Many people had asked me if I am frustrated by the delay in appointing ministers by President Muhammadu Buhari bearing in mind that I have being consistently openly engaging in dialogue about the health sector with political actors since February this year. My answer is always ‘NO’, however I will only be frustrated and disappointed if a wrong person is appointed as Nigeria’s Health Minister.
The new government can’t afford to put an unqualified person in the helms of affairs to lead the health sector knowing fully well all the recommendations made by the transition committee and the APC Policy Dialogue on health. The government will be a laughing stock if a wrong person is chosen. In another article I emphasize that “the 1st litmus test of this government commitment whether it is serious or not to implement what it’s promised Nigerians in health sector is the person President Buhari appoints as Minister of Health”.
In this article we will mention all that the APC Dialogue agreed for the new government to implement in the spirit of promoting transparency and accountability. The dialogue titled ‘From Vision to Reality-Policy Dialogue on Implementation of the Agenda for Change’ was convened from May 20th – 21st 2015 at Transcorp Hilton Hotel, Abuja, Nigeria.
In the dialogue report the chapter ‘Achieving Qualitative & Affordable Healthcare highlighted that “Nigeria’s healthcare sector is in need of reform. Lackluster infrastructure, inequality in access to services, poor medical personnel training and equipment, rampant corruption and failure to pass and implement crucial reforms has resulted in Nigeria’s healthcare system lagging most countries on key health indicators and negatively impacting Nigeria’s potential growth. As a first initiative, improving access, accuracy and availability of health related data is required to establish a baseline for target setting and results tracking. Active engagement of states and local Government areas (LGAs) for reforms will be crucial to ensure effective implementation. .”
Iam happy the new government is aware of the following as contain in the report
- Low life expectancy: 53 years vs 71 years in Egypt
- High infant mortality: 85 per thousand live births vs 15-20 in Egypt
Key challenges in the health sector as identified by the dialogue were;
- Insufficient funding: Health expenditure accounts only for 3% of GDP vs. 11% for South
- Africa; US$400M required to fund vaccinations per year, but currently FG does not have resources.
- Inadequate Infrastructure: Only 3,500 hospitals (of which 950 public) serve a population of 175M with an average of 5 beds per 100,000 persons vs. world median of 35 beds.
- Poor implementation: Weak governance of existing health acts and policies and poor execution from FG to State and LGA levels.
- Unclear accountabilities and coordination: Poor coordination in policy implementation between FG, States and LGA.
- Poor or inexistent information systems: No credible data remains a major constraint limiting accountability of institutions, inability to really understand the situation and drive decisions.
- Prevalence of strikes: Significant loss of health care productivity as a result of frequent worker strikes on contracts and compensation disputes.
- Security crisis: Boko Haram crisis has resulted in the shutdown of 37% of primary health facilities in affected areas.
- Adverse impact of the economic situation in Nigeria: Devaluation of Naira is expected to have adverse impact on imported drug and medical equipment prices
- Drug supply and accessibility at risk: Import restrictions on locally produced drugs could result in inadequate supply as limited domestic capacity exists to meet demand leading to higher prices.
With the above challenges itemized above Nigerians have already gotten a baseline to hold this government to account and to monitor performance across relevant thematic areas.
Interestingly the dialogue has already proposed the new government ‘100 Day Covenant’ as follows;
- Introduce a well-managed and properly funded healthcare delivery system
- Free healthcare for children (less than 12) and free treatment for infectious diseases
- Introduce and disseminate national healthy living program to improve life expectancy
- Raise health practitioner ratio
- Encourage active health investment and partnership programs
- Perform baseline study to clarify current situation and identify potential efficiency gains
- Define relevant KPIs for healthcare agenda and set up mechanism for monitoring results; leadership of key institutions to be held accountable for results
- Find funding for strategic vaccination programs such as polio eradication
- Identify healthcare best practices across states and determine best way to share findings
We have already covered 1/3rd of the 100 days. Is the new government on track?
On a mid -term (3 to 18 months) bases, the dialogue proposed to;
- Accelerate the expansion of health insurance coverage and thus access to basic services through the mobile national health insurance program
- Consider amending NHIS law to make health insurance compulsory for all Nigerians, after financial impact assessment
And on a long-term (18 months +) proposed to;
- Reform the Ministry of Health and reduce the number of agencies from 14 to 3 based on alignment of scope and deliverables
- Focus the federal institution on polices, regulatory and financing of health care and hold agencies, States and LGAs accountable for the delivery of core public health services.
All the aforementioned are doable but it requires not just commitment and interest but genuine desire of the new government to appoint someone capable, qualified, and skilled as Minister of Health who will lead a capable team to stir actions needed for improved services and quality of care.
1st published in Daily Trust Newspaper of 30th June 2015 by Dr Aminu Magashi Publisher Health Reporters (firstname.lastname@example.org)