Hope Rises for Healthcare Financing in Nigeria

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Adewole and Tejuoso

Following the successful inaugural THISDAY Healthcare Financing Summit in Abuja recently, the National Assembly says it is now pushing for the implementation of the Basic Healthcare Provision Fund under the National Health Act, and is recommending that the federal government declares a state of emergency in the health sector. Martins Ifijeh reports

The recently held first edition of the THISDAY Healthcare Financing Summit has continued to stair up conversations aimed at remodeling funding pattern for the health sector, as part of efforts to make healthcare more affordable, qualitative and accessible to Nigerians.

The latest being the National Assembly’s resolve to further push for the implementation of the Basic Healthcare Provision Fund (BHCPF), which is a fund allocation to cater for the basic health needs of all Nigerians.

Speaking with THISDAY earlier in the week, the Chairman, Senate Committee on Health, Senator Olarenwaju Tejuoso, said maximum pressure is now being applied for government to implement the one per cent contributory provision as stipulated in the 2014 National Health Act.

According to him, if this is fully implemented, it would mean a minimum of N45 billion has been set aside in the 2018 annual budget for the BHCPF.

“With this, our primary health centres will be more funded and more functional. Basic drugs and commodities will be available at the PHCs, including water and power.”

He described PHCs as the closest contact to communities, adding that, “the lack of these facilities would mean lack of access to simple medical challenges. And this has caused several preventable deaths in the country.

“The one per cent contribution is what has occupied half of my advocacy as Chairman, Senate Committee on Health. And now we are applying maximum pressure to ensure its implementation. It would be a major legacy for this 8th National Assembly,” he added.

Reports show that the Senate has further mandated its Committee on Appropriations to ensure that it effect the one per cent Consolidated Revenue Fund of the National Health Act in the 2018 Appropriation.

If the Senate resolution is implemented then it means that the BHCPF will mobilise additional resources of an average of about N45 billion for the delivery of a Basic Minimum Package of Health Services in Nigeria in 2018.

During the THISDAY Summit, Tejuoso reiterated that the National Assembly under the leadership of the Senate President Senator Bukola Saraki was fully committed to the implementation of the Senate resolution.

He described the implementation as a foregone conclusion and Nigerians should look towards the executive arm of government for release and its implementation.

Tejuoso argued at the Summit that Nigeria cannot walk on a path to economic prosperity without improving the health of its citizens. He stated that “It is a well-known fact that improvements in health often precede economic development and without a predictable and stable increase in health financing, our country will not be able to avert the impending health calamity,” he stated.

A document from the Federal Ministry of Health on the constituents of the basic minimum package shows that it prioritises and pays for 10 high-impact and highly cost-effective interventions focused on maternal and child health (MCH) which covers more than 60 per cent of disease burden of the country. There are four maternal health interventions for pregnant women (ANC, labour and delivery, emergency obstetric and neonatal care and caesarean section), two interventions for under-fives (curative care and immunisation), one reproductive and adolescent health intervention (family planning), and, treatment of malaria and screening of select NCDs for all Nigerians.

The Minister of Health, Professor Isaac Adewole, during one of the panel discussions at the Summit, led by the Deputy Chief of Party, United States Agency for International Developments (USAID)/Health Financing and Governance, Dr. Gafar Alawade, said the first phase of the implementation of the BHCPF will commence in the next couple of weeks with funding from the Global Financing Facility/World Bank and the Gates Foundation in Abia, Niger and Osun states. ”The release of the BHCPF by the federal government will allow for scaling up to additional states.”

Dr. Alawade, an experienced public health expert was able to extract commitments from his high powered panelists on the actualization of the BHCPF.

Dr. Olumide Okunola of the International Finance Corporation led the first panel of discussion at the Summit which focused on the role of private sector in the country’s quest for actualizing Universal Health Coverage.

Also during plenary seating of the Senate on Tuesday March 13th, Senate members asked the federal government to declare a state of emergency in the country’s health sector over decay of infrastructure.

The Senate said it was concerned over inadequate financing of the health sector, thereby urging the government to provide special funding for the overhaul of at least one public medical facility in each geo-political zone in the country.

The Senate resolutions were sequel to the unanimous adoption of a motion by Senator SuleimanHunkuyi (Kaduna-APC). Moving the motion, Hunkuyi expressed worry over increasing decay of infrastructure in the country’s healthcare institutions. He said that the “sorry state of affairs’’ in government hospitals and other healthcare facilities had rendered their services ineffective, resulting in dire consequences for the citizens.

According to him, “the decayed infrastructure occasioned by epileptic power and inadequate water supply further increased the risk of hospital-transmitted infections.”

Leading the debate, Hunkuyi added that critical diagnostic equipment essential for providing efficient diagnosis was either non-functional or not available.

He pointed out that the situation had led to failure by the system to attract the required calibre of health professionals and skilled manpower to the public health institutions.

“The situation in our public health institutions has resulted in increased medical tourism by Nigerians, with doctors and other healthcare professionals leaving for greener pastures to private medical facilities or even abroad.

“This is with attendant outflow of foreign currency to the tune of several millions of dollars spent on medical care annually in Europe, America, Asia and some African countries to the detriment of our health institutions. This sorry state of affairs has rendered our hospitals and other healthcare facilities ineffective resulting in dire consequences for the citizenry,” he added.

History has shown that the Nigerian Government spends less on health than nearly every country in the world. However, to accelerate progress to Universal Health Coverage (UHC) the government will need to significantly invest more in health.

In 2016, government health spending was 0.6 per cent as a share of our Gross Domestic Product (GDP) or just $US11 per capita, among the lowest in the world. The consequences of this abysmally low level of public spending means is that there are limited resources available to pay for basic preventive and promotive health services that could have outsized impact; and expectedly there will be high levels of out-of-pocket payments at the point of delivery which reduce the use of services and act as a barrier to care, especially for the poor and vulnerable.

Healthcare stakeholders believe the poor health outcomes in Nigeria are stark, noting that the level of deaths amongst children under-five in Nigeria is particularly high by comparison to other lower-middle income countries.

Dr. Benjamin Loevinsohn of the World Bank Group, during the build up to the healthcare Financing Summit said most poor Nigerians were unable to afford adequate healthcare because enough investment has not been made in the sector by the government.

“This government’s low spending also means the country is unable to spend adequately for health services and facilities. For instance, only about 10 per cent of Nigerian children areimmunised, whereas in Chad and Niger, about 30 per cent and 50 per cent are immunised, respectively.

“In addition, Nigeria is pretty much the worst place in West Africa to be a poor child or a poor mother. Again, this outcome is worse than in Lake Chad and in Niger. This is a real problem we can’t wish away. That is why we are involved,” he added.

Indications show that the lack of investment in the country’s healthcare has made immunisationcoverage in Nigeria the lowest in West Africa, especially for poor children. Similarly, skilled birth attendance in the two poorest quintiles in Nigeria is considerably lower as compared to its neighboring countries. Only 10 per cent of the poorest Nigerian children are immunised (Penta3) compared to 28 per cent in Chad and 52 per cent in Niger.

Other health indices do not fare any better – the total fertility rate (TFR) has not changed in 25 years, and the nutritional status of poor children has worsened over the last 13 years.

Yet reducing under five mortality rate or addressing maternal deaths is not just about improving welfare, it is also a crucial contributor to economic growth without which Nigeria’s development will be stunted. Almost 75 per cent of under-five mortality rate in the country, excluding neo-natal mortality, is due to three diseases: malaria, pneumonia, and diarrhea. Yet these diseases are susceptible to very cost-effective and evidence-based technologies.

However, in the absence of adequate public financing for health the main killers of children and women in Nigeria will continue unabated despite the fact that they can be prevented or treated using low cost, highly efficacious, and easy-to-implement interventions. These results implicate the performance of Nigeria’s primary health care (PHC) system.

Beyond financing for PHCs, stakeholders believe there are problems around allocative efficiency where existing resources are misallocated to secondary and tertiary care resulting in dysfunctional or non-functional delivery of services at PHC facilities.

The THISDAY Summit identified that accountability is weak and there has been little focus on tangible results, and that the potential of the large private sector, which provides 60 per cent of care in the country, has been largely ignored by the government.

While conversations around the Summit continue to elicit actions and policy statements, lovers of qualitative, affordable and accessible healthcare in Nigeria are hopeful that this would bring the needed change in the sector.