Huwe as an Electoral Issue

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The Horizon By Kayode Komolafe kayode.komolafe@thisdaylive.com 0805 500 1974

Huwe is an Ebira word meaning life. The Federal Ministry of Health has fittingly located in Ebira language, one of the hundreds of Nigerian tongues, the name to give the Basic Healthcare Provision Fund (BHCPF). The new logo of BHCPF as Huwe was launched two weeks ago in Abuja by the Director General of the World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus.
The occasion was the Second THISDAY Policy Dialogue on Universal Health Coverage.

According to the National Health Act of 2014 signed by President Goodluck Jonathan, at least 1% of the Consolidated Revenues Fund in the annual budget should be allocated to the provision of basic healthcare. Four years after the law was made, the federal government is just gearing up to begin the first phase of Huwe in Abia, Niger and Osun states while efforts are afoot to sell the initiative to the state governments.

As the Health Minister, Professor Isaac Adewole, put it, Huwe is to complement the efforts at funding basic healthcare at state and local government levels. It is, therefore, no excuse to abdicate responsibility. The issue involved here is the social investment that is critical for national development. Governor Ifeanyi Okowa of Delta State aptly made the point in his contributions during the discussion: the National Health Act is a law that is to be obeyed by all governments like all other laws of the land. The state governments should, therefore, respond to Huwe positively. Huwe should not suffer the fate of the education funds similarly established and backed by laws, which some state governments seem to ignore to the detriment of their people. Waving the flag of “federalism,” the state governments exploit the fact that education is on the concurrent list to deny their people the benefits of such funds. Hence billions of naira lie idle in the Central Bank not accessed by the states that refuse to provide counterpart funds for education projects in their respective states. The flaws in the implementation of education funds should be a lesson in the management of Huwe. State governments often talk of lack of funds. Huwe will at least provide some funds to help the poor people if honestly and competently managed. After all, there are no federal poor people different from state poor people.

So, why should Huwe be an issue in the 2019 elections? Next to the central question of security, the investment in the social sector should be a defining issue of the elections. Social investment has become an imperative to widen the access to quality basic healthcare and education. Those who have voices in the public sphere should pay attention to the issues involved in security and the social sector because elections should, after all in theory, be about choosing among the candidates as they canvass solutions to the problems confronting the people.

Huwe means life. And incidentally, life is what is involved in the insecurity plaguing the land as well as the virtual collapse of public healthcare and education.

So, in a sense, Huwe is a metaphor for the issues that should define the elections.

The 2019 elections should be fought on issues arising from the poor condition of the people and not the monumental diversions dominating the headlines. It is more relevant to the people to identify candidates by the issues they are passionate about rather than their religions and regions. The whole gamut of problems in the land actually dictates such an approach to politics. In the present circumstance of Nigeria, healthcare delivery should be worth the passion of political parties and candidates that truly care about the people.

The continuum from policy idea formation to implementation of Huwe makes it a good example of an electoral issue. The bill for the establishment of Huwe was signed into law by Jonathan. Now the administration of President Muhammadu Buhari is just taking steps towards the implementation of the law. The little progress in this regard should be duly acknowledged. First, it is important to note that the Buhari administration is poised to implement the law rather than chase the partisan shadows of making another law all in the name of being different from the previous administration. More fundamentally, the National Health Act of 2014 is one the victories of the years of advocacy for the respect of the socio-economic rights embodied in the Chapter II of the 1999 Constitution. Unknown to many citizens, a number of laws that could reduce inequality by deepening socio-economic rights do exist. In fact, radical lawyer Femi Falana has recently come up with a book exploring the legal dimensions of these socio-economic rights while situating things with a historical context.

The tragedy of the Nigerian condition is that the federal and state governments mostly ignore these laws in the course of policy conception and implementation. It is important to reflect on the trajectory of the struggle for socio-economic rights to understand why politicians may elect to ignore an important policy initiative such as Huwe while they claim to be offering “dividends of democracy” to the people. If such initiatives such as Huwe is not embraced and made part of national life, those in charge of governance would only be paying lip service to poverty reduction.

Therefore, instead of applauding politicians making bland statements about healthcare provision, political parties presenting candidates should be pinned down to the specifics of how to fund basic healthcare. Huwe is a categorical rebuke to the neo-liberal shibboleths often made in response to the popular demand for universal healthcare that “government cannot do everything” or that “privatisation is the answer.” The Fund is an important advancement of the age-long debate on the role of the government in providing healthcare for those who cannot afford the exorbitant prices of private healthcare providers. The grim health statistics associated with Nigeria have proved that that the one-size-fits-all answer of some neo-liberal ideologues that all those who need good healthcare service should be prepared to pay for it is callously inadequate. Those who want market forces to allocate healthcare services accuse their ideological opponents who think otherwise of being emotional in this debate. Well, this is a historically legitimate emotion to express at this time. The truth is that not all the people are in a socio-economic position to pay for the healthcare they badly need in all situations.

For clarity, Huwe is to widen the access to basic healthcare. Beyond this, however, the organising principle in the debate is how to fund healthcare. Incidentally, the response of those in government to the crippling funding crisis in the health sector is underlined by huge hypocrisies. On May 29, for instance, the federal and state governments would advertise their “achievements” in the health sector among others. However, these “dividends of democracy” in the health sector are obviously not good enough for the President, governors, ministers, legislators, senior civil servants and indeed the rest of us members of the elite outside the government when healthcare is needed. The option for some of us as members of the elite is to seek medical attention abroad. Yet, this is a privilege that over 99% of the population is not entitled to because of the burgeoning poverty in the land. The social crisis inherent in this trend is often ignored in the several technical seminars on healthcare funding.

Relative to Nigeria, Cuba is a poor country in terms of the size of the economy. The tiny Caribbean Island provides universally adjudged quality health services to all its citizens and even sends good doctors abroad to assist other countries. When its late leader, Fidel Castro, was ill in his last years, he was provided medical care in his country. Castro was never flown to any country for medical attention. The sobering lesson in the Cuban example is often lost on the purveyors of “dividends of democracy” in Nigeria.

In fact, as it was pointed in the THISDAY Policy Dialogue, some countries began to increase their budgetary allocations to the health sector during recessions. Thailand was cited as an example. So the perennial excuse of economic downturn for the poor funding of the health sector by successive governments in Nigeria is no longer tenable. It is simply a policy choice not to care about the people’s healthcare in so far as the elite can seek quality care any where on the globe. That is precisely why the nitty gritty of funding healthcare should be an issue in the next year’s election.

With a target of reaching 100 million poor people and about N60 billion budgeted in 2018, the take-off of Huwe looks promising. What is required now is for political parties and their candidates to state their positions on this policy step and others in the health sector. Are their candidates who see Huwe the way Donald Trump sees Obamacare? If any party or candidate plans to repeal the law backing it, it would be good for such political party and its candidates to spell out the alternative clearly. Those who are persuaded by the logic of Huwe and other initiatives should also concretely state how to improve on the implementation.

That is the way of issue-based elections.