The year 2023 began with much hope and anticipation for the country. It was a year of transition, and every transition brings hope for a brighter future. The presidential elections that took place in February 2023 was tightly fought and left a lot to be desired in its execution. However, it also presented an opportunity for a policy reset to enable reforms in key sectors, including the health sector.
Naturally, our hope of the nation is for a new administration that will prioritize health.
The leadership appointments in the health sector by the new administration set an exciting tone for the prioritization that health might be given. The appointments of Professor Muhammad Ali Pate as the Coordinating Minister of Health and Social Welfare and Dr Tunji Alausa as Minister of State for Health, as well as Dr Salma Ibrahim Anas as the Special Adviser, Health to the President set the stage for a health sector eager to deliver on the new administration's campaign promise for health, in line with it's Renewed Hope Agenda. These appointments at the helm of the country's health sector were followed up with the appointment of Dr Muyi Aina to lead the National Primary Health Care Development Agency (NPHCDA) and Dr Kelechi Ohiri, appointed to lead the National Health Insurance Authority (NHIA). No one can challenge the competence of any of these appointees- without doubt we have many round pegs in round holes and an alignment in the leadership team that provides a real opportunity for the country.
Nigerians have great hopes and expectations for the healthcare sector. As the economy bites harder, there is an increased urgency for a well-functioning health system that provides access to affordable, readily available, and high-quality health care. Our health indices have barely moved in the last few years, and despite pockets of success the sector is still seen as unprogressive and a drain to the economy. The current economic challenges and constrained fiscal space will make this an even greater challenge.
Amidst all of this is an opportunity for the Nigerian health sector to become not only a benefactor of an improved economic outlook,but a driver of economic growth.
The new leadership team shared a strategy to bring improvements in the health sector, focusing on a few critical areas. These should be given renewed focus, in keeping with the Coordinating Minister of Health and Social Welfare's four-point agenda.
To start the year, Nigeria Health Watch is offering the current administration these five opportunities of focus to ensure that we have a health sector that meets the aspirations of Nigerians:
1. "Put your money where your mouth is..."
The surest indication of the current administration's commitment to healthcare, beyond words, is actually investing in healthcare. After an initial disappointment that the N2.18 trillion supplementary budget approved by Nigeria's cabinet in October 2023 did not include additional funding for health, the new budget for 2024, included N1.23 trillion allocated to health. This represents less than 5% of the proposed N27.5 trillion aggregate government expenditure. Historically, Nigeria has consistently underfunded the health sector, and for a country with a rising population and continued poor population health outcomes, investing in health is not a cost, but a strategic and vital investment in the well-being and productivity of the country's population, as well as contributing to the country's economic prosperity.
2. Make the strong political choice to commit to UHC
Investing in health is a political choice, and political will is needed at the highest level to ensure that all citizens have equitable access to healthcare. This can also be a source of immense political capital for the administration. To lay the foundation to achieve Universal Health Coverage (UHC) will require strengthening health systems across board, with strong primary health care as the fulcrum around which other improvements in healthcare delivery can be made.
The signing of the Nigeria Health Sector Renewal Compact and Investment Initiative attended by Mr President during UHC day in December 2023 is an early indication of political will at the highest level. It also signaled a commitment to bring improvements in the funding mechanisms for primary health care, with an integrated monitoring and accountability framework. The sector-wide approach, if implemented, will improve the coordination and drive for better alignment between the government and development partners. The Coordinating Minister of Health and Social Welfare has promised to redesign the Basic Health Care Provision Fund (BHCPF), to bring the number of functional PHCs from 8,000 to 17,000 and to channel $3 billion of pooled and non-pooled financing towards primary healthcare between 2024 and 2026. If all these are achieved, then we do have brighter days ahead.
3. Retaining the country's health workforce
The international migration of health workers has reached breaking point for healthcare delivery in Nigeria. In 2023 it was notable to hear politicians proffer solutions and proposing poorly thought through legislation to stop the migration of health workers. The World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel sought to establish principles based on the ethical recruitment of health workers. However, the Code of Practice is voluntary, so there is no legal enforcement on adherence. The reality is that Nigeria is training an insufficient number of health workers for a population of nearly 200 million people. The WHO recommends a density of 4.45 doctors, nurses and midwives per 1000 people in order to provide health services and achieve universal health coverage.
To address the international migration of health workers, many of the core problems must be addressed, including both the "push factors" that cause people to leave Nigeria and the "pull factors" that draw health workers to their destination countries. The Lancet Nigeria Commission recommended the training of more health workers to increase the current supply. However, the government should also leverage the Nigerian diaspora, ensuring that there is an enabling and conducive environment for health professionals looking to invest or engage with the Nigerian health sector. This would enable the country to benefit from a "brain gain".
4. Unlocking the health value chain
In 2023, a number of pharmaceutical companies announced they would be ceasing operations in Nigeria. A major issue that manufacturers faced was the lack of local production of pharmaceutical raw materials, including Active Pharmaceutical Ingredients (APIs). This issue has been compounded by the unstable exchange rate and poor power supply in the country. This has resulted in a significant hike in the price of medicines and patients have had to make difficult choices, cutting back on their medicine dosage or worse still forgoing treatment.
Nigeria like many other African countries is very reliant on the importation of medicines, diagnostics and vaccines. The COVID-19 pandemic exposed this acute vulnerability and since then, initiatives like the African Vaccine Manufacturing Accelerator (AVMA) and Partnership for Vaccine Manufacturing (PAVM) have sought to improve access to medicines in Africa, in addition to the establishment of manufacturing sites for vaccines.
The Coordinating Minister of Health and Social Welfare, has stated that one of his priorities will be medical industrialization and unlocking the health value chain. The appointment of Dr Abdu Mukhtar as the National Coordinator of the Presidential Unlocking Healthcare-Value Chain Initiative signals the focus that will be given in expanding domestic manufacturing of pharmaceuticals and diagnostics in Nigeria.
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5. Prioritising health security
Strengthening health security needs to receive greater focus in 2024. Lessons learnt during the COVID-19 pandemic should not be forgotten. The improvement in Nigeria's Joint External Evaluation (JEE) from 39% in 2017 to 54% in 2023 showed the country's strengthened capacity to prevent, detect and respond to infectious diseases outbreaks.
Building on and sustaining the investments that came from the COVID-19 response, the surveillance and laboratory infrastructure, the Emergency Operations Centres (EOCs) in each state must be supported with adequate and sustained funding. With all these, the country should be better prepared to prevent, detect and respond to infectious disease threats.
In his speech during UHC day in December 2023, President Tinubu told Nigerians that "health is back on the front burner". For many years, the health sector has not been given the priority it needs. The National Health Act, 2014 NHA (2014) took many years before it was finalized, but is not yet fully and successful implemented. For President Tinubu to demonstrate that health is really on the "front burner", the provisions of the NHA (2014) will need to be fully implemented, leveraging the capacity of the private sector.
To turn around the health sector in Nigeria will be an arduous task, but we believe that if the new government focuses on the five issues above, the future is indeed brighter.
Happy New Year to all our readers.
