Matters arising in the public health sector

The ‘health’ of the health sector ordinarily should be a gauge of the wellness and wealth of a nation. This assumption takes its root from the saying that a healthy man is a wealthy man. Little wonder, therefore, that Nigeria is under severe need to improve health facilities and healthcare delivery systems for its citizenry.

Lately, the increasing spate of suicides, among other ills, has been rightly or wrongly attributed to the paucity of facilities and feasible long-term plans to get the health sector out of the woods. The previous government’s 2014 National Health Act (NHAct) was a step in the right direction. It made a case for 1 percent of the Consolidated Revenue of Government towards the setting up and maintenance of basic health care facilities and the provision of basic healthcare services to all Nigerians.

The laudable nature of this programme and its intention for the general good notwithstanding, government bureaucracies and less charitable personal egos and aggrandizements, sadly, are clogs in the wheel of its implementation.

Meanwhile, in view of the importance of the sector, the World Health Organisation (WHO) insists that countries dedicate 15 percent of their annual budgets to the health sector. It is disheartening that Nigeria has never met this onerous responsibility, leaving the health sector perpetually in a shambles.

In light of the huge deficit in health facilities and feasible development initiatives, the coming of Isaac Adewole as Minister of Health in November 2015 was received with applause. The very impressive profile of the erudite professor as former Provost of the College of Medicine, University College Hospital (UCH), Ibadan, and as a former vice chancellor of the University of Ibadan rekindled hopes among stakeholders and the nation in general.

Felix Obi, a physiotherapist and health policy management consultant, in his contribution to A-H Nigeria noted that health budgets are one of the victims of government’s fiscal tightening in times of economic crisis. From a high of 6 percent budget allocation in 2012, the health budget as a percentage of total government budget fell to 5.8 percent in 2015 and plunged further to 4.23 percent in 2016, he said, adding, “In stark terms, the budget is N659 billion short of the 15 percent commitment made by African Heads of State in Abuja in 2001.”

This reality manifests in the deterioration of public health facilities. Other issues of concern in the country’s health sector include reproductive health challenges.

To show how bad the situation was, a 2014 WHO report on healthcare delivery which surveyed 200 countries placed Nigeria in the 197th position, just ahead of Congo Democratic Republic, Central African Republic (CAR) and Myanmar. The report gave a damning verdict: “Nigeria lacks a serious approach to health care.”

This is worse at the primary health-care level, which has deteriorated rapidly over the years due to lack of political will and wilful neglect.

The country, no doubt, needs to pool resources to finance healthcare sustainable development goals, especially umbrella projects undertaken by the likes of UHC that translate to “universal financial risk protection of the population from catastrophic spending on health services, which further impoverishes already poor and vulnerable households”.

The ways and means towards mobilizing necessary funds for Nigeria’s health sector should, therefore, be of paramount concern to all. Tax must be fair, equitable and just. The process should be devoid of vindictiveness to any industry or sector.

The Western region had a head-start in good healthcare system when, in 1953, Obafemi Awolowo introduced free health programme, which committed 50 percent of government’s budget to the health and education sectors without strangulating any industry or operator. Similarly, late Olikoye Ransome-Kuti as Minister of Health made his imprint in developing and stabilizing the Primary Health Care (PHC) system in the country.

In less than two years in office as health minister, Adewole has also facilitated development of the 2016 National Health Policy based on the theme ‘Promoting the Health of Nigerians to Accelerate Socio-economic Development’, which captures the intent of the UHC. The policy replaces the 2004 National Health Policy. The professor should also be commended for his ambitious ‘100-Day Better Health for All Nigerians’ launched on July 18, 2016 as part of government’s Rapid Results Initiative (RRI), whose objective is to fast-track his vision of ‘One PHC centre per Ward’ through the revitalization of 10,000 PHC centres across the country within the next two years in a bid to provide access to quality health care to about 100 million Nigerians.

However, a recent tweet from the minister’s twitter handle (@IsaacAdewole) seems to make a mockery of the job he is doing to salvage the health sector. The tweet proudly announced, “We are exploring raising taxes on tobacco for financing UHC while achieving major public health outcomes (NCDs) like the case in Thailand”.

Reading between the lines, one could see some signs of an over-zealous determination which may meet healthcare demands for a while before unintended consequences appear. Without holding brief for tobacco manufacturers, there is a legitimate fear that if legitimate operators are forced out of the system through over-taxation, because nature abhors a vacuum, the gap so created will indirectly prepare the ground for illicit importers/traders to take over the industry to the detriment of legitimate operators, consumers and the government. The same tobacco products hitherto manufactured to standards but now covertly imported under illicit trade, which may be of inferior standards, will be unleashed on the market and on consumers, while government will lose revenue in the form of taxes – excise duties and import licences.

In justifying its quest for increased taxes on tobacco, the tweet referred to Thailand’s tobacco industry’s experience, but there is a huge difference. Thailand Tobacco Monopoly (TTM) operates on a different plane entirely. TTM is state-owned and enjoys government’s protection with about 75 percent of the market share as against Philip Morris’ 22.5 percent share. Imported substandard brands that evade taxes do not have much of a space or chance to compete in the Thai market because of the legislations in place. Therefore, the company, established in 1939 as a state enterprise under the supervision of the Ministry of Finance and according to the Cabinet’s resolution, as a responsibility contributes substantially to the running of the nation by taxing other players heavily while generating revenue from consumers purchasing state-owned tobacco products.

What this shows is that Nigerian consumers need to be reasonably assured of the quality standard of the products they choose to consume, while companies are reasonably taxed and levied for development projects. It will be rather counterproductive if legitimate entities are forced out of business while the targeted product still finds its way into the market illegally, only to cause greater harm to consumers. Once again, that will eventually put some strain on Nigeria’s healthcare facilities and do more harm than the planned good.

Kola Orilowo