Will Anyone Vote for Health Policy?

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

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

There is one huge deficit in the campaigns towards next month’s elections; political parties and their candidates are not definite enough about their plans to improve the condition of the Nigerian people.

There are on display several manifestoes stating what politicians promise to do if given the mandate. However, there isn’t much of how the missions would be accomplished.

This trend is surprising given the large number of technocrats turned politicians who are energetically seeking votes. It may, of course, be idealistic to expect candidates to go into policy details in the brief opportunities they have while on the hustings. But it is, at least, expected that some specifics about how to execute a policy should be stated in policy documents. The websites of political parties should be replete with details of how policy objectives would be achieved. This is more so in respect of issues that directly affect the condition of the poor people.

It is certainly not asking for too much to ask candidates with backgrounds as technocrats to enrich and elevate policy debates. Technocrats should go beyond the slogans of “end of hunger,” “education for all” or “ “universal healthcare.” One difference that technocrats could make in politics is to help build the culture debating policy details beyond a few minutes of appearance on television.

The health sector is one of the policy areas that specifics are sorely needed for an informed choice by the electorate. Healthcare delivery is a crucial component of the social sector. And there is a seeming unanimity of opinions among experts across ideological divides that poverty is a central question of development. In fact, poverty defines the Nigerian society.

The primacy of the social sector in the development is no more disputed in an age in which even the World Bank and the International Monetary Fund (IMF) are now the “champions” of anti-poverty programmes. Those enforcers of the ground rules of global capitalism are not just focussing on growth rates anymore.

So to tackle poverty the specifics of health policy especially funding should be stated.

In a commissioned report late last year, the Economist Intelligence Unit made a survey of 50 countries to find out what “building inclusive societies” means to citizens. Healthcare was rated top among the priorities of citizens in different parts of the world in the report entitled “Priorities of Progress: Understanding Citizens’ Voices.” This is followed by other priorities namely education, social protection, and public safety, research and development (R&D), environment and transport infrastructure. Perhaps the most instructive observation in the report is that despite the differences created by the factors of economy, culture, technology and geography, peoples hold common views across the boundaries about “change and progress” in the society.

Nigeria is squarely within the global currents of people’s expectations from their governments.

In a comment on the important report on this page on November 14, 2018, this reporter observed as follows: “A theme that could be extrapolated from the foregoing (that is Economist Intelligence Unit report) 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 treat the health of the people as just another commodity.

“What this report by a unit of a consistently liberal newspaper has confirmed again 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 also 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.”

To play anti-poverty politics, a greater attention should be given to the social sector than what is currently the case among politicians and political parties in the current campaigns.

Last year, this newspaper in partnership with the federal ministry of health held a series of policy dialogues on healthcare. In one of the lively sessions, a passionate advocate of the synergy of purpose among stakeholders in shaping and driving health policies, Dr. Olumide Okunola, drew the attention of the audience to a development that should interest politicians, political parties and the electorate alike in this season. As the director of programme, Okunola, a gynaecologist, reminded Nigerians that in Ghana the articulation of health policy is a determinant in winning presidential elections. The example of Ghana should particularly be sobering to politicians here who merely sloganeer about health policies during elections. This is because cynics in some quarters might dismiss the examples of American and British elections as far to seek. In the last presidential election in the United States, what to do with the signature health policy of President Barack Obama called Obamacare was a major issue of the election. It is already projected by some pundits that health would be among the 10 defining issues of the 2020 American elections. The fate of the British National Health Service (NHS), as a cherished institution, is always an electoral issue in which political parties are definite on their policy options.

Yet, most politicians and political parties taking part in next month’s elections are hardly spelling out the specifics of funding their health policies. This should ordinarily not be the case because implementation of health policies is gradually becoming a continuum in Nigeria. Like the British and American examples cited above, there is already a substratum of policy for those shaping party policies to work upon in the health sector. The National Health Act was signed into law in 2014 by the People’s Democratic Party (PDP) government of President Goodluck Jonathan, just a year before the expiration of his tenure. In fact, as a PDP senator, Governor Ifeanyi Okowa of Delta State was the chairman of the senate committee on health when the law was passed. At the second THISDAY Health Policy Dialogue, the PDP governor called on all his fellow-governors to “obey the law” by implementing the provisions of the law.

Again, the continuum demonstrated in the health policy is another reason why strategies of development should be owned by political parties and should be embraced by candidates contesting elections at all levels on their respective platforms.

Although healthcare was hardly a prominent issue in the 2015 elections, yet it is a good thing that President Muhammadu Buhari, candidate of the All Progressives Congress (APC), has given life to the 2014 Act by taking concrete steps to implement its provisions.

Only last Tuesday, Buhari rolled out the Basic Health Care Provision Fund (BHCPF) already appropriated in six states and Abuja. Funds to implement the provisions of the National Health Act were appropriated for the first time in 2018. The current provision is the N55 billion from Consolidated Revenue Fund to the basket fund of BHCPF. The Bill and Melinda Gates Foundation has also contributed $1.5 million of the pledged $2 million into the basket.

It is clear that the specifics needed are mostly in terms of funding.

In an apparently institutionalised manner, the National Health Act makes it mandatory that 1% of the Consolidated Revenues Fund in the annual budget should be allocated to fund basic healthcare.

In April last year, a new logo for BHCPF was unveiled under the name, Huwe, an Ebira word meaning life. The occasion was the second THISDAY Policy Dialogue on Universal Health Coverage. This electoral season, in which the limitation of resources comes into the fore as politicians set priorities, is therefore appropriate to state the specifics of health policy. Reflecting on the discussions at that forum this reporter wrote on this page on April 25, 2018 inter alia: “In fact, it was pointed out that 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.”

Despite the credible steps taken by the Buhari administration in giving effect to the National Health Act, it is not yet universal health coverage in Nigeria. In fact, the nation is still very far from that destination of healthcare as a socio-economic right in the light of the slow journey in that direction.

There is nothing in the Buhari’s “next level” manifesto to that a significantly different approach would be adopted in the health sector if the president is re-elected.

The other parties should, therefore, come up with specifics of changing the health policy if they have what they consider superior or improving on the implementation of the existing policy, which is certainly not satisfactory.

For instance, it is remarkable that unlike most of the other presidential candidates, Atiku acknowledges the reality of the National Health Act. In fact, in his plan “to make Nigeria work again,” Atiku plans to establish a commission to ensure “quality” and “standards” in the implementation of the provisions of the law. Atiku also plans to reduce by 40% in 2024 the percentage of those “impoverished” by health expenses. Expectedly, the liberal tone and tenor of the details of the Atiku plan in the health sector is manifest. In a review of the unsatisfactory condition in the sector, Atiku refers to the World Health Organisation (WHO)’s recommendation of allocating 17% of annual budget to healthcare.

However, it is not stated specifically in the Atiku plan what percentage of the budget would be allocated to health in Nigeria. Instead, the specifics of the role that the private sector would be expected to play are spelt out in the plan.

Now, the private sector is evidently playing a significant role in healthcare delivery. Yet, quality healthcare is beyond the reach of the poor. What the electorate should be told is the definition of the role of state in the organisation of the sector and how much of public resources would be devoted to healthcare in the interest of the poor majority.

To make health policy a determinant of people’s votes, candidates and their parties should go beyond the slogan of “free health service” and state the specifics of how to fund universal healthcare.


“To make health policy a determinant of people’s votes, candidates and their parties should go beyond the slogan of “free health service” and state the specifics of how to fund universal healthcare”