Our Health Correspondent
Nigeria has repeatedly been lauded for the detailed prevention strategy and considerable resources it pumped into its polio campaign. It is also praised for managing to contain the Ebola virus within three months of the outbreak in 2014. But the resilience and responsiveness of Nigeria’s health system at the primary care level has been questioned in recent times. Aside from these feats, the country’s health system, which deals with about 178 million people, perennially under-performs.
Nigeria has been unable to curb the ongoing outbreak of Lassa fever, which has killed many people across several states. Primary health care – as the first point of call – has been neglected and under-utilized. It is evident that there has been an undue focus on more specialized tertiary health care. For Nigeria to have a successful system, its health sector needs to be repositioned to focus on primary health.Nigeria’s health minister, Dr. Osagie Ehanire, inherited a health system with legislation that stipulated that primary health care should be a focus of policy. But to make primary health care a viable reality, Ehanire would need to get three things right:
- its financing;
- human resources and
- the provision of quality service.
The Nigerian Health Act is the first of its kind in the country and guarantees health for all. In line with the act, Ehanire seems to have identified primary health care as a focus area. He would do well to strengthen existing primary health care facilities rather than build new ones. He should also renovate and equip at least 10,000 primary healthcare facilities in the country. These would offer basic care and relieve the burden on tertiary and secondary health facilities across the country. The honourable minister should as well strengthen accountability in the health sector and the partnerships between the federal and state ministries of health and state primary healthcare agencies. These will result in patient-centred health care being delivered in the primary healthcare system.
Nigerian President Muhammadu Buhari once said he was set to establish a Basic Health Care Provision Fund to improve funding for programs that provide primary healthcare services in the country. Yet, the budget for health continues to be lower than previous years. In his budget speech to the National Assembly, Buhari announced a proposed recurrent budget of NGN 221.7 billion for the health sector, with an overall health budget of N257.3 billion. This compared with education, which received NGN 369.6 billion. The capital budget for health has in fact been increased. But the increase still doesn’t mean that Nigeria has met the commitment it made when signing the Abuja Declaration in 2001. This committed it, along with other signatories, to spending 15% of their budget on health care.
One of Ehanire’s serious challenges has been how to find funding to implement the act. To date implementation of the National Health Act has been slow as the Federal Ministry of Health has largely depended on financial support from development partners. The act came up as Nigeria asked the World Bank and the African Development Bank for US$3.5 billion in emergency loans to fund its state deficit of US$15 billion. The bailout was not expected to have a direct bearing on health funding.
Ehanire faces his biggest challenge in getting funding from local government areas. To access the funds states must establish functional primary healthcare agencies or boards and contribute counterpart funding. Traditionally, local government areas which have the statutory function of providing primary healthcare funding, have been unable to provide quality primary healthcare services. This has been because of poor capacity and lack of funds. Ehanire would have to revisit this obligation and a constitutional review might become imperative. One solution would be for him to set up performance-based financing schemes, rewarding those who provide results. Currently, the pilot phase of the Nigeria State Health Investment Program has been financed by the World Bank in three states. The scheme has had varying results but has been successful in some respects. Ehanire could scale this up.
Another critical issue is to provide quality services. The health workforce needs to be adequately primed to deliver these services. There have been unending labour crises and inter-professional rivalry within the health sector. These disrupt the health sector unduly and have had an impact on patients and users. According to a recent impact evaluation conducted by RAND Health, some of the human resources used in health interventions at the primary healthcare level appear not to have produced significant result. Health workers need to be reoriented to put the welfare of the patients ahead of their parochial interests. Ehanire would need to establish and institutionalize clinical governance and quality improvement frameworks. These are provided for in the act, which guarantees patients and healthcare users the right to health.
It is obvious that since his appointment, Ehanire has held several stakeholder consultations and engagements with both state and non-state actors. He now needs to develop a new national strategic health development plan to realize the vision of reforming the health sector and appoint a crack team to translate his vision into practical steps with clear deliverables and timelines.
This plan must include a blueprint for achieving universal health coverage for all Nigerians, as we step into the new era of sustainable development goals.