“Health Minister; appoint one who has the will and commitment”

The title of this article is a deliberate one to press home the need for President Muhammadu Buhari to do what is needed for Nigeria’s comatose health sector. It is also placed in inverted commas to buttress the fact that it is adopted from no other document than the recommendations of the president’s own transition committee who have reportedly submitted their report to Mr. President. We are all anxious and waiting to hear the announcement from Mr. President of who the cap fits.

This column in the last 2 months have published many useful articles to provide an open guidance to Mr. President and his team to have a better understanding of the challenges ahead. The 1^st performance indicator to measure how serious Mr. President is in improving the health sector is the person he appoints as Minister of Health.

The myriad of problems, the opportunities, and what is needed to be done to revamp the health sector should guide Mr. President in chosen the right person not only with the will and commitment but also with the requisite experience and tenacity to catalyze actions according to the APC manifestos and what have being recommended by the transition committee.

Let’s take a look at the section of the health sector in the transition committee report. 1^st and foremost we must commend the transition committee for incorporating many of the submissions done by national health NGOs and that of Dr Muhammad Ali Pate during a formal presentation by the duo to the committee on Tuesday 12^th May 2015. The incorporation is a demonstration of willingness to carry Nigerians along in designing policies and implementation.

The health section of the report observed that “the current level of our health indicators is without doubt Nigeria’s biggest obstacle to achieving sustainable economic development.” And also observed as follows;

Nigeria’s health care indicators remain some of the poorest in Africa.

• Life Expectancy of 54 years and One of 6 countries with highest rate of Maternal & Child Deaths – over 1m lives lost each year, with North-East and North-West most at risk
• 27% of all deaths due to Non-Communicable Diseases and 42% of Adult population at risk for High Blood Pressure
• Less than 5% of GDP is spent on health care per annum and per capita expenditure of $94 significantly below BRICS average of $600
• 68% of Total Health Expenditure is Private Out-Of-Pocket essentially prohibits access to quality health care for most of the population and insufficient capital investment to improve quality of healthcare from the supply side (poor facilities, poorly remunerated health workers etc.)
• Under-investment and fragmentation of Primary Care strategy with Local, State and Federal Governments all providing sub-standard facilities and lack of coordinated approach for infectious diseases
• Lack of Safety Standards & Regulation resulting in high rates of hospital infections and medication errors
• Poor management of tertiary care, leading to minimum $1b per annum of outflow of foreign exchange for medical tourism.
• Lack of incentives to private sector who is now delivering minimum of 50% of the care system and fledgling health Insurance sector, with less than 5% of the population covered by any form of health insurance and current enrolment of 7m mostly of people who are in the formal employed sector
• Lack of clarity in the division of responsibilities across different levels of government and poor operational coordination between each tier of government and lack of transparency and accountability within the health care system

We should also hold President Buhari to account in line with his APC Party Manifesto on the Health Sector, which say as follows;

• Coordinate more effectively, the work of the numerous federal healthcare agencies
• Immediately increase the proportion of Federal spending on healthcare from 5.5% to 10% with the aim of bringing it to 15% by 2020
• Build a network of local and mobile clinics providing free health services and drugs with the aim of ensuring that no Nigerian lives further than 5km from a free clinic
• Improve life expectancy through a grassroots National Healthy Living programme

The transition committee report recommended 6 Strategic Goals for the Sector for action;

1. Universal Health Coverage through Health Insurance
2. Implement National Health Act
3. Co-ordinated National Response for Infectious Diseases
4. Targeted Investment in Human Resource Development
5. Transformative Private Investment & Effective Public-Private Collaboration
6. Effective Health Sector Governance & Institutional Coordination

Due to lack of space I will only highlight few areas. A 100-Day Priorities on short term has being proposed to look at concrete action to increase Universal Health Coverage and identify a target population of 10 million people to be covered by Federal & State Governments within the 1^st 12 months of the administration (5m vulnerable groups & 5m subsidized state health insurance schemes).  Also inject N100b per annum to drive the current float of funds at the NHIS and from 0.5% of the Consolidated Revenue Fund (CRF) from Federation Account (as mandated by the National Health Act of 2014).

Iam happy to note that the report also recommended the full implementation of the key components of the recently signed National Health Act and to increase Government funding for health care (Basic Healthcare Provision Fund: 1% of the consolidated revenue  to be dedicated for primary healthcare service delivery via NPHCDA, and demand side financing via NHIS).

The 1^st test of this government commitment whether it is serious or not to implement the above mentioned is person President Buhari appoints as Minister of Health who has the will and commitment to hit the ground working from day 1.

1st published in Daily Trust Newspaper of 16th June 2015  by  Dr Aminu Magashi Publisher Health Reporters (healthweekly@yahoo.com)