Working differently with a sense of urgency were some of the undertones that shaped the deliberations at the 64th National Council on Health (NCH) that took place between the 13th and 17th of November 2023. Ekiti State hosted the highest health policymaking body, a first for the state since the Council's inception.
In his welcome remarks at the Council's opening ceremony, Ekiti state Commissioner for Health and Human Services, Dr Oyebanji Filani, expressed the state's delight to host ''this agenda-setting'' council meeting.
The Ekiti State governor, Mr Biodun Oyebanji, in his opening address, shared that the Council meeting was unique given that it was the first to be held in a new administration. He added that members of the Council carry upon their shoulders the weighty responsibility of driving Nigeria's health system and therefore, the decisions made will have a significant impact on health outcomes in the near future.
The start of a new administration in the health sector under the stewardship of the Honourable Coordinating Minister for Health and Social Welfare added to the vibrance of the deliberations at the 64th NCH. Goodwill messages from the Development Partners Group, World Health Organisation (WHO), Civil Society Organisations (CSOs), and Sterling Bank echoed their willingness to collaborate and support the federal and state governments in achieving the new vision for Nigeria's health sector. These remarks implied that the health sector is heading in a new direction, and the key stakeholders present appeared to be on board this new wave.
''Business unusual''- the Nigeria health sector renewal initiative
The 64th Council on Health-themed ''Building A Resilient and Inclusive Healthcare System for A Healthy Nigeria'' was accompanied by the following sub-themes:
- Strengthening Healthcare Access and Institutional Governance as a Panacea for Attainment of Universal Health Coverage,
- Building a Skilled and Motivated Workforce,
- Evidence-Based Research and Development for Better Health,
- Innovative Financing for a 21st Century Healthcare Agenda,
- Digital Transformation and Health Information System.
This theme echoes that of the 63rd Council meeting of the previous administration, which was held in Abuja in December 2022- 'Building a Resilient and Sustainable Health System for Improved Health Outcomes and Universal Health Coverage (UHC)'.
However the similarity ends with the themes, as the presentation by the Coordinating Minister Of Health and Social Welfare, Prof. Muhammad Ali Pate, at the 64th Council on Health unveiled the Nigeria Health Sector Renewal Initiative, a strategic blueprint set to ''drive implementation of a domesticated, context-sensitive sector-wide approach as an innovative, holistic, and coordinated strategy for the improvement of health outcomes in Nigeria'' -- a deviation from the norm, but built on the existing structure and the available enabling environment.
The goal of the 2023-2026 strategic vision for the health sector is to save lives, reduce physical and financial pain and produce health for all Nigerians regardless of socio-economic status. It is predicated on the Ministry of Health's 'diagnosis to action' system-wide initiative that was shaped by taking briefs and consulting with all levels of government and relevant stakeholders, including state Governors, Health Commissioners, Development partners, private sector, and CSOs, to diagnose the root issues of the poor health indices in the country.
This consultation did not end with these statutory bodies, as the Ministry of Health took to the streets to hear the views of Nigerians on public health services. The 30-minute video documentary screened at the 64th NCH showed a collation of interviews from 12 states representing the country's six geopolitical zones where citizens shared varying experiences, which ranged from lack of trust in the health system, unavailability of drugs and high cost of services as well as the long waiting time at public health facilities. Indeed, it is commendable that this administration is keen to listen to and elevate citizens' voices.
The BHCPF 2.0
Before unveiling the nitty-gritty of the ministerial blueprint to the Council, Prof Muhammad Pate stated that seeking the support of a whole-of-government approach 'is pertinent because we know that health is on the residual list of the constitution, and the country is therefore only as strong as its weakest link'.
The Basic Health Care Provision Fund (BHCPF), established by the National Health Act in 2014, has been redesigned to become more efficient and effective. According to Prof Pate, 'the BHCPF 2.0 will serve as a special purpose vehicle to drive the strategic shifts and priority initiatives that will see us moving towards accomplishing our ambitious but achievable goals and objectives'.
The presentation on the blueprint expounded that to make progress in addressing maternal and under-5 mortality (of which the northwest and northeast zones of the country account for 65% and 72% of the deaths in neonates and children aged 1-59 months) the Basic Healthcare Provision Sector -Wide Approach will address antenatal coverage, skilled birth attendance, stunting/wasting, adolescent birth rate, zero dose children, Penta 3 Coverage, % of children 0-12 months fully immunised, health insurance coverage and patient satisfaction with PHC services.
'Leveraging the instrument of Decentralised Facility Financing, the initiative will aim to improve the service readiness of 17,000 PHCs and 774 secondary facilities across the country to deliver Universal Primary Healthcare free to beneficiaries''. -Prof Pate
This tall order means prioritising locations by heightened needs, focusing on rural and hard-to-reach areas with limited transport availability and those with a higher incidence of high-risk pregnancies. Simultaneously, acknowledging the non-functional status of some PHC facilities, the approach aims to deploy the powerful tools of equity and equality in response to existing disparities in healthcare statistics across the country.
Working out the 'how' of the Sector-Wide Initiative
Delivering the keynote address, the World Bank Country Director for Nigeria, Shubham Chaudhuri, said Nigeria needs to spend more on health, but, more importantly, needs to spend better on health, and the 'how' to do so is through a strengthened and renewed compact between the national, subnational and the international partners supporting Nigeria.
The sector-wide approach is a coherent, coordinated direction toward the 'north star' to improve population health outcomes. It requires a multilevel platform for dialogue, resource mobilisation and accountability framework. The implementation steps of the sector-wide approach will be co-created within the next 4 months, and deployment will be adaptive so that issues are dealt with as they arise.
A panel discussion with the Honourable Coordinating Minister- Prof Pate and Honourable Minister of State for Health, Dr Tunji Alausa, Dr Walter Kazadi Mulombo, WHO Country Representative to Nigeria and the representative of the Foreign Commonwealth Development Office (FCDO), and moderated by Dr Olumide Okunola, Senior Health Specialist with the World Bank, explained the drive behind the new vision for the health system. The discussants agreed that the blueprint is in the right direction, but it must be urgently responded to and implementable. Moreso, accountability must remain central for improved transparency, answerability, and the elevation of citizens' voices. Although the problem of national consensus, governance, and effective coordination of partner activities has derailed tangible progress in the health sector, the panel agreed that this is a pivotal time in the country's health sector to act urgently and do something different.
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The 64h NCH was preceded by a two-day Technical Session from 13th -- 14th November 2023 under the chairmanship of the Permanent Secretary, Federal Ministry of Health & Social Welfare, Ms. Daju Kachollom, mni. During the technical session, 7 technical presentations on the theme and sub-themes were reflected on, while 82 memoranda were considered. The Council deliberated on the summary of the 82 memos and voted to approve, note, or step down each presented. Accordingly, 16 memos were approved, 43 were noted, and 23 were stepped down/withdrawn by the Council.
The memo to Adopt and implement the Sector-Wide approach policy for Nigeria's Health Sector Renewal and commit to co-creation by the 36 States, FCT, and other stakeholders, as outlined, received the support of the entire Council and was approved.
The level of consultation to justify and secure buy-in for the sector-wide approach of Nigeria's Health Sector Initiative is commendable. Hopefully, the Council's approval will translate to actionable steps in the coming months. NCH is chaired by the Honourable Coordinating Minister for Health and Social Welfare and includes the Honourable Commissioners of Health from each of the 36 states and the Honourable Secretary of the Federal Capital Territory. You can find out more by downloading the app here.
