Nigeria’s health sector in dilemma, as donor agencies signal withdrawing support

Nigeria’s dilapidated health sector could be facing additional dilemma as donor agencies who are principal supporters‎ of the country’s immunisation and other critical health projects signal withdrawing their support following Nigeria’s emergence as a middle income country.

During his recent visit to Nigeria, Bill Gates specifically commented that Nigeria could see gains made in polio eradication reversed and other deadly diseases, confirming fears by other experts that the government alone is not well equipped to handle health emergencies such as Lassa Fever, Ebola and Type C Meningitis.

Speaking at the special session for the National Economic Council in Abuja, Bill Gates said, “…Nigeria’s national income level is about to make it ineligible for certain kinds of development assistance and loans, which Nigeria’s government has been relying largely on to fund its health systems and other priorities.

“Without more and better spent domestic money, investment in your people will decline by default as donor money shrinks, a lose-lose scenario for everyone.”

The Bill and Melinda Gates foundation, for instance, which has

intervened with vaccine financing in Nigeria with over $1.4 billion is worried that the government appears not be able to close the funding gap if donor agencies pull out their funding as they are indicating.

Eze Onyekpere, lead director, Centre for Social Justice, responding to the development, told BusinessDay that the government must take hard decisions on the appropriate way forward, especially in the social sector, including health care.

“Groups like the Centre for Social Justice have been championing a Nigeria Immunisation‎ Trust Fund Bill, as well as compulsory and universal health insurance for all Nigerians because we are very much aware of that the primary health-care system, like other Nigerian systems, is broken down and non-functional,” Eze said.

According to him, the “Centre for Social Justice is propounding bold ideas like a Nigeria Health Bank, being a developmental bank to fund among others, capital projects in the sector and human resources for health.

“Again, we‎ are calling for new sources of revenue to the sector

Including a 2% surcharge on all imports.”

Eze also pointed out that non-implementation of the basic health care provision fund provided in the ‎National Health Act since the enactment of the act, shows poor prioritisation of the health sector by the Nigerian government, and is also affecting poor referral systems in health challenges.

Eze also attributed the failure of the primary health system in the country to poor leadership.

“The primary health-care system, like other Nigerian systems, is broken down and non-functional. The same leadership question .We are more interested in contracts and commissioning of PHCS, rather than securing commitments from local and state governments to run them after the

Buildings  have been commissioned,” he said.

Experts are more concerned that the non-implementation of the Basic Health Care Provision Fund of 1 percent of the National Health Act, over four years of enactment could worsen the crisis already bedeviling the health system, already in chronic shortage of basic amenities and necessary infrastructure.

The 2017 Multiple Indicator Cluster Survey 2016-2017 shows that between the ages of 12 – 23 months, only 21% of children are fully immunised in Nigeria, which health experts are concerned about.

Breaking it down further according to states, the cluster shows that the immunization levels stand at: North West 7.9%; Northeast 17.5%; North Central 26.7%; South East 36.5%; South-South 38.2% and South West 47.9%.

Interestingly, government acknowledges that although Nigeria has been categorised as a middle income country, it is still very difficult for citizens to meet their basic needs, as confirmed by Minister of Finance, Kemi Adeosun.

“You are right that our transition from a low income country to a middle income country is a statistical transition, but the reality when you travel around the country does not really portray us as a middle income country,” she told Gates during one of the visits.

 Obi Onwujekwe, a professor and the Dean Faculty of Health Sciences and Technology at the University of Nigeria Nsukka, who is also a consultant to the Federal Ministry of Health said the Federal Government must pay more attention to primary health care centres, and implement the provisions of the National Health act, as a way of laying proper foundation for Nigeria health system.

The government has the money, but is lacking seriously in political will to in health budgeting and implementation, he said.

Onwujekwe said the Federal Government ‎must adopt a multi-sectoral approach to health budgeting system in the country, where there are identifiable roles by each party.

“There is no way the Minister of Health would be doing health budget and he does not make proper economic case on what he wants the government addressed, where in the Ministry of Budget and National Planning, Ministry of Finance and the economic adviser, Office of the President, must be involved to give it the proper cost analysis and wider economic implications, “Obi said.

According to him, the Federal Government must ensure that the zeal with which it approved the $1bn issue on security is applied to health funding budgets, so that appropriate priority is given to health concerns, since it has a way of spurring inclusive growth and stopping out of pocket spending which hovers around 70% among the populace.