THE HORIZON BY KAYODE KOMOLAFE   kayode.komolafe@thisdaylive.com

Discussions could be illuminating when issues are situated in a global context. It is also a good thing that Nigerian public intellectuals are wont to summon examples from other parts of the world to support their arguments. After all, Nigeria should adopt the international best practices, as they say.

For instance at the April THISDAY Policy Dialogue on Universal Health Coverage, a strong case was made for making health a focal point of policy and politics. The point was brought home with a remark that in Ghana no political party would expect to win elections without canvassing its health policy in clear terms to the electorate. The Ghanaian example is particularly instructive as no one could possibly say it is an inappropriate parallel to draw. In other words you don’t have to go as far as Canada or Japan to see what premium is placed on health in policy making in other lands.

So in a clime in which elections are issue-based, it is expected that 93 days to election competing health policies should be on display in the public sphere.
The universal concern about the health of the people is captured in a report of the Intelligence Unit of The Economist of London released two days ago. The report entitled “Priorities of Progress: Understanding Citizens’ Voices” is a loud confirmation that the advocacy for universal healthcare is not peculiar to Nigeria.
According to the survey, health is “top priority among citizens globally.” Social protection and education come second and third respectively on the table of priorities. Other priorities include public safety, transport infrastructure, environment and research and development (R&D).

Again, the primacy of social protection has been brought into focus by this survey, which should interest the politicians, experts and the people. It is also remarkable that a liberal journal is providing the platform for the discussions.

By the way, such a report may not receive enthusiastic response from politicians and their publicists here because it may not embody a political missile to throw at their opponents. However, the report is indubitably a matter of policy and politics. The decision to respond to the voices of the people can only be a political one as experience has shown in places where relative progress has been made in the health sector. Such decisions are central to social protection. And that is why such a report should be worth the attention of pundits.

The report says among other things: “Citizens don’t often think about resource constraints when they vote or think about the kind of society they want to live in. Many want free education and healthcare, security, high incomes, low taxes, a clean environment, and affordable housing. However, resource constraints mean that societies need to prioritise their focus areas. And citizens’ opinions have become an increasingly relevant policy input as governments seek to restore trust in institutions and better serve their populations.”

A theme that could be extrapolated from the foregoing is that it is not enough for a political party to blandly declare that it would provide free health services. It is equally socially insensitive for free market fundamentalists to glibly dismiss the idea of universal healthcare coverage and the treat the health of the people as just another commodity.

What this report by a unit of a consistently liberal newspaper has shown is that health is a basic human need. In the Nigerian specific context, you cannot be talking seriously about poverty eradication without the access to primary healthcare by the poorest in the society.
Implicit in the report is the fact that the people’s perception about the funding of heath services could sometimes be at variance with the calculations of politicians and their experts of various ideological hues. That is really the issue. A mother clasping her baby dying of a preventable disease is not the right person to lecture on the economics of health. The fact of limited resources should compel those who think for governments to ponder how to make the social sector a priority in policy conception and articulation.

While discussing funding health services, there should be a particular focus on the need of the most vulnerable segment of the society. The luxury of dwelling on technical health economics might not be available when the care of those in desperate conditions is involved.

The lack of priority in this area becomes poignant in crisis situations. Just imagine what degree of the humanitarian catastrophe that would be recorded in the camps of the Internally Displaced Persons (IDPs) if you remove the healthcare provided by organisations such as UNICEF, Doctors without Frontiers and the philanthropic bodies. The interventions by these organisations are far from being informed by the logic of market.
When experts debate the costs of healthcare, it seems they sometimes forget those who cannot afford the cost of their own healthcare even if it is N100. In such a situation, making healthcare “affordable” is not even good enough.

At the root of the strikes of the workforce in the health sector is the poor funding by the government. International standards are often invoked to justify why all tiers of government should increase health budgets. Yet the official response to the legitimate protests often reveals policy confusion.

Beside funding, other policy elements include the role of technology, the place of alternative medicine and how to re-channel the huge resources devoted to medical tourism. In a country, where people still die of cholera for lack of immediate oral rehydration therapy (ORT), how do you factor in technology when some thinkers are already making a prognosis of artificial intelligence (AI) doctors? The sector here is still bedevilled with rudimentary questions. So can policy-making accommodate jump-starting health care delivery system? These and many others are the questions that should worry those strategising for the parties and their candidates.

It is, therefore, worth the while to drum home the point in this season of elections that political parties and their candidates should respond to voters’ expectations with well-reasoned plans to reverse the sordid story in the health sector.
The health statistics of Nigeria are grim even by the standards of West Africa. As an unfortunate example, infant mortality is worse in Nigeria than some West African countries. Underlying this problem is poor policy conception, articulation and implementation.

As the report cited in the foregoing suggests, health remains a global issue. Even developed countries still make it an issue of politics. Donald Trump wants the health policy put together by his predecessor, Barack Obama, repealed. The problem is how to formulate a credible alternative policy to replace it. The policy called Obamacare in the popular parlance seeks to ensure health insurance coverage for millions of Americans who would otherwise be without healthcare insurance. There are politicians who are critical of the British National Health service (NHS), a cherished national institution. During elections, options to reform the NHS are canvassed from various perspectives.

To be charitable to officialdom in Nigeria, discussion about reforming the healthcare delivery cannot be said to be in a policy vacuum. The good thing is that there is already a substratum on which political parties and their candidates can build their policies. Since 1999, health ministers have endeavoured to articulate health policies.

Even during the military regimes, health policies were matters of public discussions. Yet many of the poor people still lack access to basic healthcare.
For instance, the presidential candidate of the people’s Democratic Party (PDP), Alhaji Atiku Abubakar has reportedly unveiled an agenda, which includes lifting “our people out of poverty, we shall improve their access to basic services including education, health, electricity and water – by making these services not only available but affordable.” It is hoped more flesh will be given to such a proposition in the coming days of campaign.

Talking about health specifically, the question of affordability has to be clearly framed by the PDP. How can the policy on ground be improved upon or be entirely replaced with a better one?
To start with, Chapter II of the Constitution makes abundant provisions for socio-economic rights including the right to healthcare. For now, forget about the non-justiciability clause applying to these socio-economic rights. The socio-economic rights remain “fundamental objectives and directive principles” of the policy of the Nigerian state. Besides, some laws have been enacted to enhance the enjoyment of these rights by citizens.

One of such laws is the National Act Health of 2014. The pro-people law makes provision for 1% of the Consolidated Revenues Fund in the annual budget to be spent on providing basic healthcare. In implementing this law, the Buhari administration is selling the Basic Healthcare Provision Fund (BHCPF) to the states. With a target of 100 million poor people and about N60 billion budgeted in 2018, the federal government is giving leadership in this respect.
The law is supposed to be obeyed by the federal and state governments. Although, the Health Minister, Professor Isaac Adewole, has said the BHCPF, otherwise called Huwe, is to complement the efforts at funding basic healthcare at state and local government levels, there seems to be reluctance on the part of most state governments to implement the law for the good of the people.

Every political party should, therefore, declare its position on the compliance with the law by all governments elected on the platform of the party. If a party thinks its own health policy would be better implemented by amending or even repealing the law, it should canvass the position in the process of seeking mandate.

The findings that health is top priority for people globally seem to justify the observation made on this page eight months ago that health should be made an issue in this election as follows: “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.”
If a survey were to be conducted in Nigeria today, health would certainly be among the “priorities of progress.”

QUOTE
“The fact of limited resources should compel those who think for governments to ponder how to make the social sector a priority in policy conception and articulation”