THE HORIZON BY KAYODE KOMOLAFE
Before the coronavirus crisis, advocates of a better funding of the healthcare sector were often told to temper their expectations.
The reason often adduced by brilliant experts and technocrats in Nigeria is that there were competing priorities in the budget. With graphs and figures they would seek to convince you in their inimitable power-point presentations on why Nigeria could not meet the international standards in health budget.
You would be reminded of the hundreds of billions of naira needed to fund already awarded contracts and, of course, the cost of running government among other expenditures.
However, in the last few weeks the implementation of these other aspects of the budget has been virtually kept on the hold because of the monumental disruptions caused by a public health emergency.
The health of leaders and the people alike has been threatened around the world. Governance has more or less become crisis management while economies of nations have been shut down. People’s day to day lives have been put in a microbial danger. Community life has gone comatose. Companies and players in the informal sector of the economies are counting their losses.
While scientists are busy studying the nature of coronavirus as well working on the cure and the production of vaccine for its disease, development experts are already making projections based on the impact of the crisis on the economy, polity and society.
Will the consequences of this crisis bring back social goods into its pride of place in planning for development?
This is one question to which experts should find answer as they make assessment of the COVID-19 war as well ponder the changes that are expected in the world after the crisis.
Yes, it might not be predicable in prescient terms even by this time last year that a virus would close down the world by the first quarter of 2020. But then given the experience of Ebola, SARS, MERS-CoV and other epidemics, the world ought not to be so easily overwhelmed given a better preparedness for public health emergency. After all, there is often some preparedness against natural disasters , terrorist attacks, famine even when they invariably happen. The projection and preparedness could help a long way in mitigating against the inevitable disaster.
One way in which governments could be prepared for public health emergency is by investing in public health as a social good. Concomitant social goods with health include education, environment and security.
Globally, if institutions are supported to perform their roles effectively the common good would be achieved. If economically powerful nations embrace multi-lateralism instead of recoiling into misplaced isolationism, a viral common enemy of humanity might be stopped before killing people in hundreds of thousands.
For instance, the World Health Organisation (WHO) should have its capacity enhanced with better funding and diplomatic support to deal with outbreak of epidemics. It should be placed in position to promote a synergy of purpose among nations, poor and rich, as they collectively confront global health crisis. Strengthening the capacity of the WHO would be a wise step in fortifying the global community against pandemics.
It is, of course, to be expected that it is only those countries that prioritise health as a social good that would support funding public health coordination at the global level.
A global power that treats its own institution responsible for disease control with levity in the name of cutting cost would not be expected to see adequate funding of WHO as a good step in the interest of our common humanity.
The folly in treating health budgets as just another cost is now manifesting in this crisis engulfing poor and rich countries alike.
In the circumstance, a global institution such as the WHO can perform only to the best of its capacity in terms of resources and structure.
Part of the global tragedy of this era is the relegation of the social goods as various governments calculate their growth rates and watch their fancy ratings by financial agencies. It is one proof that only a lip service is paid to fighting global poverty and meeting the social development goals.
Come to think of it, , when social goods such as health are treated as commodities it is the poor that would be excluded. It is only when social goods are treated as social goods that the poor would have a greater access to these basic needs.
Incidentally, two of the 2019 Nobel prize winners in economics, Abhijit Banerjee and Esther Duflo, have focused on this issue in their career. Hence along with Michael Kremer they got the award “for their experimental approach to alleviating global poverty.” It is believed that their experimental work has changed things significantly in development economics. Their work has reminded experts to ponder on what exactly is economic development while questioning some general assumptions.
In their book, Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty, Banerjee and Duflo, devote a whole chapter on the issues of public health. According to them, with the right mix of policies, global health could actually be a “low-hanging fruit.”
As if envisaging the current global emergency in the health sector, the Nobel Laureates respond in the book to the neo-liberal arguments that government’s investments in the health of the people amount to “paternalism.”
They put the matter this way: “…It is easy to sermonize about the dangers of paternalism and the need to take responsibility for our own lives, from the comfort of our couch in our safe and sanitary home. Aren’t we, those who live in the rich world, the constant beneficiaries of a paternalism now so thoroughly embedded into the system that we hardly notice it? It not only ensures that we take care of ourselves better than we would if we had to be on top of every decision, but also, by freeing us from having to think about these issues, it gives us mental space we needed to focus on the rest of our lives.
This does not absolve us of the responsibility of educating people about public health. We do owe everyone, the poor included, as clear an explanation as possible of why immunization is important and why they have to complete their course of antibiotics…”
The moral of the global observations by these Nobelists should be noted by those in government given the task of preparing Nigeria for the socio-economic consequences of COVID-19.
Banerjee and Duflo had written their book before the COVID-19 war began to ravage the world. They proposed huge investments in the heath sector as a pillar of a credible anti-poverty strategy. The investment is to enable the health sector deliver social goods for the poor.
Regardless of the ideological orientation of any government, it is now compelled in this raging COVID-19 war to make public health a social good.
Beyond that, however, the crisis should force a rethink about the centrality of human development on a sustainable basis.
Things should not end with putting out the fire of coronavirus. This should be the beginning of a fiscal culture of adequate budget for the health sector.
Must it take COVID-19 emergency to vote the required billions to develop health infrastructure? The structures and equipment being put in place now should be ones that would be sustained after the crisis. More of such structures should be established in more locations in the various states.
The various task forces being put together by the state governments should assist the respective governments to view things beyond the present crisis and think in strategic terms. Their jobs should not be limited to raising solidarity funds for the purpose of the emergency. Governments should be prepared to handle future crises better by making healthcare a social good.
It is now proven beyond reasonable doubts (to borrow the lawyers’ common phrase) that creating the wealth of the nation is conditional on the health of the nation. So, the health budget should be so prioritised.
The federal governments should also invest more substantially in the tertiary health institutions and make them centres of excellence.
Research centres and specialised agencies such as the NCDC should be well funded and equipped to perform according to the international standards.
If things are done properly in the health sector, even President Muhammadu Buhari would have no cause to step out of Nigeria for medical attention.
If Nigeria learnt good lessons from the Ebola crisis, it should not take the coronavirus to get the Nigeria Centre for Disease Control (NCDC) to set up new laboratories for testing. After all, before coronavirus Lassa Fever had been killing people in dozens. Lassa Fever patients still die. Their stories are only eclipsed by the coronavirus tragedy. The situation is similar in the tackling of other epidemics.
If social goods are to return to the table of policymaking, the public sphere ought to be sanitised so that the governments could be nudged to move in the pro-people direction with informed discussions.
Another thing that this emergency has also proved is that harvesting ideas for policy-making should not be left to the governments at all levels alone. The public should push well-articulated options in informed debates for the policymakers to consider in the crucial business of governance.
The public and social goods should return to the arena.