With the return of the Global Alliance Vaccine Initiative to Nigeria, after some years of withdrawal from the country, due to poor accountability issues, a new bar for transparency in donor funds has now been set up. This is to usher in a new template for healthcare financing and as well improve the nation’s healthcare service delivery, Paul Obi reports

In 2015, the Global Alliance Vaccine Initiative (GAVI), also known as the Vaccine Alliance, descended on Nigeria with a big hammer after the Geneva-based body discovered that Nigerian government officials and some non-governmental organisations (NGOs) siphoned about $7.6 million of its funds. The organisation now chaired by Nigeria’s former Minister of Finance and Coordinating Minister of the Economy, Dr Ngozi Okonjo-Iweala, not only uncovered the cesspool within the Nigerian healthcare system, it withdrew from Nigeria and demanded the refund of the $7.6 million. The federal government commenced the refund in 2015, doling out a whopping $2.2 million, followed by other installmental payments in 2017 and 2018 through the nation’s appropriation.

Over the years, the government has been challenged with the task of ensuring accountability and transparency on how healthcare funds are spent. The easing of bottlenecks and checks on donor funds had slit the door open for thievery of the nation’s meagre health funds. In 2016, about six officials from the Federal Ministry of Health were quizzed by the Economic and Financial Crimes Commission (EFCC) for allegedly dipping their hands into the Global Fund’s HIV donor funds. These cases on the long run created phobia among foreign donors in investing in Nigeria’s healthcare system.

Since then, foreign donors’ intervention in Nigeria’s healthcare system took a nosedive, creating a gap in healthcare financing. The return of GAVI to Nigeria in June with the donation of about $1.03 billion has raised the hope for better days in tackling diseases and other healthcare challenges. But this is coming with the assurance that foreign donor funds would no longer disappear into thin air.

At the announcement of the new GAVI fund, Minister of Health, Prof. Isaac Adewole, gave assurance that things will now be done differently. He said: “GAVI board’s approval of the funding envelope the decision for extension of transitional period from 2021 to 2028 was a direct testament of the renewed commitment of this current administration and demonstrable leadership in enshrining accountability and transparency in all governments’ dealings especially with donor agencies.” The minister observed that the new funding would compel government to be discreet in implementing the funds and ensure adherence to the objectives of the investment at stake.

He added that, “This implied that government would have to progressively increase funding for its immunisation programme and the co-financing of vaccines until Nigeria transitions completely in 2021 out of GAVI support. However, due to poor macroeconomic indices, tight fiscal space, a further reduction in funding for Polio related activities and very low immunisation coverage, Nigeria sought an extension of GAVI support from 2021 to 2028, in order to ensure the country can fully finance its immunisation and primary health care system,” Adewole stated.

Despite the assurance by government to ensure transparency and accountability in implementing the funds, stakeholders within the sector have expressed fears about government’s ability to be accountable. The worries across the sector are borne out of the naked display of sleaze that have characterised foreign donor funds in the years past. Several cases abound where such funds have been diverted by government officials and NGOs. To this end, the Nigerian Medical Association(NMA) has indicated interest to follow the GAVI money to its final destination.

Speaking with THISDAY, NMA President, Dr Francis Faduyile, hinted that the body would put in place a mechanism that will monitor the GAVI fund. The NMA president explained that the association would ensure transparency in the implementation of the funds by tracking the expenditure of the funds.

He said: “The first thing is, we have to congratulate ourselves as GAVI has decided to come back and that’s because of our inability to be transparent with the expenditure. GAVI had to withdraw, but we have confidence in one of our members, Dr Shuaib Faisal, an executive director of National Primary Health Care Development Agency (NPHCDA), who has shown a lot of transparency. He added that the NMA was already in talks with government on the plan, adding that, “working with them and we are going to follow up actively with our members in place and have a committee that will have to work with the intended tactical committee. Also, with NPHCDA, we can follow up the activities and monitor and evaluate what things are done regarding the primary health care centers,” Faduyile stated.

Similarly, a Professor of Viorology and board member of GAVI, Prof. Olawale Tomori, also shares the same fears on government’s poor accountability credentials. In his views, the prospect of funding Nigeria’s health projects is doomed should the GAVI funds suffer similar fate of sleaze. “If we refuse to adhere to strict accountability measures conditional for our taking advantage of the transition, we are doomed. You will recall that this is not the first time donors are accusing Nigeria of ‘misusing’ or misappropriating funds.” Citing the cases, Tomori added that, “The report went further to identify in-house sharing of contracts by government officials, inflicting allowances and transport cost.”

On the way forward, Tomori recommended thoroughness in the handling of the funds. The GAVI board member charged government officials to save Nigeria from shame and stick to the principles of transparency, particularly, as it concerns foreign donors’ funds. He contended that consequences of another round of diversion of the funds would be more than devastating. The professor of virology said: “My advice is that we must in addition, allocate 99 per cent accountability and transparency to the disbursement and use of the funds. Otherwise, most of the allocated funds will be sucked down the vortex of fund misappropriation.”

Notwithstanding the various suggestions on how to make the GAVI funds profitable to Nigerians, officials of the initiative also have a critical role to play. The biggest challenge with foreign donor funds had been that donors only focused on donating the funds and not turning their attention on what become the outcome of such donations.

Observers believed the absence of tracking the funds by the donating international organisations has in turn been the bane of accountability in Nigeria’s health sector.

And now that GAVI has returned to Nigeria, let new things be done to ensure that the $1.03 billion is not lost to corruption. With Okonjo-Iweala at the helm of affairs at GAVI, Nigeria should not suffer another global bashing as a result of stealing of donor funds meant for vaccines and immunisation.

Also, rather than GAVI officials holing up in cosy hotels and engaging in talk shops in Abuja, Lagos, Port Harcourt, Calabar, Enugu, Maiduguri and Kaduna, they should be on the field tracking the money and primary healthcare projects, and monitoring vaccination and immunisation programmes across the villages. If anything, this is the time to declare Operation Follow Money (OFM) to the villages where the challenge of diseases is rampaging.

That in itself, is a potential way to cement the current gaps in transparency and accountability in the nation’s healthcare financing. That way also, the gains of Nigeria’s health sector will be plenty.