In 2019, Nigeria’s health sector is set to witness major strides in Nigerians having access to affordable healthcare service delivery. This Outlook provides a bird’s eye view of progress to be made on Nigeria’s Healthcare delivery space which has remained a critical driver for productivity and targets of establishments.
As Nigeria’s health sector gears towards the achievement of Universal Health Coverage (UHC) and continues its quest to increase the number of Nigerians covered by health insurance, reduce high maternal and child mortality, a number of bespoke practices and innovations are been implemented by States and Private-Public Partnerships to address challenges such as inadequate infrastructure, poor primary health facilities, malnutrition, poor health emergency response, brain drain in the health sector, to mention but a few.
The country’s progress in this regard can be determined by a majority of stakeholders in the health industry taken actions to adopt and implement principles and approaches. Key to this include spurring Private-Public Partnerships to improve the health and well-being of citizens which is intended to shape the sector in 2019 experts say.
Budgetary
The 2019 recurrent budget increased from N269.34billion to N315.62billion, which amounts to N46.3 billion increase from 2018 Recurrent Expenditure. It is expected that additional funds will address issues in the sector in terms of Human Resource for Health, staff welfare in the Federal Ministry of Health, analysts believe.
The Federal Government Strategic Document that reels out the budget for 2019 reads: “Health is an important part of our aspirations for human capital development and we will continue to strive to make our people healthy and happy,” President Muhammadu Buhari stated while presenting a total expenditure of N8.83 trillion in 2019 Budget Proposal tagged “Budget of Continuity” to the National Assembly recently.
“In addition to building world class treatment centres, including for cancer, we will be establishing a health system that prioritises primary health care so that millions of our people can be insured for a minimum package of services with the poorest exempt from co-payments. In so doing, we will reduce the stress, strains and costs that the Nigerian people face in accessing decent health care,” the President added.
Currently, Nigeria has not met with the minimum requirement of allocating 15 percent of the Total Annual Budget to improve the health sector, despite being a signatory to the 2001 African Union Abuja Declaration “the performance of this 2019 budget will basically depend on how good the budget is executed and public financial supervision,” analyst say.
Cancer care in Nigeria
According to the latest estimate on the global burden of cancer, in September 2018, by the International Agency for Research on Cancer (IARC), there will be an estimated 18.1million new cancer cases and 9.6 million cancer deaths in 2018. In Nigeria, 115,950 new cases and 70,327 deaths are predicted.
It is important that we continue to build public health awareness regarding the rising prevalence of cancer cases in Nigeria. The country needs to arrive at innovative financing models for better cancer healthcare outcomes.
The Federal Government 2019 budget proposes to spend N780 million for the establishment Of Chemotherapy centres in UBTH, UITH, ABUTH, UMTH, OAUTH, UNTH, UPTH, FMC Owerri, FMC Abeokuta in 2019, BusinessDay can reveal.
“This will help deal with all the different aspects of the prevention, early detection, acute diagnosis, treatment and palliative care that are important,” said Chukwumere Nwogu, a Cancer Epidemiologist; Thoracic surgical oncologist and chief executive officer, Lakeshore Cancer Centre.
Uche Orji, managing director and CEO, Nigerian Sovereign Investment Authority (NSIA) while speaking on the status of Nigeria’s wealth fund and the second Niger Bridge said the shortest thing the organisation has done with the infrastructure fund is the healthcare project.
“In healthcare by January 15, 2019 we are commissioning of cancer care centres at the Lagos University Teaching Hospital (LUTH) as part of private public partnership programme and also commissioning a diagnostic centre in Kano and Umuahia.”
Orji further said that is the 13th phase of project across in healthcare in Nigeria. “There is huge account of opportunities that we are wasting in this country; People still go to Ghana for cancer screening which can be done locally.
“What we are doing is not social responsibility but commercial investment, so we are expecting to make about 8-12% profit in healthcare. At the moment it is owned by the NSIA in 7 years to earn our return and over time transfer will be made to LUTH,” he said.
Francis Abayomi Durosinmi- Etti, consultant clinical oncologist and chairman, National Programme on Cancer Management, emphasis that the government are aware of the need of cancer care and are trying to increase the number of machine use and facilities of treating cancer including training of staffs. This entire projects on-going means that in the next 2-3 years these situations of cancer treatment would have been a lot better than it is now,” Durosinmi- Etti, said.
Vaccinations
One of the most important interventions for the protection disease outbreaks from life-threatening conditions such as polio, measles, pneumonia, Lassa fever, cholera, Ebola, Yellow Fever has been working successfully by providing vaccination.
Steps have been taken scale-up the immunisation efforts for maternal and child healthcare. Most of the non-communicable diseases can be reduced or prevented if we further invest and strengthen our public health education system.
For vaccines in the 2019 health budget, N7.63 billion is for earmarked for procurement of Routine Immunisation (RI) vaccines and devices; N21.25 billion provided for GAVI/Immunization; N1.26 billion for the procurement Of non-Polio Supplementary Immunisation Activity (SIA) Vaccine; and N1.12 Billion for the procurement Of Kits and Commodities for Community Health Influencers.
With SIAs considered as opportunities to strengthen routine immunization and other health programmes, Africa Resource Centre for Supply Chain (ARC), serves as an independent advisor to the Government to help strengthen public health supply chain strategies by providing thought partnerships in the adoption of transformation agendas for supply chain improvement.
An effective supply chain reduces the direct cost of providing patient care, reduces counterfeit drugs and waste, including the availability of medicines, family planning choice and vaccines. Recently, Isaac Adewole, Minister of Health said access to this in a core leads to Supporting warehouse infrastructural upgrade of 31 states Central Medical Stores (CMS) in Nigeria.
“Setting up a visibility platform in the Ministry of Health’s office will provide real-time online status and performance of CMSs across Nigeria through a monitoring dashboard and institute a stakeholder engagement forum to foster ownership and advocate for fund allocation to the states warehouse improvement and measure progress,” he outlined.
Vaccination drives ensure preventable infectious diseases and protects the mother’s and children’s’ health.
UNIVERSAL HEALTH COVERAGE
The world is moving towards attaining Universal Health Coverage. Report by the Nigerian Government on National Health Insurance Scheme (NHIS), indicates government’s quest to increase the pool of Nigerians covered by health insurance to cover about 198 million people with access to a collective set of comprehensive health services of adequate quality. This quest is in tandem as financial protection is achieved when direct payments made to obtain health services do not expose people to financial hardship and do not threaten living standards.
The National Health Act 2014 set aside 1% consolidated revenue for the health sector and consequently laid the foundation for Nigeria towards achieving Universal Health Coverage. The 2019 health budget has proposed N51.22 billion for the implementation of the National Health Act, BusinessDay can reveal
The World Health Organisation (WHO) says the Universal Health Coverage is a political choice for countries themselves to make. A study released recently by WHO showed that 85 percent of the funding gap to achieve universal health coverage could be met by countries themselves, although up to 32 of the poorest countries will require development assistance.
As part of efforts to achieve UHC, Nigeria has been to set of guidelines defining the basis for Administration, Disbursement, Monitoring and Financial Management (ADMFM) through the Basic Healthcare Provision Fund (BHCPF, “The Fund”). The guidelines address urgent interventions put in place to tackle persistent and emerging causes of population mortality in Nigeria including Maternal Mortality, Perinatal Mortality and Road Traffic Injuries (RTIs).
The guidelines processes is also to be applied, the responsibilities of various stakeholders including (but not limited to) participating healthcare providers, healthcare facilities, Federal Government parastatals such National Health Insurance Scheme (NHIS), the National Primary Care Development Agency (NPHCDA), Federal Road Safety Corps (FRSC), National Emergency Management Agency (NEMA), State Governments, Local Governments and their participating agencies including State Primary Health Care Development Agencies (SPHCDAs) and the accompanying accountability expectations contingent on these responsibilities.
The models at the moment both the NHIS and the HMOs have covered less than 5 per cent of the population which attaining universal health coverage is one of the core mandates of the scheme.
Newborn and maternal mortality
Nigeria’s abysmal position rating of the country with the second highest maternal mortality rate is a sad foretaste of the nation’s primary healthcare system. Nigeria’s newborn death rate (neonatal mortality) – 528 per day– is one of the highest in the world.
“Newborn mortality is one of Nigeria’s worst health problems, compared to interventions in other health sectors; there has been minimal progress in efforts to reduce newborn deaths in Nigeria,” said Ezeaka.
For Nigeria to drastically reduce maternal mortality and newborn death rate to attain the sustainable development goal SDG BY 2030, leadership is highly critical, finance, technology and capacity building.
Chinyere Ezeaka, Professor of Paediatrics, College of Medicine, University of Lagos emphasis on solutions in 2019 expectations to reduce the death rate of newborn and maternal mortality in Nigeria.
“Until the country address the gaps of policy implementation we will still continue to have the gaps in maternal and new- born mortality rate in Nigeria. The county really need to work to increase in its capacity building and include a lot of trainings in respect of maternity care. Also improve on critical issues which have to do with services, emergency reserves and increase budgetary allocation for health sector,” Ezeaka explained.
She continued “We have the integrated new- born and maternal policies, Adolescent health policy; a lot of policies are documented withstanding the amount of death, but what we are encouraging is for shared commitment from the federal to state and local government level. We have to strengthen the system, have access to service delivery, increase the health insurance coverage so that these mothers will come to the hospital and access care.”
“For technology, a lot of deaths in the country relate to equipment not been available or have gotten bad and not repaired. This equipment is live saving and needs to be available always. Having the following equipment will go a long way to reduce the number of new born date, diagnosis equipment, treatment equipment, monitoring equipment and then availability to repair these equipment as at when due,” Ezeaka added.
In conclusion, Analyst says to determine the impact of these commitments constitutes a crucial part of the evidence-informed health policy-making cycle in the county.
“It reflects the importance of setting goals and using monitoring frameworks to focus the invention of support, and enables capacity of change in health and well-being and impact of policy over time,” Analyst says.
ANTHONIA OBOKOH
