources and huge population. It’s declaration of commitments on global or regional stages do not turn into actions back home.

For instance, while many countries implement health commitments made during programmes, the list of un-implemented or poorly implemented global or regional commitments on health for Nigeria are endless, an attitude that has in no small measure contributed to poor improvement of health indices in the country.

Every Woman Every Child (EWEC)
The Every Woman Every Child (EWEC) is a unique initiative launched by the former United Nation’s Secretary General, Ban Ki-moon, during the UN’s Millennium Development Goals Summit in September 2010 aimed at saving lives of at least 16 million women and children by 2015.

The effort puts into action the Global Strategy for Women and Children’s Health, which presents a roadmap on how to enhance financing, strengthen policy and improve service on the ground for the most vulnerable women and children.
As usual, in 2012 during the London Family Planning Summit, Nigeria jumped into the otherwise laudable initiative, declaring several commitments to the admiration of the crowd who clapped endlessly believing with such decisions, Nigeria will help reduce mother and child deaths in its own way since it has one of the highest burden among this vulnerable group in the world.

First, Nigeria made commitments to achieve the goal of a contraceptive prevalence rate of 36 per cent by 2018, thereby enhancing maternal and child survival, which in turn will contribute to the government’s initiative to save one million lives by 2015.

Nigeria said in addition to its current annual commitment to US $3 million for the procurement of reproductive health commodities, it will provide US $8.35 million annually over the next four years.

This increases Nigeria’s total commitment for the next four years from the day of declaration from US $12 million to US $45.4 million, an increase of almost 300 per cent.

It also declared at the summit that the federal government would work with the state and local governments to secure complementary budgets for family planning and reproductive health service delivery.

The leadership of the Nigerian delegation at the declaration will include training frontline health workers to deliver a range of contraceptives and action to improve equity and access to family planning for the poorest, adding that it will partner with the private sector, civil society, traditional and religious institutions and development partners on the initiative.

“If these commitments were fully implemented by the likes of Nigeria and other countries, by 2015, about 16 million women and children would have been saved, 33 million unwanted pregnancies would have been prevented, 88 million children stunted globally would have been avoided, about 120 million children suffering from pneumonia would have been protected,” said the Health Advocacy Coordinator, Save the Children International, Dr. Innocent Ekene Ifediluchukwu, who gave his thoughts on this during a sensitisation meeting on Maternal, Newborn and Child Health, organised by the Save the Children International in Lagos recently.

Abuja Declaration
In April 2001, Nigeria played host to African leaders where they all pledged to ensure that 15 per cent of government’s annual budget is used to improve the health sector, and that declaration was tagged the Abuja Declaration.

But despite Nigeria spare heading the regional meeting and even playing host to it, the country, 16 years after, has refused to implement a commitment it willingly signed, an approach that has continued to put Nigeria’s healthcare drive in doubt in the eyes of the world.

Currently, the health budget in Nigeria is at 4.17 per cent of the annual budget. Only Bauchi State is currently implementing the Abuja Declaration even though money release may pose a threat.

Lagos, which prides itself as the economic hub of the nation is following the federal government’s lack of prioritising healthcare through budgetary allocation. Lagos health budget for 2016 was 9.76 per cent but surprisingly reduced it in 2017 to 7.05 per cent.

As of 2011, six African countries had already surpassed the 15 per cent target: Rwanda (23.8 per cent), Liberia (18.9 per cent), Malawi (18.5 per cent), Zambia (16 per cent), Togo (15.4 per cent) and Madagascar (15.3 per cent). But up till today, Nigeria is yet to make any significant increase on its healthcare allocation to the national budget.

On healthcare alone, the United States this year will spend at least $7,000 per citizen, which is about N3 million per person. Switzerland will this year spend $6000, which is about N2.5 million. This, when compared to Nigeria’s N1,688 per head for a whole year, suggests why the country still grapple with poor health indices and the poor mortality rates.

Nutrition for Growth
Nutrition for Growth is an initiative led by a partnership between the United Kingdom, Brazil and Japan governments and championed by leading philanthropic foundations and civil society organisations.

The first Nutrition for Growth summit was held in London in 2013 and new commitments in the order of over $4 billion for nutrition-specific projects, and $19 billion in nutrition-sensitive projects, was pledged.

A Global Nutrition for Growth Compact was endorsed by 100 stakeholders (from science, business, civil society, private foundations and governments), committing by 2020 to reduce child stunting by 20 million.

The communique from the London – led 2013, Brazil-led 2016 N4G event highlighted the need for a global movement to increase global attention to the nutrition challenge, and to build global momentum for a major pledging moment.
Nigeria recognised the initiative, hence in 2012, the then Nigerian President, Goodluck Jonathan launched the Saving One Million Lives (SOML) Initiative, with nutrition as a key pillar.

He said at the time the nation would take advantage of the agricultural transformation and improve national policy on food and nutrition – ensuring that there is a comprehensive, multi-pronged and multi-sectoral response.

Nigeria committed to sustaining the current average annual Federal Spend of USD $10 million on nutrition specific interventions; establish a distinct budget line for nutrition within the budget in the National Primary Healthcare Development Agency; Sustain the level of funding under the SURE P and MSS programmes; Leverage the use of mobile technology to reach mothers and children, empower the health workers and strengthen the system; and then strengthen regulation and enforcement to ensure compliance for example with fortification standards, working across agencies.
It also said it will expand monitoring and evaluation of nutrition programmes over time, through the expansion of SMART surveys and other programmes.

But while since 2012 till date the level of malnutrition in the country continues to increase, with already, over 11 million Nigerian children said to be malnourished, there has not been clear cut implementations in this regard.
Just recently, the Chairman, Senate Committee on Health, Senator Lanre Tejuoso told THISDAY that in 2016 Nigeria, which has about 11 million stunted children only allocated N2 million to tackle malnutrition in the entire country.

Family planning summit
July 2012, Nigeria was one of the governments in attendance at a summit convened by the United Kingdom Government and Bill and Melinda Gates Foundation with UNFPA and other partners

The summit proposed to mobilise global policy, financing, commodity and service delivery commitment to support the rights of an additional 120 million women and girls in the world’s poorest countries.

The aim of the summit was to revitalise global commitment to family planning and access to contraceptives as a cost-effective and transformational development priority; improve the access and distribution of contraceptive supplies, and remove the barriers to family planning.

In the summit, Nigeria, again as usual, made several commitments including achieving contraceptive prevalence rate of 36 per cent by 2018; to increase total commitment from 12 million USD to 45 million, an increase of almost 300 per cent.

It also committed to working with states and local governments to secure complementary budgets for family planning and reproductive health service delivery. Also, it said it would train front line health workers to deliver a range of contraceptives and action to improve equity and access to family planning for the poorest.

But despite Nigerian Government’s pledge that with the sequence of commitments outlined the country will achieve 36 per cent contraceptive prevalence rate by 2018, available statistics still show that Nigeria is yet to reach 20 per cent mark even though 2018 is just two months away.

One PHC per ward
The present Minister of Health, Prof. Isaac Adewole, during the ‘Policy maker summit – Evidence and Prospects for a Healthy Nigeria’ in 2016 committed to either building or renovating one Primary Healthcare Centre in each ward across the country.

These centres, according to him would create access to healthcare for the Nigerian citizens, adding that one PHC per ward in Nigeria will culminate in about 10,000 facilities that will be functional, service-ready and able to provide quality services at affordable cost.

But 17 months after the commitment, not much has been heard about the initiative. How long will Nigerians continue to wait for the initiative to become reality or even kick off.