Events that Shaped the Health Sector in 2017

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As 2017 winds down, Martins Ifijeh chronicles major events that shaped the health sector

Every year comes with its defining moments and that make it memorable. And 2017, is not any different. It is the year of the unpredictable. For many Nigerians, it is a mixture of the good, the bad, and the ugly; leaving tales of sweet or sour memories behind.

It represents a year of striking happenings; from accusations and counter accusations on which cabal was ruling the country following President Muhammadu Buhari’s long absence from the country, the Senate’s disagreement with the executive on issues of appointments, the return of fuel scarcity and long queues, the changes in different sectors, including Ministries, Departments and Agencies, and most importantly the changes these made in the plates and pockets of Nigerians.

The health sector is one area where there were major happenings which impacted the lives of the citizens either positively or negatively. It started with a high hope following the launch of the economic recovery and growth plan which had sections bordering on health. But the thousands of deaths from preventable disease outbreaks remains a downside for many.

Buhari’s long medical trip abroad

If there is any event that consistently made news for more than three consecutive months in 2017, it is the medical tourism embarked upon by President Muhammadu Buhari, who stayed in London for 103 days treating an undisclosed ailment between May 7th to August 19th 2017, that is after undergoing the same trip earlier in the year where he stayed for 50 days on same medical vacation.

First, Nigerians didn’t know what to make of his vacation as mixed reactions continued to trail the decision to access healthcare abroad despite allocating billions of naira for the running of the presidential clinic in Aso Rock, where ordinarily he should get quality healthcare if the funds allocated to the clinic were released and utilised accordingly or in any other health facility in the country if priority was before now given to the health sector.
Then the anxiety began to grow stronger every week until it clocked 90 days of his absence, leaving many Nigerians to clamour for his forced return to the country or for outright resignation for a more healthy person, to stair the ship of the country.

The agitation grew until #ResumeorResign, protest began, not only to trend on twitter, but became an emblem for a daily protest in different cities, including Lagos, Abuja and London for the president to either come to Nigeria and resume or outrightly resign. He surprisingly came back to Nigeria after 103 days hail and hearty.

Stakeholders believed the clamour to end medical tourism in the country, was given a big blow by Mr. Buhari’s decision to access healthcare abroad.

One of those who cried out is the Chairman, Board of Trustees, Health Writers Association of Nigeria (HEWAN), Dr. Emmanuel Enabulele who described the president’s medical vacation abroad as another opportunity missed in the eyes of the world to rate the country’s healthcare high.

Suspension of NHIS boss and the drama that followed

Nigerians woke up July 6th to the suspension of the Executive Secretary of the National Health Insurance Scheme (NHIS), Usman Yusuf by the Minister of Health, Professor Isaac Adewole, over what he termed fraudulent activities.
He was first asked to embark on a three months suspension pending when a panel set up by the Ministry of Health determines allegation of fraud and nepotism against him, including the procurement of a N58 million SUV without due process; an approach that led to a barrage of accusations and counter accusations by Yusuf, Adewole and their respective supporters.

Yusuf, July 12th fired back in a daring tone, never seen in the history of the public service, that he could not be suspended by the minister, nothing that only President Buhari, who was on sick leave in London at the time, could terminate his appointment.

He had said that although the NHIS Act empowers the minister to give directive of a general nature to the Governing Council of the Scheme, and could exercise presidential mandate in the absence of the council, such powers did not include “discipline, suspension or removal of the Executive Secretary of the Scheme from office.”
Despite the kickback by Yusuf, Prof. Adewole, after the three months suspension, further approved the indefinite suspension of the NHIS boss.

According to him, the committee has completed its investigation against Yusuf, and has found him culpable in many areas. The letter said the committee’s report has been submitted to the president, and while awaiting the president’s decision, the NHIS boss is expected to go on an indefinite leave.

This led to wits of strength displayed on the pages of newspapers for and against the suspension, as though these stakeholders suddenly realised the importance of NHIS, a scheme that has refused to grow in coverage beyond one per cent since 2005 when it was established.

Subtly put, it would be fair to describe Nigeria’s NHIS as the worst performing health insurance coverage in the world, as it has continued to enmesh itself in controversies year-in-year-out among the major players, leading to Nigerians refusing to buy into what they offer because trust had been lost or not properly packaged.
In fact, Nigeria’s health insurance scheme started same year Ghana started theirs. But as at December 12 this year, Ghana’s universal health coverage has grown up to 50 per cent, while that of Nigeria, which prides itself as the ‘Giant of Africa’ is still stagnated at one per cent.

Outbreak of Lassa fever, Monkey pox and Cerebrospinal Meningitis

Nigeria in 2017, experienced the worst burden of Lassa fever since the discovery of the disease in 1969 in the country with 718 cases recorded, 227 laboratory records confirmed and 68 cases of deaths as at August 21st this year.

The outbreak surpassed the previously known outbreak prevalence since its discovery, making the burden to increase progressively with attendant impact on the health of Nigerians. This has added to the draw-backs in ensuring the delisting of Nigeria from countries with Lassa fever.

Monkey pox is one of the disease outbreak that gripped Nigerians few months ago, with weird signs and symptoms, leaving victims to have rough skin with noticeable bumps.

As at the last count, over 100 persons have been suspected to be affected, with nine confirmed case in 11 states, including Akwa Ibom, Bayelsa, Cross River, Delta, Ekiti, Enugu, Imo, Lagos, Nasarawa, Niger, Rivers and the Federal Capital Territory.

Meningitis serotype C, a strain of meningitis new to Nigeria Killed over 1,166 people earlier in 2017 with more than 14,518 reported cases in 181 local councils in 22 of the country’s 36 states, including the Federal Capital Territory.
While it is unfortunate that over a thousand people died from a disease the World Health Organisation has said was highly preventable, it took the federal government the death of almost 200 people before it announced that the country was experiencing the dreaded, but preventable epidemic.

Lassa fever, monkey pox, meningitis C and other disease outbreaks that occurred in 2017 can be prevented if proper measures are put in place by stakeholders and the citizens.

Launching of the Economic and Recovery Growth Plan (the health sector perspective)

On March 7, 2017, the Nigerian Government, in its bid to strengthen the economy and end recession that had spilled into the year, launched the long-awaited plan to restore macroeconomic stability in the short term, and the structural reforms and investments in the social sector in the medium and long term, which it termed the Economic Recovery and Growth Plan (ERGP); a plan for 2017-2020, broadly targeting restoration of growth, human development and globally competitive economy.

The plan, which the government said was an ambitious move to achieve a seven per cent economic growth for the country by the year 2020, represented a policy and reform framework to boost productivity in all sectors and achieve sustained diversification and inclusiveness.

According to the document, which was midwifed by the Presidency and the Ministry of Budget and National Planning, 60 critical initiatives have been outlined to form the strategy the government said represents the blueprint for the type of foundation it wants the country to follow.

A critical look at the 60 listed strategies showed that at least five of such strategies give a clear design to what Mr. Buhari’s administration has in stock for the healthcare sector.

The federal government, in the document said it would invest in health and education to fill the skills gap in the economy, and meet the international targets set under the United Nation’s Sustainable Development Goals (SDGs). Adding that it will improve the accessibility, affordability and quality of healthcare, and expand coverage of National Health Insurance Scheme across the country.

Among plans listed in the ERGP for healthcare is that the federal government will give a new lease of life to primary healthcare system through revitalising 10,000 Primary Healthcare Centres (PHC) and establish at least one functional PHC in each ward to improve access to healthcare; fully implement the PHC refinancing programme to mobilise domestic resources; drive progress to meet UN SDG’s health targets; and reduce infant and maternal mortality rates. The ERGP says the federal government will roll out universal health coverage through expanding the National Health Insurance Scheme (NHIS); enforce the Tertiary Institutions Social Health Insurance Programme for students in tertiary institutions; pilot the Public Primary Pupils Social Health Insurance Programme to provide quality health services to pupils in middle-and lower-income socio- economic levels who are less likely to have insurance; and scale up the Mobile Health Insurance Programme to provide coverage for the poor.

The government’s economic document also shows that the federal government will strengthen delivery beyond the PHC system through provision of anti-retroviral medication to people living with HIV/AIDS; ramp up projects to eradicate polio, measles and yellow fever; make strategic investment in tertiary healthcare institutions in collaboration with the National Sovereign Investment Authority (NSIA) and other relevant stakeholders; and develop and adopt an e-health scheme to connect specialised hospitals to rural communities via mobile tele-medicine; among other things the Plan seeks to achieve.

But as the year winds down, not much is heard about the economic and recovery growth plan as it relates to the health sector. Is the plan just on paper or yet to kick off? When will Nigerians start benefiting from the otherwise laudable idea?

While lessons can be learnt from the major events that shaped the year, what are the fantastic breakthroughs made in the course of the year? How many breakthroughs were recorded in the sector, where are the researches, where are the vaccines to stop malaria, Lassa fever and other indigenous diseases, where are the 10,000 revitalised PHCs the Minister of Health talked about, where are the radiotherapy machines? Has our indices on maternal and child mortality reduced? Has mortality rate for cancer, sickle cell, tuberculosis, pneumonia, diarrhea, cholera reduced? Did doctors and health workers refused to go on strike this year? These are events that could have shaped the health sector for good in 2017. Can we really say progress has been made? Be the judge!