As Nigeria continues to push towards Universal Health Coverage, Martins Ifijeh examines the role of the federal government’s Saving One Million Lives in achieving the goal
It is no longer news Nigeria is one of the worst places on earth to give birth due to the poor maternal and child health indices in the country, but many a time, those who are affected do not have a say in which country they should get pregnant from, or where their innocent children should be born. They do not have a say in what will be the outcome of their pregnancies. Whether they will give birth safely or lose their lives or that of their babies is an exclusive preserve of the country they live in.
This lack of choice also plays out among other citizens, especially the poor, who are unable to afford or access basic healthcare like treatment for malaria, vaccination, management of the human immune virus, accessibility of family planning commodities, among others; hence leading to high mortality rate and the embarrassing life expectancy ratio for both males and females in the country.
But since the inauguration of the Nigerian Government’s Saving One Million Lives Performance for Results (SOML-PforR) initiative, and the granting of $1.5 million to each of the 36 states of the federation and the Federal Capital Territory (FCT) less than a year ago, has the narrative changed? Can this programme propel Nigeria into achieving the single most prioritised health advocacy of the 21st century globally, which is Universal Health Coverage? Will Nigeria achieve healthcare for all by 2030?
Will this and many more investments put into the country’s healthcare amount to business as usual; leaving the poor Nigerians to die from preventable illnesses? Is this programme already saving millions of lives, or is there another messiah (initiative) to be expected.
It is in answering these pertinent questions that THISDAY reached the National Programme Manager, SOML-PforR, Dr. Ibrahim Kana, who believed the programme was designed to provide a paradigm shift for the country, with a plan to stop payment for inputs, as been previously done, and then start paying only for clearly defined and objectively measurable results or across the country.
He said the initiative is geared towards driving the country into UHC for all, adding that the initiative has provided an opportunity for each state to achieve UHC.
“With SOML-PforR’s focus on improving primary healthcare, and on increasing insurance coverage especially for the most vulnerable in the society, states can now ensure that their people have access to quality health (including prevention, promotion, treatment, rehabilitation and palliation), while also ensuring that the use of these services does not expose their people to financial hardship. If each state is able to do this for themselves, Nigeria as a whole will achieve UHC.
“We believe this is an approach to structuring the flow of resources to pay for results. It is the federal government’s flagship intervention to improve maternal and child health by changing federal-state relationship to becoming a results-based partnership. This programme relies on extant polices and systems, and is designed for the federal government to influence the states through: collection of robust data on service delivery at community and health facility level and feeding it back to states; rewarding and recognising states for better performance; and provision of technical assistance.”
Kana said SOML-PforR was predicated on quantitative indicator, which is the sum of increase in vaccination coverage, contraceptive prevalence rate, vitamin A coverage, skilled birth attendance, insecticide treated nets usage by children under five, and the testing of pregnant women for HIV, adding that the other area is the improvement in quality of care.
He said the SOML-PforR means that the Primary Healthcare Centres (PHCs) across the country will be functional, as citizens will get quality healthcare as at when due, noting that hospital staff will by this programme get adequate training and motivation.
“This also means children will no longer suffer or die from vaccine preventable diseases. There will be less episodes of malaria, while mothers will be able to determine how many children they want to have, space them, and prevent them from dying from simple complications.
But how effective has the programme been since its commencement? Kana said SOML-PforR publishes results on all selected key health indicators, as they are already seeing state governments becoming more accountable to their people.
“No single past programme has been as effective in forcing decision makers to collect, analyse and review data and use evidence to inform/guide their decisions and actions as SOML-PforR has done in the short time since it commenced operation. There has been a marked improvement in transparency by government at all levels due to the SOML-PforR’s requirement that due process and financial regulations/systems are strictly adhered to.
“SOML-PforR measures progress in each state through these robust surveys: National Nutrition and Health Survey as well as the National Health Facility Survey. Each state competes with itself and both zonal and national champions are rewarded in order to create competition between the states and zones. The result of these surveys are then published on national dallies as well as on the SOML-PforR website.”
He said following an analysis of state’s results from the 2016 MICS compared against the 2015 National Nutrition and Health Survey, 12 states in the country have performed high, noting that the star states have qualified for the federal government’s earned performance rewards.
He said on a general note, all states were making progress on different aspects of the programme to varying degrees.
How has the states utilised the $1.5 million granted to them? Kana explained that states were participating actively, while the Nigeria Governor’s Forum was in full support, adding that several international partners have also keyed into the programme as a novel way of financing healthcare in the most transparent manner.
For incentives to states who judiciously spend the grant, he said states have been given flexibility in what they spend the funds on as long as due process is followed, as this was done to avoid interfering with their ability to deliver the expected results. “Judicious use of the funds is expected to result in improved health outcomes that can be measured. States will receive direct financial incentives for such improvements.
“On accountability, what we do is that each state and the FCT has opened an SOML-PforR Operational Naira account at the CBN, which is part of the TSA, but the funds within are ring-fenced, and can only be accessed directly by the SMOH; Access to the fund is only possible via the REMITA platform; all disbursements are made directly to beneficiaries; all transactions are conducted via electronic transfers only; approving officers are not signatories, and the state governor forwards the names; all expenditure must be from approved expenditure plans (approved at Federal level by HMH, approved at State level by HCH and FMOH).
“Regular auditing is also conducted for compliance with financial regulations to ensure fund utilisation in line with approved work-plans; we also make sure all programme expenditure is tracked and a summary report produced by the state programme management unit; and the Auditor General of the Federation reserves the right to audit the programme financial statements in any of the states.”
He also added that other measures put in place include audits by state auditor generals, reporting of published and consolidated budget execution report for all income and expenditure on PHCs, and a signed agreement between the World Bank and the federal government for anti-graft agencies (EFCC, ICPC, etc.) to cross check and verify all expenditures under SOML-PforR.
He said among other things the programme has actively helped to support partnership between the federal and state governments by encouraging joint planning and shared accountability for results.
With the world tilting towards universal health coverage for better healthcare globally, time will tell if this programme will push Nigeria into achieving this goal by year 2030.