The 65th National Council on Health, held in Maiduguri, the Borno State capital, drew participation from diverse sectors that make up the backbone of Nigeria's healthcare sector. The theme of the event was 'Accelerating Pathways to Universal Health Coverage Strategies for 2030 Success' was informed by three sub-themes:
a. Health Workforce Development: Building Capacity for Quality Healthcare Delivery in Maternal and Child Health.
b. Community Engagement and Health Promotion: Empowering Communities for Better Health.
c. Innovations in Digital Health: Transforming Healthcare Delivery, underscoring the targeted areas requiring immediate attention.
A total of 1,150 delegates were in attendance, including members of the Borno State House of Assembly, the leadership of Association of Local Governments in Nigeria (ALGON), representatives from the National Population Commission, the Department of State Services and representatives from the Armed Forces and Paramilitary Agencies.
Coming on the heels of the Joint Annual Review of the Health Sector and the launch of the 2023 Nigeria Demographic Health Survey (NDHS), the 65th National Council of Health was driven by a clear destination in mind: to prioritise and strengthen strategies and programmes in the health sector, accelerating progress towards achieving Universal Health Coverage (UHC) for Nigeria by 2030. Guided by a clear roadmap and the strategic blueprint unveiled at the 64th National Council on Health in November 2023, the health sector has been implementing the Nigeria Health Sector Renewal Investment Initiative (NHSRII). This initiative is being coordinated through a sector-wide approach, established by a health renewal compact signed by national, sub-national governments and development partners-CSOs and statutory health bodies in the country.
Driven by the principles of "one plan, one budget, one report and one conversation", the presentations, speeches, and technical discussions at the 65th National Council on Health reflected the strategic focus that are critical for improving health outcomes for all Nigerians. The sessions emphasised the goal of building a more cohesive, effective, and sustainable health sector for the country.
Scorecards and political will
The world is off track in making significant progress toward achieving Universal Health Coverage, with the SDG target of 3.8 set for 2030. This bleak reality was captured in the keynote presentation at the National Council on Health. Dr Walter Kazadi Muolombo, the WHO Country Representative, recommended the selective prioritisation of encapsulated PHC strategies and financial protection interventions in the run-up to 2030. (We will take a closer look at these strategies and interventions, as well as lessons and innovations in maternal and child health programmes in the sequel to this article).
However, in his opening remarks at the council meeting on the 21st of November 2024, the Honourable Minister of State for Health and Social Welfare, Dr Iziaq Adekunle Salako, referred to the recently released medium-term expenditure framework and fiscal strategy paper, which captures the federal government's commitment to delivering UHC in an Inclusive, equitable, and evidence-driven manner and urged state governments to implement the health renewal compact.
"The recently released medium-term expenditure framework and fiscal strategy paper has as part of its key objectives to improve healthcare preparedness and revitalise the healthcare system; this strategic direction, among other pronouncements and actions of the federal government, clearly demonstrates that the federal government of Nigeria under President Bola Ahmed Tinubu is determined to walk the talk with respect to Universal Healthcare Coverage and general improvement of the health status of Nigerians", he noted.
The Federal Ministry of Health & Social Welfare strategies and action plans to ensure UHC coverage by 20230 are hinged on the four pillars of the strategic blueprint. They include strengthening and prioritising PHC, reorganising the Basic HealthCare Provision Fund (BHCPF), training and retraining healthcare workers, especially at the PHC levels, and infrastructural upgrades of healthcare facilities across health institutions, with essential equipment and supplies, to mention a few.
Dr Salako noted that incessant industrial action in the health sector can derail the sector's renewal plans. "It is not only demarketing the sector and various professional bodies, but also a major stumbling block to attaining UHC". The ministry is, therefore, putting in place a robust framework to address this.
In his keynote remark at the opening ceremony, the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, said it has been a year of diligent planning and preparation, which is now progressing into the year of execution. He delivered a concise summary of tangible achievements recorded from a year ago when the strategic blueprint for the NHSRII was unveiled.
Highlighting the impact the recently launched Maternal Mortality Reduction Innovations Initiative (MAMII) will have on the country's high maternal mortality rate, Pate emphasised that strengthened community engagement, increased PHC service utilisation, and financial protection for vulnerable and underserved communities are at the core of this project.
The 65th National Council on Health was officially opened by the Governor of Borno State, Professor Babagana Umara Zulum. He described health as a fundamental pillar for societal progress. He highlighted Borno State's commitment to allocating 15% of its annual budget according to the Abuja Declaration, focusing on infrastructure, maternal and child healthcare, and disease control.
The governor commended the Federal Ministry of Health, the National Primary Health Care Development Agency, and the National Health Insurance Authority for revitalising primary healthcare.
"We receive our counterpart funding promptly and as at when due. What matters now is not the lack of funding but how we can effectively and judiciously utilise the little resources we have".
He also expressed gratitude for the support of religious and traditional leaders in promoting health-seeking behaviours within the state's communities. However, he highlighted the persistent challenge of the lack of coordination among humanitarian and development partners.
Under no circumstances should partners come and work in our state without our own consent...Under no circumstances should partners come and work based on a top-bottom approach. We want community-driven approach for the implementation of health-related projects throughout Nigeria...
The governor stressed the importance of community-driven approaches and effective horizontal and vertical coordination to ensure the delivery of quality healthcare services.
Onboarding ALGON and deepening commitment at the sub-national
In what can be described as their 'debut' at the council since gaining financial autonomy, ALGON engaged with the council and presented their strategic blueprint, which outlines their mandate on PHC and grassroots engagement. Empowering communities and the functionality of PHCs largely depends on the local government tier of government is in addressing disparities that hinder the acceptance, accessibility, and affordability of healthcare in rural and conflict-affected areas.
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So, what does a commitment to realising the full potential of the health sector renewal compact from the subnational look like? To address the issue of salary disparities between federal and state medical doctors, Borno State committed to aligning the salaries of its medical doctors with federal standards, including residency training allowances. Additional measures like housing and furniture allowances will be provided to motivate healthcare workers. Starting December 1st, 2024, the state will upgrade the salaries of medical doctors to be on par with their colleagues at the national level.
Technical Sessions
A two-day technical session, chaired by the permanent secretary of the Federal Ministry of Health and Social Welfare, Ms. Daju Kachallom mni, deliberated on 81 memos, laying the foundation for the decisions made during the council meeting. 29 memos were from the coordinating Minister of Health and Social Welfare, 48 from the State Commissioners for Health, and 4 from Federal MDAs.
Following extensive deliberations, the technical committee recommended 18 memos to the council for approval, 40 for noting, 18 to be stepped down, and 5 to be withdrawn by the originators.
On the fifth and final day of the council meeting, 4 additional documents to aid Reproductive, Maternal, Newborn, Child, Adolescent, and Elderly Health (RMNCAEH+N) RMNCAEH+N programming and decision-making for the health workforce were also launched.
Although achieving UHC appears daunting now, concerted efforts in expanding financial coverage, revitalising PHCs, and leveraging digital health innovations to complement the investment in building our Human Resource for Health are plausible strategies to keep on the front burner. This must be accompanied by robust citizen engagement for accountability and transparency in the process to build trust and strengthen communities' resilience, as we inch towards UHC.
