There is need for a major reform that will place healthcare as the leading public policy issue
As part of its corporate social responsibility, THISDAY newspapers last week held a policy dialogue in Abuja on the challenges of the health sector in Nigeria and the prospects for sustainable solutions. With participants drawn from both the public and private sectors as well as domestic and international public health institutions and non-governmental organisations (NGOs), there was a consensus that all relevant stakeholders must come together to make healthcare available and affordable to the generality of Nigerians.
However, it became instructive from the various interventions at the THISDAY summit that Nigeria has, over the years, had several national health plans, including the National Health Act of 2014, the National Health Insurance Act, the Presidential Summit on Health, the National Healthcare Financing Policy, the National Policy of Incentivising Investments in Healthcare, etc. Yet, despite all these, the situation in the sector has hardly improved nor has the health and wellbeing of the citizens and residents of Nigeria. Despite significant progress in containing malaria and polio, Nigeria faces serious challenges that need a bold and determined national response.
As one of the speakers noted, “There is a health emergency in the country. Nigeria is among the worst place in West Africa to be a poor child or mother, and the situation may be getting worse.†Indeed, improvements in the health sector in the last decade are now being eroded. Nigeria’s poor children and mothers reportedly have worse nutritional status and poorer access to preventive and curative services. In the last three years, there has been a spike in infant mortality rate while stunting is on the rise. And as a consequence of poor public financing, 75 per cent of health expenditures in Nigeria are out-of-pocket. The average life expectancy in Nigeria is a mere 53.05 years as against 75-85 years in both Europe and America.
The reasons for this policy failure, according to participants at the summit, are many and some of them include lack of political will, inadequate investments in healthcare (from both the public and private sector), human resource challenges, especially professional rivalries and emigration of medical personnel and unsustainable financing for the sector. Other challenges include the inability of the various local governments to take up their primary healthcare responsibilities as well as the declining reputation of medical practice in Nigeria which discourages patronages from both the rich and the middle class and in turn encourages outbound medical tourism.
Some of the observations by participants were that although investment in health leads to economic growth, Nigeria invests far too little in the critical sector, spending less than nearly every country in the world. Meanwhile, in climes where political leaderships have rallied stakeholders behind investments in the health sector, significant improvements have been possible. It was also observed that the National Health Act passed in 2014, provides a legal framework for achieving the much talked about Universal Health Coverage (UHC).
On the way forward, some of the recommendations from the participants include improving transparency and accountability around public financial managements; making the legal framework for financing the health sector robust enough to support the delivery of a set of high impact interventions for all Nigerians; increasing public investment and ensuring that assistance from donor agencies and development partners align with government policy for the sector. It was also recommended that state governments should increase spending on health as more than two-thirds of public sector funding currently comes from the federal government while the public should take more interest in the policy and funding of their health sector.
At the end, the main takeaway from the THISDAY intervention is that to resolve most of the issues militating against healthcare delivery in Nigeria, citizens and the media must engage the implementers on the various policies that are already in place. Some of the policies include the National Health Act of 2014 and the implementation of the provisions for one per cent of the Consolidated Revenue of the Federation to be invested in healthcare while health insurance should be made compulsory for all citizens and residents of Nigeria.
While credible metrics and effective health planning, monitoring and evaluation, by federal and state ministries of health are required to encourage confidence, it was also agreed that there should be a reduction in out-of-pocket payments at point of service delivery, through better and improved public investments. And of course the need for a strategic engagement with the private sector to harness their potential.
But to achieve these objectives, there is need for a major socio-political reform that will place healthcare as the pre-eminent public policy issue as it is in most countries in the world. As rightly observed by one of the speakers at the event, “When health is absent, wealth is useless.â€
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Although investment in health leads to economic growth, Nigeria invests far too little in the critical sector, spending less than nearly every country in the world. In climes where political leaderships have rallied stakeholders behind investments in the health sector, significant improvements have been possible
