Open Chat with Buhari’s Transition Committee on Health (2)

Last week I commenced this chat with the above title with a promise to continue this week aimed at providing additional insight among what the new government of General Buhari should prioritise for Nigeria’s health sector. On the 24^th February 2015 in Abuja under the auspices of the  Partnership for Advocay in Child and Family Health (PACFaH) a coalition of 7 civil socieity organisations , I co-facilitated a press conference  dedicated for politicians contesting for the March 28^th election and more particularly the presidential candidates of the 2 dominant parties jostling  to clinch the power at the center.

The key messages of that press conference are still fresh and more relevant now that Nigerians have elected their leaders. It is time to begin to set priorities.  We took a non-partisan approach as we expect governments at Federal, State and LGA levels to fulfil their parties commitments on improving the state of child and family health in Nigeria.

What were the issues  we raised ?

1. Huge funding gaps in the provision of key MNCH interventions and even where funds are available, there are unnecessary delays in the approval, release and utilization of budgetary allocation to child and family health in Nigeria.
2. Nigeria’s poor performance with Maternal, Newborn and Child Health (MNCH) has been made worse by huge inequalities/disparities between geopolitical zones in the country.
3. Nigeria is off-track in meeting the MDGs targets for Maternal, Newborn and Child Health (MNCH) for 2015, and the country’s health indices continue to be unacceptably poor. Nigeria’s 2015 target for MDG4 (Under-5 mortality) is 70 deaths per 1,000 live-births; while for Maternal Mortality Ratio (MMR) is 250 deaths per 100,000 live-births and can’t be achieved.
4. 2013 NDHS figures show that the contraceptive prevalence rate (CPR) for Nigeria was just 15%. While availability of Family Planning (FP) services at health facilities may have improved in the last 2-3 years, this has not been matched by improved service quality and increased demand especially at the community level where women from poor households with low education abound. The low utilization of FP services is worse in North East and North West where the utilization is less than 1% according to the 2013 NDHS figures. The Nigerian government in 2010 made commitments to release US$3 million annually for the procurement of FP commodities, and later at the London Summit in 2012 made an additional commitment of US $ 8.35 million annually over the next four years for reproductive health commodities including contraceptives. However, the government has not fulfilled the respective commitments to fund these services.

5. While Nigeria has in recent years made progress in local food production, the poor nutritional status of Nigerian children has been a major concern. 37% of children under five in Nigeria are classified as stunted. This rate is the highest in sub-Saharan Africa and second in the world.
6. In 2013, about 3 million children under age 5 years died globally, 51.8% of them from infectious causes with Nigeria being one of the countries with the highest number of deaths. In Nigeria most of the deaths are caused by malaria and pneumonia with pneumonia as the single infectious and preventable disease with the highest mortality. The NDHS 2013 have identified five issues as important risk factors for Childhood Pneumonia and they are malnutrition, low birth weight, non–exclusive breastfeeding, , crowding (7 or more persons sharing the same household) in a household, in addition to zinc deficiency, measles and poor hygiene especially lack of hand washing culture.
7. A call on the Government to revise the National Treatment Guidelines with Amoxicillin (dispersible tablet) adopted as first line of treatment for Childhood Pneumonia by 2016 as well as increase buy-in and support for Zinc and oral rehydration solution (ORS) as treatment for Childhood Diarrhea.
8. It is commendable that Nigeria as at the end of December 2014 achieved 87% reduction of the Wild Polio Virus Type 1 (WPV1) burden and 78% reduction in geographic spread of the virus with only 6 confirmed WPV1 in 2 states recorded in 2014 compared to 50 cases in 9 states for the same period in 2013. Notwithstanding these successes, the government need not relent on its efforts until the country is certified as Polio-free.
9. With the rebasing of Nigeria’s economy and reclassification as a Medium Income Country, our continued dependence on donor agencies for the funding of our nation’s immunization programme will no longer be feasible.
10. A recommendation for a paradigm shift from building more hospitals and clinics to strengthening health systems that are necessary for providing affordable, accessible and equitable healthcare services for the populace who voted politicians to various offices.

Finally, is good to note that it is no longer news that with international oil price taking a dip has affected significantly Nigeria oil revenue and invariably available resources to spend in 2015 and beyond. It is also not a news that Nigeria’s foreign reserve has shrunk tremendously over the years as it was used to fund some sector of the economy and the state governors at some point weren’t interested in ‘saving’ money, so funds meant for foreign reserve (rainy day) that accrued previously from increased oil revenue were shared among the federal and state governments.

Having said this, the health sector will be hit with delays in release of funds or approval without cash backing. It is imperative for the new government to explore alternative financing sources as well as ensure what is budgeted is timely release.

1st published in Daily Trust Newspaper of 14th April 2015 by  Dr Aminu Magashi Publisher Health Reporters (healthweekly@yahoo.com)