For the health sector, many key areas are demanding for urgent measures despite efforts by government to tackle it. Onyebuchi Ezeigbo reports that this year, government is expected to double up its strides in tackling the COVID-19 pandemic and its many variants, health emergencies,
vaccine hesitancy and growing apathy to health insurance, as well as apply strict enforcement of the various health advisories needed to check spread of infectious diseases
The outlook of the country’s health sector for the new year is a very challenging and difficult one, with many key areas demanding urgent and tasking measures. Last year, the sector performed fairly well as the country was able to contain the various health emergencies ranging from COVID19 pandemic, cholera, measles, Lassa Fever and new polio variant. However, despite impressive efforts by the federal government in tackling emerging health emergencies, the preceding year had many unmet targets.
COVID-19 pandemic has continued to prove a major threat to the people with challenges of meeting vaccination targets. The preceding year was a very busy one in terms of the efforts by the country to push up vaccination of eligible populace.
With the advent of more active variants of the COVID-19 virus like the Delta and Omicron variants, the federal government had issued an order making proof of vaccination a prerequisite for civil servants gaining access to their places of work. It also rolled out mass vaccination programme and encouraged vaccinations at private facilities.
However, at the end last year, Nigeria was only able to vaccinate a little over 10 million persons less than the target of 40 per cent of eligible Nigerians expected to have been vaccinated in line with the projections of the World Health Organisation (WHO).
The implication is that the federal and state governments have to redouble efforts at implementing more rigorous mass vaccination campaign early in the new year if the country is to be able to meet the target of immunising 70 per cent of her eligible population and for us to achieve the much expected herd immunity.
The government will be expected to address the issue of vaccine hesitancy and growing apathy in the observance of the health protocols meant to curb spread of COVID-19. Current vaccination statistics in the country does not give hope that the country will be able to meet the target of vaccinating 70 per cent of her eligible populace.
No doubt, efforts at further containment of COVID-19 pandemic will take centre stage in the priority list of the government in the New Year. Ehanire had assured the nation that government was making serious efforts to roll out a vaccine manufacturing facility in the country in a year’s time through a special purpose vehicle – Bio-Vaccine Company.
In the same vein, the country’s drug and food regulatory body, the National Agency for Food and Drug Administration and Control (NAFDAC) had given hint that the road was now clear for local manufacturing of vaccines having met the requirements of the World Health Organisation (WHO) in terms of providing standard regulatory instrument.
The main objective of restoring NAFDAC’s regulatory capacity is to help resolve the problem of vaccine inadequacies and to attain some level of medicine security.
Going forward in the new year, federal government will be expected to apply strict enforcement of the various health advisories needed to check spread of infectious diseases. More importantly, the government will be expected to make good its pledge to revamp the country’s vaccine manufacturing capacity in order to improve on vaccine availability.
Fighting Malaria Scourge
Malaria has continued to pose major health concerns to Nigerians and indeed Africans as a whole. Efforts being made to stamp out malaria in the country appears to be experiencing a lull with federal and state governments not being able to meet their obligations in terms of paying up their counterpart funding obligations and for the states showing reluctance in owning up various Anti-Malaria initiatives set up in their domain.
According to the Civil Society in Malaria Control, Immunisation and Nutrition (ACOMIN) about 55,200 under-five deaths were recorded in Africa in 2020 due to malaria illness in the last one year. Quoting the latest World Malaria Report, ACOMIN said there were “241 million cases of malaria in 2020 compared to 227 million cases in 2019, an increase of about 14 million cases”.
It said the estimated number of malaria deaths stood at 627,000 in 2020 an increase of 69,000 deaths over the previous year. About 80 per cent of all malaria deaths in Africa came from children between the ages of 0 and 5″.
Speaking at a quarterly advocacy meeting of the group held recently in Abuja, ACOMIN National Coordinator, Mr. Ayo Ipinmoye said half of the world’s population are now at risk of malaria, with the most vulnerable groups being pregnant women and children below the age of five.
Ipinmoye lamented that one of the problems observed in the implementation of the malaria intervention programme in Nigeria was that most state governments were not doing enough to take ownership of the health facilities provided by the Global Fund.
With the increase in malaria morbidity and mortality, it has become necessary to look into some of the existing gaps that are yet to be adequately resolved. Funding of anti-malaria intervention programmes is suffering set back in it’s implementation. Ipinmoye expressed concern over the continued delay in the approval of funds to defray federal government’s counterpart obligation in the malaria intervention programme.
The partnership programme is being used to execute one of the most potent anti-malaria intervention initiative in Nigeria by providing mosquito tested nets for pregnant women as well as other malaria treatment regimen for rural dwellers.
While speaking in comparative terms, Ipinmoye said: ” If we are spending billions renovating the buildings of the National Assembly, that same National Assembly has no justification not to support investment in the provision of quality healthcare for Nigerians”.
On his part, the representative of the Country Coordinating Mechanism for the Global Fund, Mr. Ibrahim Tajudeen has expressed disappointment over the poor attention being given to the funding of malaria intervention programmes in the country.
He particularly frowned at what he described as misinformation about the $200 million loan being sought from the World Bank for the execution of the anti malaria intervention programme. He said that contrary to the erroneous report, the loan is intended to pay federal government’s share of the counterpart funding to enable the country access the over $1.1 billion grant from the United States and the Global Fund.
Tackling Challenges Posed by AIDS
Federal government had said that an estimated 1,629,427 persons living with HIV have so far been put under regular anti-retroviral treatment as at 2021.
It also said that out of about 150,000 children infected with HIV only 80,000 are currently receiving regular treatment. Director General of the National Agency for the Control of AIDS (NACA) Dr. Gambo Aliyu said the agency has been implementing a programme to drastically curtail the spread of HIV infection in the country.
But he said that the agency is experiencing some challenges limiting the progress at ending HIV transmission in the country. Some of these challenges include; poor access to retroviral drugs, stigmatisation, lack of funds, poverty and gender inequality.
Speaking on the areas for further interventions, Aliyu said that the aspect of Mother-to-child transmission of HIV represented a large source of new infections nationally and is the largest source in several states. Aliyu said a study of the formation and dissolution of partnerships among these groups may help in understanding the dynamics involved.
According to him, most of the women who do attend Antenatal check up (ANC) get tested for HIV but the problem is that over 60 per cent of pregnant women do not attend ANC. He said that increasing ANC attendance would have benefits not only for reducing HIV transmission but for the overall health of the child and the mother. NPHCDA boss canvassed the need for development of alternative funding sources to serve as a buffer for the dwindling funds from donor partners.
The health sector last year also witnessed industrial crisis which dragged on up to the court of arbitration and is yet to be fully resolved. The new year will definitely prove a decisive one for the government in being able to manage the crisis that may be precipitated by the poor funding being witnessed in the health sector and the disagreements amongst various professional bodies over welfare issues. Indeed, government will need to brace up to deal decisively with the existing dichotomy between medical doctors and other allied health workers. The matter has continued to fuel disagreements and industrial unrest in the country’s health sector.
Health Sector Outlook/ Projections for 2022 and Beyond
Adequate funding for health sector remains a major challenge for the country. There is no better way to look at the challenges and prospects of the country’s health sector than to take a cursory look at the outcome of the last National Council of Health meeting held in Abuja towards the end of last year, between December 3rd and 5th.
The annual event also considered the thorny issue of the growing finding gap in the country’s health sector and how to improve on investment to help achieve overall health security for Nigeria.
At the National Council of Health meeting, Minister of Health Dr. Osagie Ehanire gave hint on the direction the federal government was pushing it’s policies in the health sector in the next few years. He said government is working on a strategy to improve on health financing.
Part of the strategy is the formulation of a new law on a mandatory health insurance scheme in Nigeria, as part of the health sector reforms aimed at revolutionising funding in the sector. Ehanire explained that government was implementing an innovative digital health technology reforms and building a network of well equiped National Primary Health Care centers across the country to take healthcare delivery to the grassroots.
He said: “We have come a long way in expectation of a law for mandatory health insurance in Nigeria, a critical health sector reform to revolutionise funding and undergoing innovative digital health technology reforms. one of these ways of ensuring proper funding of the health sector as well as making health services affordable for the citizens is the implementation of the Nigeria Health Insurance Scheme (NHIS).
In order to widen the scope of coverage of the health insurance scheme, federal government has presented a Bill to the National Assembly to make the health insurance scheme mandatory for all Nigerians.
Side by side with this, is the plan by government to set up a network of National Primary Health Care centers to take care to the healthcare needs at the grassroot level. Ehanire said that models of the new Primary Healthcare Centres designs have been sent to all state governors adding that each PHC will have staff quarters, assured water supply, solar powered aggregates and a sound complement of human resource for health.
According to the minister, primary healthcare centres are the most important building blocks of the country’s health system and should be prioritised by all states as the platform to attain the Universal Health Coverage (UHC)”.
Ehanire added that benefits from COVID-19 pandemic included construction of a total of 50 oxygen plants by the federal government and Global Fund, and importation of thousands of oxygen cylinders to make oxygen available to all hospitals, as well as the setting up of the National Emergency Medical Service and Ambulance System (NEMSAS).
The minister said the target of government is to establish an innovative care system that will make medical services available at the site of medical emergency ambulance with just a phone call. While speaking at the Council of Health meeting, UNICEF Country Representative, Dr. Eduardo Celades said meeting will provide the much-needed opportunity for Nigeria to holistically review the impact of COVID-19 pandemic and response on the health sector and propose appropriate strategies for building back better from the pandemic.
He listed some of the challenges Nigeria should address to include; persistent decline in health expenditure as a proportion of GDP from 1.20 percent in 2004 to only 0.58 per cent in 2018, inadequate financing of primary healthcare services at service delivery point and the current allocation of 1.5million naira per ward under the Basic Health Care Provision Fund which it said was suboptimal.
In addition, UNICEF listed other challenges to include: inadequate human resources for the health sector, suboptimal primary healthcare infrastructure and equipment, erratic availability of essential commodities and supplies and poor maintenance culture, weak coordination and accountability mechanisms resulting in duplication, inefficiencies and lack of value for money.
According to Celades, hopes to partner with Nigeria to tackle the problems using tried and true strategies and available best practices. Celades said the body is finalizing the next Country Program Document for 2023 – 2027, with an increased emphasis on coordinated multisectoral action, PHC system strengthening and improved generation and use of data and evidence to drive action, accountability and results.
“We are committed to continued partnership with the Government of Nigeria to protect and promote the right of every to survive, thrive and transform. We are determined to use our comparative advantage as a multisectoral agency to support Nigeria’s development efforts within the health sector and beyond,” he said.
On his part, WHO Representative in Nigeria, Dr. Walter Kazadi Mulombo, said COVID-19 has provided Nigeria a unique opportunity for a thorough evaluation of existing resources and mechanisms and for it to build back better towards a more resilient system for the future.
At the National Council of Health meeting, stakeholders resolved to set up a committee to review all guidelines, policies and data on diseases in line with global and WHO guidelines; capturing tools in use to reflect current diseases, emerging and re-emerging ones. 2022 definitely will be very critical for health sector because the attention of federal government will be divided due to heightened political activities ahead next year’s General Election.
This implies that health budget may be negatively imparted upon. At the same the year might an opportunity to engage in robust debate with political actors on setting agenda for the next government on health issues.
Ehanire explained that government was implementing an innovative digital health technology reforms and building a network of well equiped National Primary Health Care centers across the country to take healthcare delivery to the grassroots