As the year 2023 comes to a conclusion, it is a good time to look at the current state of Nigeria's health sector. In the midst of global crises and the dawn of a new government, the new President's "Renewed Hope" agenda has brought about a shift in gears in the health sector. This retrospective review not only acknowledges the progress made, but also highlights Nigeria's continued journey towards a better and more robust healthcare sector.
The healthcare sector has faced several challenges, which have been exacerbated by economic headwinds. Ensuring adequate healthcare financing to meet the needs of the growing population is just one of the issues. Nigeria continues to experience poor health outcomes, such as high maternal death rates and poorly functioning primary healthcare (PHC) facilities. As Nigerians look to the year ahead and reflect on the past twelve months, there have been some significant achievements in the health sector, such as the signing of critical bills like the Mental Health Act and the initiation of the HPV vaccine rollout.
Nigerians have high hopes for the current administration to overcome recurring health challenges. These are some of the highlights that shaped the health sector in 2023.
- Leadership and Health
The year 2023 witnessed a transition in leadership that holds immense promise for advancing public health initiatives in Nigeria. The appointment of Dr. Salma Ibrahim Anas as the Special Advisor, Health to the President provided some indication about the focus health would have in the new administration. The subsequent appointment of Prof. Mohammad Ali Pate as the Coordinating Minister for Health and Social Welfare presented a unique opportunity to re-evaluate and reinforce the new administration's commitment to improving health outcomes for all Nigerians. Further changes in leadership included the appointment of Dr Muyi Aina as the Executive Director of the National Primary Health Care Development Agency (NPHCDA) and Dr Kelechi Ohiri as the Chief Executive Officer of the National Health Insurance Authority (NHIA).
Professor Pate immediately hit the ground running with his 4-point agenda for health that includes improvement in governance, population health, health value chain, and health security. This was followed by the launch of Nigeria Health Sector Renewal Initiative (NHRI). A strategic blueprint, aimed to propel the implementation of a domestically tailored, context-sensitive, sector-wide approach to healthcare delivery.
The NHRI launch was in tandem with the presentation of the Basic Health Care Provision Fund 2.0, which was redesigned to ensure equitable healthcare for all regardless of socioeconomic status.
2. Transformative health legislations
In January 2023, former President Muhammadu Buhari signed the Mental Health Bill into law, now the National Mental Health Act, 2021. The Act protects people suffering from mental illnesses and emphasises the government's commitment to addressing the mental health care gap. However, in 2024 all stakeholders must work to ensure increased access to mental health services by integrating mental health care into primary care services.
A further landmark achievement in 2023 was the successful passage of the Federal Medical Centre Act (Amendment) Bill, 2023 (HB. 1665). After rigorous deliberation and thorough examination, the bill reached its final stage, being read the third time and ultimately receiving resounding approval. This amendment signifies a commitment to enhancing the efficiency and effectiveness of Federal Medical Centers nationwide, ensuring better healthcare services for all Nigerians.
While we look forward to the implementation of various legislation in 2024, policymakers are must prioritise pending bills, such as the Maternal Perinatal Child Death Surveillance and Response (MPCDSR) bill which has not received further action since the second reading. Nigeria maternal mortality rate ranks among the highest in the world. Institutionalisation of a legal framework for maternal death accountability should enable quality improvements in maternity care in Nigeria.
3. "Brain Drain" or "Brain Gain"?
The international migration of healthcare workers has seen a significant surge in the recruitment of health professionals trained in countries considered among the world's poorest. The migration from low- and middle-income countries (LMICs) like Nigeria presents a pressing global health concern, impacting population-level health outcomes. An estimated 200 resident doctors have been leaving Nigeria every month, in the last two years. The World Health Organisation (WHO) estimates a shortage of 18 million health workers by 2030, primarily LMICs
During the 2023 Future of Health Conference, Professor Cheluchi Onyemelukwe, Managing Partner, Health Ethics and Law Consulting, pointed out that "we are training healthcare professionals for the world and it's not as if we have enough for ourselves". She raised an important question during that session- "how is it possible that we cannot come up with solutions that work?"
This requires addressing the drivers of healthworker migration. According to a recent study, similar factors drive healthcare workers to migrate or consider migration, across various regions in LMICs. This includes remuneration, security problems, career prospects, good working environment and job satisfaction. This rising trend needs to be adequately managed because health professionals are critical to achieving Universal Health Coverage (UHC).
4. Health security
The upsurge of diphtheria tested the country's health security capabilities, exposing gaps and highlighting the need for improved health security measures in the country.
In the midst of rising case of diphtheria across the country, Nigeria conducted its second Joint External Evaluation (JEE), marking a pivotal moment in the country's commitment to health security. The evaluation followed five years of implementing the National Action Plan on Health Security (NAPHS). The JEE result revealed a 15% increase in Nigeria's ReadyScore, from 39% in 2017 to 54%, reflecting significant advancements in the nation's preparedness and response mechanisms.
While celebrating these remarkable strides, it is crucial that we acknowledge that more work lies ahead. Sustaining the momentum gained and progressing further requires heightened efforts, particularly in anticipation of the upcoming NAPHS implementation.
To achieve this, it is crucial to foster comprehensive multi-sectoral coordination across all levels of government. This entails prioritising the One Health approach by actively aligning efforts in human health, with those in the environmental and animal sectors. It also involves collaborating with the private sector through robust public-private partnerships. The government must also tap into external funding sources, such as the Pandemic Fund, to reinforce the nation's resilience against unforeseen public health events.
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5. Nigeria's HPV Vaccine Rollout
Cervical cancer is the third most common cancer among Nigerian women, and the Human Papilloma Virus (HPV) vaccine is highly efficacious in preventing infection with HPV types 16 and 18, known to cause at least 70% of cervical cancers. On the 24 of October 2023, Nigeria introduced the HPV vaccine into the routine immunisation programme.
In the pilot states where the vaccine was rolled out, Nigeria has attained 78% of the national target for HPV vaccination coverage with Taraba State achieving the highest vaccination rate. However, the campaign also saw the spread of conspiracy theories and misinformation. This underscores the need for effective communication to address myths and provide accurate information, using evidence-based approaches to emphasise the importance of the vaccine in preventing cervical cancer.
The success of the vaccine rollout in the pilot states and the challenges that still need to be addressed to achieve the national target for HPV vaccination coverage, are important lessons as plans for the second phase of the vaccination introduction is scheduled to start in May 2024 in 21 states.
Renewed hope in the health sector
The last year saw the groundwork being laid for transformative health reforms that included leadership changes. As we approach 2024, Nigerians aspire to see gains in the health sector being sustained, in addition to the institutionalisation of best practice.
Nigeria has fallen behind in achieving Sustainable Development Goals Target 3.8, however, there is a need for renewed hope in the health sector.
