Health Sector as we inch towards 1st 100 days of PMB

As a public health commentator I am not going to use the 1^st 100 days to evaluate President Muhammad Buhari’s (PMB) administration. That’s will not be fair however I will use the 1^st 100 days as a marker to ask questions regarding what are they steps and actions being taken by PMB to revamp the health sector in line with promises made.

I followed few meetings that PMB held during his last United State trip that are related to health and development. The meeting he held on July 21 at the Blair House in Washington DC with Dr. Susan Desmond Hellman CEO of Bill and Melinda Gates Foundations as well as with World Bank President Jim Kim and his team of Vice Presidents and Ray Chambers, UN Sec Gen’s special envoy on Malaria and MDGs financing. We were aware that some of the issues discussed bordered around Polio Eradication, Routine Immunization and Primary Health Care with an opportunity of a $300m social health bond for Malaria and instrument to increase fiscal space for health as well as an offer of $2.1billion for north east post conflict reconstruction and development.

We are happy that these important issues were discussed and if done will lead to positive change in the health sector. It is imperative that we situate them in line with what the government earlier on promised to start implementing within the 1^st 100 days.

The following items are among those already proposed by the PMB administration as the ‘100 Day Covenant’

1. Introduce a well-managed and properly funded healthcare delivery system
2. Free healthcare for children (less than 12) and free treatment for infectious diseases
3. Introduce and disseminate national healthy living program to improve life expectancy
4. Raise health practitioner ratio
5. Encourage active health investment and partnership programs
6. Perform baseline study to clarify current situation and identify potential efficiency gains
7. Define relevant KPIs for healthcare agenda and set up mechanism for monitoring results; leadership of key institutions to be held accountable for results
8. Find funding for strategic vaccination programs such as polio eradication
9. Identify healthcare best practices across states and determine best way to share findings

It is important as we move towards the 1^st 100 days to begin to shine our search light whether some actions are being considered or done already in the 9 items listed above.

The PMB government had already understood the issues to tackle if meaningful progress will be made in the health sector. In the APC 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. .”

The report also indicated that the PMB is aware that we have low life expectancy of 53 years vs 71 years in Egypt and a high infant mortality of 85 per thousand live births vs 15-20 in Egypt. And also is fully aware of the key challenges in the health sector as identified by the dialogue as follows;

1. Insufficient funding: Health expenditure accounts only for 3% of GDP vs. 11% for South
2. Africa; US$400M required to fund vaccinations per year, but currently FG does not have resources.
3. 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.
4. Poor implementation: Weak governance of existing health acts and policies and poor execution from FG to State and LGA levels.
5. Unclear accountabilities and coordination: Poor coordination in policy implementation between FG, States and LGA.
6. 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.
7. Prevalence of strikes: Significant loss of health care productivity as a result of frequent worker strikes on contracts and compensation disputes.
8. Adverse impact of the economic situation in Nigeria: Devaluation of Naira is expected to have adverse impact on imported drug and medical equipment prices
9. 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.

Also on a mid -term (3 to 18 months) bases, the dialogue proposed to the new PMB government to execute the following;

1. Accelerate the expansion of health insurance coverage and thus access to basic services through the mobile national health insurance program
2. 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;

1. Reform the Ministry of Health and reduce the number of agencies from 14 to 3 based on alignment of scope and deliverables
2. 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.

Are we on track as we inch towards the 1^st 100 days?

1st published in Daily Trust Newspaper of  11th Aug 2015 by Dr Aminu Magashi Publisher Health Reporters (healthweekly@yahoo.com)