It is time to strengthen Accountability for Health

The day Dr Muhammad Ali Pate former Minister of State for Health announced his resignation on Wednesday 24^th July 2013, I was actually punching my laptop drafting a term of reference for the emergence of a Quarterly Health Interactive Forum. The decision to establish the forum came out of a meeting between the Former Minister Pate then and Nigerian participants at a breakfast meeting during the Women Deliver Conference in Kuala Lumpur, Malaysia that took place last week of May 2013.

A day before the breakfast meeting, I met Dr Pate by chance before he presented a paper in one of the sessions. He jokingly told me “If you ask me hard question I will throw the question back at you to respond”.  His paper titled  ‘Expanding Access: Reaching the Hard to Reach; Insights from the Saving One Million Lives Initiative’  had provided insight about SURE P MCH programme and midwives service scheme and how both were contributing to reduction of maternal and child death.

The breakfast meeting then with the Minister of State for Health and the civil society organisations and media took place amidst the initial apprehension and tension that the aim was to embarrass the minister in an international forum.  It turned out to be a positive and useful interactive dialogue for the sake of Nigerian women and children.

According to the brief call to action that was read in the meeting ‘the Nigerian delegates at the Women Deliver Conference have recognized that laudable commitments have been made by the Federal Government on reproductive, maternal, newborn and child health (RMNCH) but they need to be monitored more adequately to track progress and resource flows. Consequently, there is inadequate translation of these commitments into implementable actions at the state and local government levels. The overall result is that efforts continued to be fragmented; quality of care for women is still inadequate, piloted best practices are not adequately institutionalized and scaled-up at the state and local levels.’

Also observed that ‘while we recognize that much progress has been made, it is our firm conviction that every woman in Nigeria should survive pregnancy and childbirth and any maternal death is unacceptable. Recommendations from the meeting were as follows;

1. To generate data and information on RMNCH through transparent and replicable methods and facilitate evidence-based response from the government on those issues.
2. To engage non-health sector stakeholders like the ministry of water resources on maternal, newborn and child health issues
3. Engage with the coordinating mechanism of the steering group of the saving one million lives initiative to promote accountability in RMNCH
4. Make maternal deaths notifiable occurrences through mobile reporting.
5. Civil society delegates made a commitment to generate and disseminate adequate data on RMNCH.

A consensus was reached to maintain the momentum generated at the women deliver conference on return to Nigeria through having a national civil society organisations (CSOs)’ coalition/Nigeria Independent Accountability Mechanism for MNCH in collaboration with the Federal Ministry of Health to be convening a quarterly interactive forum with Government, CSOs and Media to  be sharing  useful information, updates on various commitments, projects and activities in line with saving one million initiative and Nigeria’s  road map on accountability and other related commitments.

I volunteered to write the 1^st draft of the term of reference for the establishment of the agreed Quarterly Health Interactive Forum at national level as a means to strengthen accountability in health sector and to circulate for review and inputs. It was that day that I was writing the 1^st draft when the announcement came in that he resigned. I felt so bad and depressed that day as everything happened just so fast. He was enthusiastic about the Quarterly Health Interactive Forum and all the issues agreed in that meeting. We weren’t friends actually as we had disagreed on many public health issues and strategies and I made such disagreement known in many of my published articles but on the issue of accountability, we have found a common ground. I was frustrated then because I was very much aware that initiatives of such nature would require an internal champion within the government cycle committed to jointly make it happen. It is not just about having the structures on ground, a lot of initiatives in public health require internal and external champions to work together. His resignation actually collapsed such move as we couldn’t get another senior government official or policy maker willing to take a leadership and champion roles about establishing the quarterly forum.

It was on record that in May 2013 in Geneva at the 66th World Health Assembly, Nigeria was reportedly applauded by the World Health Organisation (WHO) and delegates to the 66th World Health Assembly (WHA) for leading global efforts aimed at reducing mother and child deaths and Dr Muhammad Ali Pate was singled out for special commendation at a high level side event for ministers and senior participants and called ‘Super hero’ for what Nigeria achieved. This also served among some of the reasons why we were happy to work with him.

Last week precisely on Friday 7^th November 2014 another opportunity came and I had a deep and thought provoking meetings with the Executive Director of National Primary Health Care Development Agency and the Minister of State for Health and in principle we all agreed that we need to push for the emergency of that quarterly accountability forum for health. Keep a date with this column for more insight on this next week.

This article was 1^st published on 11^th November 2014 in Daily Trust Newspaper by Dr Aminu Magashi  publisher of Health Reporters (healthweekly@yahoo.com)