Imperative of Dr Muhammad Ali Pate’s Paper

Last week my article titled ‘May 29^th; President Buhari please speak out on Health’ sparked off  interest  with many commending the bold move of proposing the health section of President Buhari’s paper for his inaugural speech on May 29^th, 2015. Few were sad that our focused is ‘the center’ while abandoning primary health care. All are important but leadership and political will are very key to set a new agenda for health.

I reported in the article that I led a team of 5 national health civil society organizations to formerly present a paper to the President elect Buhari Committee on Tuesday 12^th May 2015 in Abuja. Also mentioned that our presentation had coincided with the presentation of Dr Muhammad Ali Pate a former state minister of health to the same committee titled “Creating a More Responsive Health System to deliver a Better Health Care to Nigerians”.

Dr Pate’s paper to my opinion should not be only left in the hands of the transition committee because the content is so important and serves as a prescription to the myriad health problems as such providing a summary of the paper is to me a duty that I owe Nigerians who are eager to see the needed change in the health sector.

He started the paper by articulating the situation which according to him “state of the people’s health – luckily we have a DHS conducted in 2014 that will serve as a baseline for this government” Health outcomes of Nigeria’s population are poor compared to other countries with comparable (and fewer) human and natural resources. One in every 170 births in Nigeria leads to the mother’s death. One in every 15 Nigerian children die before reaching age one, and one in every eight do not survive to their fifth birthday. Nearly all of these deaths can be prevented. Until recently, Nigeria had one of the lowest immunization rates globally, and remains the last country in Africa with endemic wild polio virus transmission. Vaccine-preventable diseases and diarrhea cause hundreds of thousands of child deaths annually. In addition to communicable diseases, the country is facing a rising burden of non-communicable diseases due to changes in lifestyles.

What are the causes according to Dr Pate?

1. Poor governance and absent of accountability: Health is a concurrent matter between the Federal, State and Local governments. But the fiscally decentralized system of governance has failed to define, measure or improve health outcomes, especially at the Local government level.
2. Weak foundation: Primary Health Care is the foundation of the national health system and the most cost-effective means of preventing disease and saving lives. But it is especially weak because of insufficient funding and supervision.
3. Absent performance management: The lack of reliable data is a major constraint in holding people and institutions accountable for service delivery at all levels.
4. Poor governance: Health sector regulations are not enforced even in the few areas they exist. The best example of this is the extremely poor governance of the private health care sector in Nigeria.
5. Inadequate and inefficient financing.
6. Coordination: There is poor coordination of parallel vertical programmes all trying to solve similar problems, i.e. NPHCDA’s MSS, Sure P’s MCH and the MDG programmes all driven by the Federal Government targeting PHC.
7. Quality of care and patient safety: Standards of service are poor or non-existent. Consequently, patient safety and experience is unsatisfactory, further driving those who can afford it to spend more than US$1 billion per annum in seeking care at private facilities outside the country (India, UK, USA, UAE, etc.,).

What are the Opportunities as suggested by Dr Pate?

1. Restoration of political accountability.
2. Global recognition of progress on polio eradication, routine immunization and saving lives: Nigeria’s recent progress in drastically reducing transmission of wild polio virus in the face of many challenges is widely recognized and applauded globally.
3. National Health Act 2014: Nigeria’s new Health Act has come into being, along with the provision for a Basic Health Services Fund that will provide considerable additional financing from the Consolidated Revenue Account towards essential basic health services.
4. Private sector engagement: Led by prominent Nigerian private sector figures such as Aliko Dangote, the Private Sector Health Alliance and other entities are mobilizing private sector resources to complement public sector to save lives and improve health delivery. This engagement, if further harnessed, will contribute innovations, expand capabilities and likely attract investments to make Nigeria’s private health sector more able to retain $1billion that the country loses annually through medical tourism.

Key Recommendations;

1. Provide strong political leadership and accountability:
2. Appointments at the Federal Ministry of Health and its parastatals should be based on merit rather than pure political considerations while competence and integrity in public service should set standards for participation.
3. Clear performance management targets to be set for all public sector health institutions
4. Improve fiscal space and management for Primary Health Care.
5. The cost of vaccines, which will rise in the next few years, will need to be financed jointly between Federal and State governments.
6. Ensure passing the Tobacco Control Bill, Mental Health Bill and focus on wellness will save and improve the lives of millions of citizens, especially the youth population.
7. Put the “patient” at the centre of healthcare 

 1st published in Daily Trust Newspaper of  26th May 2015 by  Dr Aminu Magashi Publisher Health Reporters (healthweekly@yahoo.com)