The third THISDAY Healthcare Policy Dialogue held in Abuja at the weekend has extracted commitment from policymakers and major stakeholders in the health sector that would help in changing Nigeria’s poor healthcare narrative, especially in the 36 states of the federation. Martins Ifijeh reports
In Nigeria, a sick person either walks straight to the hospital to purchase treatment out of his pocket, or prays to his Creator for healing. If none of these happens and he is out of money, he then relies on his innate immunity to help him fight off the sickness, even if it is a terminal illness. And when this finally fails, the patient dies. It is that simple in Nigeria. It is the reason the country has about the highest mortality rate in the world.
About 130 million Nigerians are presently taking this risk on their health, especially poor Nigerians who constitute 73 per cent of the country’s population. This has increased the death rate in Nigeria, reduced life expectancy, and worsened the myriads of poor healthcare statistics that the country is known for.
No wonder, when health indices are discussed on a country-by-country basis, Nigeria often emerges one of the countries with the worst indices on key global health issues.
For instance, the country sits comfortably among the 10 worst places in the world with disease burdens. On specifics, Nigeria has the highest burden of malaria globally, with about 40 per cent of global malaria deaths occurring in the country and Democratic Republic of Congo alone. Not only that 90 per cent of Nigerians are at risk of malaria, it kills over 300,000 of them yearly, with 11 per cent of maternal deaths linked to it.
Just recently, Nigeria overtook India to emerge the worst country globally with maternal deaths. About 15 per cent of global maternal deaths occur in Nigeria alone, and the deaths of new-born babies in the country represent a quarter of the total number of deaths of children under five worldwide. In fact, a woman’s chance of dying from pregnancy or childbirth in Nigeria stands at one ratio 13, judging by indices from the World Health Organisation (WHO).
Among other areas, Nigeria is the second worst recipient of malnutrition burden globally, just second to India, with about 11 million children who may not reach their full potential in life because their physical, brain and learning abilities are being impaired because of hunger or lack of adequate nutrition.
Several countries with similar poor health indices decades ago have prioritised their healthcare through the provision of basic healthcare for their citizens. For instance, countries like Turkey, Mexico, Thailand, among others, are currently doing well in offering basic care for their citizens.
It is to address these myriads of healthcare challenges in Nigeria that THISDAY Newspapers has decided to champion a series of healthcare summits where high powered policymakers, development partners, stakeholders in the health sector, business community, and the general public are brought under one roof to design models that can change Nigeria’s healthcare narrative for the better.
While the first, which was held in March this year focused on Healthcare Financing in Nigeria, the second summit addressed issues around Universal Health Coverage, with the Director General of WHO, Dr. Tedros Ghebreyesus, headlining it.
It was also an avenue for the federal government to launch the Basic Healthcare Provisions Fund (BHCPF) and make commitment towards including the fund in the 2018 national budget.
The federal government, true to its promise, included the BHCPF in the national budget passed by the National Assembly on May 16 this year, which means for the first time, the Nigerian government earmarked N57.15 billion for BHCPF to address primary healthcare issues across the country.
This third edition, themed: “Funding Healthcare for All; Why States Matter,” with a sub-theme: “Emergency Medicine: Need for Action,” emphasised the need for states to provide basic health services to their people. It also honoured states that distinguished themselves using the federal government’s Saving One Million Lives Programme Performance for Results (SOMLPforR) Index as a major tool in determining star states that have delivered healthcare to their people.
Like the previous summits, which came with several commitments from governments, development partners and the healthcare stakeholders, some of which are already being matched with actions, like the earmarking of N57.15 billion for BHCPF, this third summit held last weekend in Abuja also came with several commitments to address healthcare funding, especially in the 36 states of the federation, and the Federal Capital Territory (FCT).
Basic Healthcare Provisions Fund
Speaking as Special Guest of Honour, Vice President Yemi Osinbajo said the federal government will commence the disbursement of the BHCPF in August.
The BHCPF is a fund allocation to cater for the basic healthcare needs of all Nigerians. It means at least one per cent of the Consolidated Revenue Fund (CRF) in the 2018 national budget will be deployed for the revival of the country’s health sector.
The vice president said with the disbursement, Primary Healthcare Centres (PHC) will be better equipped across the country, maternal and child health will be reduced, children will no longer die from vaccine preventable diseases, and that the country’s health indices will improve generally. He urged state governments to make judicious use of funds from the SOMLPforR initiative, warning that states which fail to make good use of such funds will be denied access to further grants in future.
The federal government in 2017 disbursed $1.5 million to each state of the federation for the SOMLPforR initiative.
Arguing that the dialogue platform does not recognise performance on the basis of political affiliation, but merit, Osinbajo pointed out that the states that had distinguished themselves through the funds received will be honoured for their good work. He added that the initiative had shown that Nigeria’s healthcare was not only functional but health workers were also trained and motivated.
The vice president said with the policy, Nigerian children would no longer suffer from preventable diseases, adding that maternal mortality will be put under control while parents will be helped to engage in effective family planning.
According to the vice president, the initiative will also help Nigeria in achieving universal health coverage, which he said included the SOML annually, and help the country in driving institutional processes on primary healthcare. He said it was against this background that the federal government took very seriously the National Health Insurance Scheme (NHIS) which he said some states had also joined with a view to providing the needed healthcare services.
“I will encourage every state to make good use of the funds. States without results will miss out in further disbursements,” he said while declaring the summit open.
According to him, “For the federal government to achieve Universal Health Coverage by 2030, we designed the SOMLPforR as part of efforts to incentivise states to enable us reward their performance. And we appreciate those that have distinguished themselves in the provision of healthcare to their people.
“Considering the importance of this fund, we will commence the disbursement from August. Our administration has seen this as a key deliverable which we must address.”
He said the government would be transparent in the transfer of the funds down to the last area where it is needed, adding that it will be disbursed swiftly across the country.
“I am therefore excited about the possibility of the programme. I will like our development partners to support the programme,” he added.
Osinbajo also noted that as part of federal government’s effort to address poverty, malnutrition and health issues, it was presently giving one meal a day to 8.2 million children in 24 states.
“We believe this feeding programme will not only address malnutrition, but will increase school attendance,” he stated.
He commended the Chairman of THISDAY/ARISE Media Group, Mr. Nduka Obaigbena, for using his platform to address pertinent issues in the health sector, adding that it is unprecedented for a media house to drive this initiative.
Social Infrastructure and Poverty Reduction
Earlier in his welcome address, Obaigbena noted that it was time to move away from politics and support efforts that would bring about development of basic social infrastructure and poverty reduction in Nigeria. While commending the federal government for providing the BHCPF in the 2018 budget, he counselled the federal government on the need for the speedy release of the funds to enable the country benefit from the counterpart funding by other development partners.
“As we said, away from politics, it is time to support social infrastructure. It is time to begin to address the issue of poverty and to make sure we bring a lot of Nigerians out of abject poverty,” Obaigbena stated. “THISDAY is supporting the federal government and the Ministry of Health in this initiative and we are supporting the SOMLPforR.”
He added, “We like to congratulate the federal government for budgeting for the BHCPF and we would like to know from Professor Osinbajo when he will do the first release. One of the development partners has promised that within days after release they will offer $20 million.”
Healthcare for All Nigerians
The Minister of Health, Professor Isaac Adewole, whose ministry, along with the World Bank Group joined THISDAY in hosting the summit, said the federal government was committed to delivering real healthcare to Nigerians. Adewole added that already, the administration of President Muhammadu Buhari had done well in the provision of healthcare.
He said, “Two years ago we took a loan from the World Bank and we distributed it to states because we want to advance their differences.
“Many states have utilised that money so well and we are celebrating them today. In the past what we celebrated was the money spent, but now we are celebrating real solutions in maternal health, child health, etc.
“We thank the VP for supporting the BHCPF. We assure him that we will deliver real healthcare to our people.”
On her part, Practice Manager, World Bank Group, Washington DC, Tryna Hague, said the BHCPF was a welcome idea, adding that Nigerians deserve healthcare facilities equipped with necessary materials like drugs, vaccines, and running water.
Hague said, “If there are vaccines, drugs and other services, the number of Nigerians accessing healthcare services in PHCs will increase. And this can happen if healthcare funding is brought down to rural areas in the country.”
Speaking on the sub-theme of the policy dialogue, Founder, Flying Doctors Nigeria, Dr. Ola Brown, said many Nigerians lost their lives because they were unable to get the right specialist, adding that this remains an issue needing attention. Brown said emergency medicine will help address a huge part of Nigeria’s healthcare challenge.
Brown, who has over 50 medical personnel as staff across Africa said, “One of the crucial factors in emergency medicine is time, and if a patient needing emergency medical care is not transported on time, it may be deadly. So a lot of evidence shows that the time a patient can see specialised doctor is one of the most pertinent issues and most important factor in a patient living or dying.”
Chief Executive Officer of First Cardiology, Lagos, Yemi Johnson, who provided an overview of the challenges posed by the lack of coordinated approach to emergency health care administration, stressed the need for a decentralised air ambulance services in Nigeria. Johnson also said that with proper policy framework that helps to provide specialised healthcare centres in the country, Nigeria can become a major hub for medical tourism in the continent.
Other panellists commended THISDAY for the laudable initiative. Professor of Neurosurgery and Vice Chancellor, Federal University Birni-Kebbi, Professor BB Shehu, however expressed regret at the poor level of funding of health centres handling surgery as well as shortcomings of the Air-ambulance services. Shehu suggested that ambulance services should be structured in such a way as to make use of local hospital facilities to attend to emergency patients.
Another panellist, the National Focal Person and Country Director of the United Nations Decade of Action on Road Safety and Traffic Injury Prevention, Sydney Ibeanusi said the UN’s emphasis was to reduce incidence of deaths and injury resulting from road crashes in the country by at least 50 per cent.
On her part, President, Healthcare Federation of Nigeria, Mrs. Clara Omatseye, expressed optimism that the strategic partnership between the private sector, the federal and the state governments would change the narrative of healthcare services in the country
New Specialist Trauma Centres
Minister of State for Health, Dr. Osagie Ehanire, disclosed that the federal government planned to construct six new specialist trauma centres, one in each of the geopolitical zones of the country, to provide effective emergency healthcare services to Nigerians. Ehanire, who disclosed this at a panel session on the state of emergency medicine in Nigeria at the health summit, said the mapping of federal highways will assist in identifying and empowering emergency health service providers located across the country.
High Performing States
States that were honoured at the summit for distinguishing themselves in the provision of healthcare to their people were Zamfara (North-west), Adamawa (North-east), FCT (North-central) and Cross River (South-south), which were selected as best improved states with overall improvement in key maternal, new-born and child health indicators; Lagos and Anambra, which were selected as best performing states on immunisation; and then Delta and Kano, which were selected as states with the most people covered under State Social Health Insurance Agency, with a focus on poor and vulnerable population covered mandatorily with public financing.
How Winning States Emerged
According to Programme Manager, SOMLPforR, Dr. Ibrahim Kana, the performance rewards were calculated based on five Disbursement Linked Indicators (DLIs). DLIs are the specific measures against which performance is determined and rewarded under the SOMLPforR.
Kana said: “The first, DLI 1, which is the increasing utilisation (quantity) of high impact reproductive and child health and nutrition interventions, relies on results from SMART surveys (the 2015 SMART Survey is the baseline for this DLI under the SOMLPforR). This survey mainly looks for improvements in six key indicators of maternal & child health, which are; immunisation coverage, bed net use by children under five, vitamin A supplementation, family planning, HIV testing during pregnancy, and use of skilled birth attendance (SBA).
“Results from the 2016 Multiple Indicator Cluster Survey (MICS) were compared against results from the 2015 SMART survey (baseline) in order to determine which states had improved on the above indicators.”
He noted that the performance result showed that more than half of the states did worse in 2016 as compared to 2015 in most indicators. Twenty nine states had a lower modern contraceptive prevalence (CPR) in 2016 as compared to 2015, and 27 states had a lower immunisation coverage with a mean decrease of 6.4 percentage points in 2016. “Slightly more than half of the states improved on skilled birth attendance and insecticide-treated net (ITN) use, with mean increases in coverages at 1.5 and 3.2 percentage points respectively—this performance is less than ideal according to analysis by the assessors.”
In the 12 states that improved on overall composite indicator in 2016, most of the improvements came from ITN coverage, followed by prevention of mother-to-child transmission of HIV (PMTCT), and then SBA.
On DLI 2, which is the Increasing Quality of High Impact Reproductive and Child Health and Nutrition Interventions, the survey relied on results from the National Health Facility Surveys (the first of which was conducted in 2016) and states were assessed according to the SOML-PforR’s Quality of Care (QoC) Index which has five indicators: clinical competence (adherence to guidelines, accuracy of diagnosis, management of maternal, neonatal complications), availability of drugs and basic equipment, readiness to deliver key SOML services, quality of supervision, Financial management and quality of HMIS data
On DLI 3, which is the improving M&E systems and data utilisation (and implementing a performance management system in all states), the Federal Ministry of Health committed to helping state Ministries of Health develop and operate performance management systems with the aim of strengthening accountability mechanisms and fostering evidence-based decision making in health.
Under the SOMLPforR, the implementation of a performance management system is meant to ensure that states remain focused on results by linking their actions/interventions directly with measurable outcomes in the shortest possible timeframe.
On DLI 4, which is the Increasing Utilisation and Quality of Reproductive and Child Health and Nutrition Interventions through Private Sector Innovation, the survey looked at how implementation of innovation fund that help address SOML challenges like small grants (up to $100,000) to test or develop new techniques, technologies; larger grants (up to $1 million) to test new approaches to improving the delivery of SOML services; and proposals judged ‘blindly’ by independent panel using explicit criteria
On the DLI 5, which is the Increasing Transparency in Management and Budgeting for PHC, the survey looked at transfer of staff at facility level to SPHCDA, and consolidated budget execution report produced and published annually.