11 January 2019

Nigeria: Health Is Primary and Universal - Priorities for Nigeria's Health Sector in 2019

Photo: Nigeria Health Watch
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2019 in Nigeria is going to be quite a significant year, given the hotly contested presidential election taking place on February 16th and the governorship elections on March 2nd. For those of us in the health sector, it is important that we continue to champion health as an election issue.

As a Nigerian citizen, as you plan to vote, remember to #Vote4HealthNaija. Healthy Nigerians will create vibrant, productive communities who will fuel the growth of Nigeria's economy. When people say, "Health is Wealth", it is not just a slogan, it is an economic reality. As we say in Pidgin English, "Na who get body dey enjoy house."

Nigeria's health sector in 2018 went through a number of dramatic twists and turns. 2019 in Nigeria's health sector is set to be historic, as we gathered from conversations with leaders in the health sector for a few interesting reasons which are highlighted below:

The Year We Eliminate Polio

As a nation, Nigeria is on the verge of eliminating polio, with seven months left until we can officially be declared polio-free. In August 2016, the last poliovirus case in Nigeria was diagnosed in Monguno Local Government Area (LGA) in the North-Eastern state of Borno. We were so close to eliminating the disease in 2016, but the insecurity in the North East of Nigeria ultimately led to sufficient gaps in immunisation coverage that allowed the virus to re-emerge.

For those working in the health space, from international donors to the frontline foot-soldiers, this would be an incredible achievement. Dr Paulin Basinga, Nigeria Country Director for The Bill & Melinda Gates Foundation, mentioned that polio remains one of the foundation's top priorities for 2019, with particular emphasis on transitioning polio resources and stopping all transmission of circulating vaccine-derived poliovirus type 2 (cVDPPV2) in the country.

The Year of Private Sector Engagement

The role of the private sector in moving the needle in the health sector through investment and providing health financing options was an emerging conversation in 2018 that is sure to expand this year. Private sector engagement and investment has been lauded as a potential opportunity to close huge gaps in Nigeria's health sector, and organisations plan to leverage the private sector in different ways. Dr Sani Aliyu, Director General, National Agency for the Control of AIDS (NACA), said one of his priorities for this year will be to "launch the National HIV Trust Fund as a private sector gateway for increased investment in the HIV sector." The Gates Foundation also plans to leverage the private sector by engaging with Private Patent Medicine Vendors (PPMVs) as part of its family planning investment. For Dr Mary-Ann Etiebet, Lead & Executive Director, MSD for Mothers, engaging private sector providers presents a viable opportunity for improvements in maternal health. "Many women access maternity care from private providers. In places like Lagos, up to 70% of services are delivered through private providers. Unfortunately, the quality of service is disparate, and women are still dying from maternal mortality related factors but most investment from government and international donors is focused on improving care in the public sector. Through our investment in the World Health Organisation (WHO) QED (Quality, Equity, Dignity) Initiative, we're working with the government of Nigeria, WHO and other partners to improve the quality of care amongst private providers."

With momentum rising as to the potential impact that private sector investment can make on Nigeria's health outcomes, and given some of the innovative health services emerging in the private sector as highlighted at our Future of Health Conference and the Directory of innovative services Nigeria Health Watch launched in October 2018, we hope that more private sector players will work to support the public sector, because there are significant health business opportunities given the significant out of pocket payments Nigerians already make for healthcare. It is time the quality of those services improve.

The Year of Primary Health Care Delivery

Strengthening Primary Health Care in Nigeria has been an ongoing conversation that received a much-needed boost in 2018 with the allocation of funds for the Basic Healthcare Provision Fund (BHCPF) in the 2018 budget. The downside was that the 1% Consolidated Revenue Fund (CRF) was not released, yet it is notable that it was included in the 2019 budget. We must now hold elected officials accountable for these funds and push hard for the 1% CRF to be released directly to the points of service and ensure that the managers of the fund are held accountable for it. (We will continue to support our readers with information to help them in this process).

A plethora of issues in Nigeria's health sector can be tied to primary health care, which is why it is a critical aspect of the sector in 2019. Increasing budgetary allocation for primary health care is one of the key priorities for Christian Aid UK Nigeria, Country Manager Charles Usie said. Paulin Basinga, Country Director, Bill & Melinda Gates Foundation said that the organisation plans to focus on stronger integration of Routine Immunization (RI) into primary health care, as well as supporting the BHCPF to be a viable mechanism of sustainable financing.

The National Primary Health Care Development Agency (NPHCDA) in 2018 launched the Primary Health Care Under One Roof (PHCUOR) Initiative, meant to integrate basic health care services under the umbrella of primary health care. In 2019 we continue to articulate exactly what will be in the basic package of services to be funded by the BHCPF as the focus shifts to the implementation of the "Huwe" system, which was officially launched at the State House on Tuesday, January 8th, 2019.

The Year of the Nigerian Woman & Child

Nigeria's maternal and child health indices have been deplorable. In 2018, Bill Gates mentioned during his visit to Nigeria that the country was the most dangerous place to give birth as it had the fourth highest maternal mortality rate in the world, ahead of only Sierra Leone, Central African Republic and Chad. This is not exactly a record we want to hold on to. The Bill & Melinda Gates Foundation in 2019 plans to prioritise maternal, neonatal and child health by supporting one or more states to establish a sustainable state-owned Community Health Worker Program. Community health workers have been used to drive demand of maternal health services by encouraging women to attend antenatal sessions as well as to give birth at the health centre. The Foundation also plans to support the Nigerian government to realise its FP2020 commitment for domestic funding of family planning, supporting the National Family Planning (FP) Blueprint, and to focus on the expansion of FP methods to include self-injection. Family planning is a best buy for global development and 2019 should see an increasing focus on a rights-based approach alongside an emphasis on the strong economic benefits that it brings, to women and to the wider community. Dr. Etiebet mentioned that MSD for Mothers and the Bill & Melinda Gates Foundation are in 2019 supporting a coalition of partners led by the Society for Family Health (SFH) to expand access to a range of quality family planning services through the implementation of the Pharmaceutical Council of Nigeria's tiered accreditation system for proprietary patent medicine vendors (PPMV) and community pharmacies (CP) in Lagos and Kaduna. Key research on this was carried out by the Population Council in 2018 when they looked at ways to advance access to family planning services in Nigeria.

The Year of Epidemic Preparedness

It was a significant milestone in 2018 when President Buhari signed the bill for an act to establish the National Centre for Disease Control (NCDC) on the 13th November 2018. The Nigeria Centre for Disease control worked to strengthen epidemic preparedness. This included the rolling out of Emergency Operation Centres (EOCs) across different states in the country. This would now mean that data on potential outbreaks is now live and relevant bodies across the country can trigger responses and prevent the escalation of disease outbreaks. In 2018 the NCDC set up a number of reference labs where samples of suspected epidemic-prone diseases can now be tested. In addition, in order to strengthen Nigeria's capacity to detect, respond and prevent health emergencies, the Nigeria Centre for Disease Control collaborated with 19 federal agencies to develop the National Action Plan for Health Security (NAPHS), which was launched in December 2018. This means that there is a costed implementation plan for dealing with health security issues and should translate to a more prepared Nigeria for any impending epidemics. Again, here at Nigeria Health Watch we will continue to push for accountability on these commitments.

The Year of Universal Health Coverage?

Twenty-two states in Nigeria have now signed into law, health insurance legislation, which means that in these states, it is now mandatory for every resident of the state to have health insurance. The impact of this on out of pocket expenditure should be immense as 2019 sees some of these states move into the challenging implementation stage. It is important now for Nigerians to know whether their state is one of the 22 so that they can adequately demand for effective implementation of these new laws. In these states and in those that have not yet signed the health insurance into law, the election season is a good time to ask aspiring governors and state legislators what their plans are for improving access to healthcare and expanding insurance coverage. One of the challenges the National Health Insurance Scheme (NHIS) has faced is that the law setting it up is voluntary, and that it serves as both a regulator and a Health Maintenance Organisation (HMO). It has therefore been virtually impossible for it to function effectively under these conditions. An important question in 2019 is how and whether the National Health Insurance Scheme (NHIS) will begin to tackle this challenge? For Charles Usie, Country Manager for Christian Aid Nigeria, Universal Health Coverage (UHC) is his most pressing priority in 2019, as well as expanding Community Based Health Insurance Schemes. With the passing of the National Health Act and the allocation of funds for the BHCPF, the improved resource base, if secured, could make this a watershed year for Nigeria as it continues on the road to Universal Health Coverage.

The Nigerian health sector we want to see lies within the actions we take today. What are the issues you think should be health sector priorities for 2019, and what are you willing to do today to help make them a reality? Do let us know by leaving a comment below or engaging with us on our social media channels: by commenting on our Facebook and WhatsApp (07085014676) or by tagging us @nighealthwatch on Twitter or via our Instagram account and Medium page. You can also follow us on LinkedIn and if you have not done so yet, follow our YouTube channel where we are always adding to the informative material on the Nigerian health sector. And do continue to watch and listen to our radio and television interviews. We look forward to greater engagement with you in 2019, hearing your stories and viewpoints on all aspects of the Nigerian health sector, the examples of good practice, the things that need to change, issues you think we should address.

Thank you for your support and do stay with us in 2019 as we all work towards greater accountability in the Nigerian health sector, an essential requirement towards building the Nigeria of our dreams.

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