Every year, at the National Council on Health (NCH), health leaders across Nigeria congregate to deliberate and approve policies aimed at improving the health of all Nigerians. The NCH, legislated through the National Health Act 2014 remains the highest decision-making body on matters relating to health in Nigeria. The 63rd NCH which kicked off on 5th December 2022 was themed "Building a Resilient and Sustainable Health System for Improved Health Outcomes and Universal Health Coverage".
The Council meeting, which was preceded by technical sessions chaired by the Permanent Secretary of the Federal Ministry of Health; received numerous memoranda for review and recommendation for the council's approval. With over 40 memoranda recommended for approval by the technical session, the 'Memorandum of the Honourable Minister of Health on the need to institute programs and policy actions to fast track the demographic transition in Nigeria', got an approval. The council dedicated a panel session themed, "Nigeria's Demographic Transition: addressing the urgency of now" to discuss Nigeria's demographic transition and its connection to Universal Health Coverage (UHC).
Nigeria, classified as a pre-demographic dividend country, has experienced only modest declines in mortality and fertility. However, the numbers have remained high, stalling the country's demographic transition and hindering its growth and development. Data from Nigeria's Demographic and Health Survey 2018 revealed that Nigeria's total fertility rate has been stagnant since 1990 at 5.3, with the poorest populations indicating rates as high as 6.7 percent.
The panel, made up of economic and demographic experts discussed the need for Nigeria to grow and reap its demographic dividend by transiting from its 'stalled' state to being 'in transition'. They also,
Highlighted the urgency of addressing the current population growth trajectory in Nigeria.
Discussed the opportunity cost of inaction or continuing business as usual.
Emphasised key intervention areas (especially in the health sector) that can fast-track Nigeria's demographic transition journey
Identified how to deploy a whole-of-government approach for critical interventions.
A demographic dividend requires investment
In his opening remarks, the Honourable Minister for Health, Dr Osagie Ehanire said that the population of every nation is an asset if the nation has a significant proportion of trained and skilled workforce, relative to the dependent population. He emphasised the need to address Nigeria's high maternal mortality, morbidity and fertility rates, and ensure that women and girls are empowered and educated.
Citing countries like South Korea, Brazil and Indonesia who have achieved a demographic dividend, Shubham Chaudhuri, Country Director, World Bank for Nigeria, said that Indonesia, for example, took advantage of its demographic transition by ensuring that the government had enough fiscal resources to invest in its Primary Health Care (PHC), UHC and basic education. He recommended that Nigeria address the challenge of ensuring that government has enough fiscal resources and direct them towards the most urgent and important needs, like PHC and basic education. According to a review on Nigeria's public financing, the government spends only 15 dollars per capita, per year on health.
Investing in family planning services
To achieve a demographic transition, countries must go beyond lowering mortality rates to also lowering fertility rates. One key strategy to achieving this goal is by providing women and men with voluntary family planning information and services. South Korea charted its course to achieving a demographic dividend by prioritising access to family planning and implementing an aggressive population policy. As a result, the country's Total Fertility Rate (TFR) dropped from 5.4 children per woman in 1950 to 2.9 in 1975 and 1.2 in 2005.
Also speaking at the event, Ulla Mueller, United Nations Population Fund (UNFPA) Nigeria Country Representative said state and federal governments must commit to delivering on the many commitments they have made to scale up family planning services. "The investment case is clear... If investment is not made in education and family planning at a sufficient level, Nigeria will not reap and harness a demographic dividend. We need every state to have a budget line for family planning and to deliver on that into the family planning commodity basket. At federal level, we also need a budget line; we need the money to be released and not just remain a budget line," she added.
Mueller also called on the government at federal and state levels to commit to fulfil the FP2030 commitment of allocating a minimum of 1% of the health budget to family planning annually, which will project the country towards reaping demographic dividends.
Quick wins in achieving a demographic transition
While recognising family planning as part of the issues to be addressed in achieving a demographic transition, former Executive Secretary, NHIA and Ex-CEO, Health Reform Foundation of Nigeria (HERFON), Dr. Muhammed Mustafa Lecky, said there were other multiple sources of demographic transition pathways working concurrently to deliver on demographic dividend that must be engaged and scaled up. Some of such pathways include ensuring the mandatory enrolment of Nigerians through the National Health Insurance Authority (NHIA) Act and implementing the Ambulance Emergency Response Scheme, among others. "Making sure that these policies and interventions are fully implemented will move Nigeria's population from a 'stalled' transition stage to becoming a transitioning demography and by extension achieve Universal Health Coverage," he added.
Addressing the urgency of 'Now'
The meeting ended with the following calls to action on ways government and stakeholders can address the urgent need to jump-start Nigeria's demographic transition.
Improve access to safe, affordable and free family planning commodities and services, as well as access to quality Primary Health care services including antenatal and postnatal care, immunisation and nutrition services.
Increase child survival and life expectancy by encouraging compulsory secondary school education for girls to dissuade early marriage and delay childbearing age.
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The public and private sectors must boost women's empowerment at all levels by ensuring productive labour force opportunities for women.
While the federal government takes the lead in policy formulation and design, state governments must domesticate policies and commit to their implementation.
Only a multi-sectoral approach that is well coordinated can deliver the goal of achieving a demographic transition in a timely fashion.
The national demographic plan and the recently revised national population policy for sustainable development should be implemented under the coordination of the relevant arms of government.
The world population hit an estimated 8 billion on 15th November 2022. The summary of results of the World Population Prospects 2022 revealed that more than half of the projected increase in global population by 2050 will be concentrated in eight countries: the Democratic Republic of the Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, the Philippines and the United Republic of Tanzania. Government must therefore ensure to make the necessary investment in human capital, while implementing sound economic and governance policies, and sustaining the political commitment necessary to ensure that come 2050, Nigeria can reap the benefit of a youthful population. As Dr Oyebanji Filani, Commissioner for Health, Ekiti State said, "It takes 20 to 30 years before a country begins to see the dividends of a demographic transition. The core of the Nigerian agenda for 2050 should look at how we can harness the demographic dividends by 2050".
