—Dr. Osahon Enabulele,  President, Nigerian Medical Association, NMA
Though the health sector like most other sectors of Nigeria’s economy is not immune from the challenges of the Nigerian system, I would say that the aggregate performance of Nigeria’s health sector in 2013 was not remarkably different from that of 2012 despite some efforts made to address the challenges carried over from 2012.

It was clear from the onset that the unsatisfactory amount allocated to the health sector in the 2013 National budget and the slow process of release of funds was not going to impact on the quality of health of Nigerians. The poor funding of the health sector manifested in the country’s inability to give expression to some laudable initiatives in the health sector, including postgraduate Residency Training Programmes.

It was however not all gloomy in the health sector in 2013 as there were some progressive developments like the eventual reconstitution and inauguration of the Medical and Dental Council of Nigeria (MDCN) and other Health Professional Regulatory Councils as a result of the agitations and committed efforts of the Nigerian Medical Association (NMA); medical professionals also led expert teams that undertook some highly skilled interventions such as kidney transplantation, Stem cell transplantation, and Cardiac surgeries etc.

NHIS

In the critical area of Universal Health Coverage for Nigerians through the National Health Insurance Scheme (NHIS), there were some developments, particularly the launching of more Community Based Social Health Insurance Schemes in various Nigerian communities, including the Federal Capital Territory. However, these efforts paled into insignificance considering that the Universal Health Coverage in Nigeria is still less than 6 percent.

Now that a substantive Executive Secretary for the NHIS has been appointed it is expected that the application of more innovative and social-based health financing mechanisms in 2014, together with strong commitment and transparent leadership of the NHIS Management, will propel the administrative wheels of NHIS in 2014 towards accelerating the enrolment of more Nigerians into the scheme as well as boost financial access of all Nigerians to a minimum healthcare package.

HIV/AIDS
Nigeria still has a lot to do in the fight against HIV/AIDS. It is imperative that the Director General of the National Agency for the Control of HIV/AIDS (NACA) and his management team learn from experiences garnered in 2013 to hopefully devise better strategies of securing improved results in Nigeria’s efforts to combat HIV/AIDS in 2014.

Time has come for Nigeria to review her dependence on donor agencies so as to prevent the calamitous consequences of their eventual exit for whatever reason. I believe Nigeria is rich enough to make treatment of HIV/ AIDS truly free without relying on donor agencies. I therefore strongly advocate that Government should give a budgetary headline to TB and HIV at the hospital level if any meaningful impact is to be made in 2014 and subsequent years.

I also call on the Government to thoroughly investigate the complaints by PLWHAs about the FGN supplied combination drug—Nevirapine, Lamivudine and Zidovudine. If the drug is found wanting, it should be withdrawn immediately. NMA is prepared to make her informed contributions in this regard.

Research
It is not surprising that there was no appreciable breakthrough in operational research. This may not be unconnected with the fact that Nigeria still has no strategic research policy, and probably does not consider research as a necessary tool for national development. In addition, investment in research by government, corporate bodies, and individuals is still at a low ebb in Nigeria such that potential Nigerian researchers and inventors are enveloped in a state of diffidence.

Infrastructure and equipment
Year 2013 witnessed some effort to upgrade existing federal health infrastructure and equipment with the aim of improving the capacity of the Federal Tertiary Health Institutions. There were also efforts by some state governments to upgrade their state hospitals. However, these efforts were not significant enough, thus leaving the aggregate performance in terms of public health infrastructural upgrade and development in Nigeria below par.

Again, the private healthcare sector did not witness significant push in terms of health infrastructural development. The Federal Government of Nigeria through the President has accepted the proposal of the Nigerian Medical Association for the establishment of a Hospital Development and Intervention Fund (HDIF) which will help provide a platform for the establishment of world class health facilities in both the private and public health sectors. The NMA has called on the Federal Government to urgently give effect to the active development and implementation of the proposal in the year 2014.

Medical tourism
On the issue of Nigerians still traveling abroad for treatment, it has become a status symbol for some, while for some others it is because of the ready availability of public funds to be spent. There are few germane cases. Nigerian doctors are doing a lot, and our people should have confidence in the system. It is better and easier to travel to Enugu or Ibadan or Benin to receive expert treatment than to travel all the way to Asia to receive the same services that are available locally.

Public-Private-Partnership
The government needs to truly take matters concerning healthcare more seriously and allocate more funds to the health sector in addition to firmly instituting Public Private Partnership (PPP) arrangements in the hospitals/health institutions or the outright outsourcing of some services such as pharmacy, radiography, physiotherapy, e.t.c, so as to free funds for more critical services.

Professionalism
In terms of Health Human Resource, one unfortunate feature witnessed in 2013 was the unwarranted bickering, agitation, professional territorial and sometimes politically motivated quest for equality with medical doctors. This undoubtedly impacted negatively on health service delivery.  One hopes that in 2014 there will be greater harmony amongst the various healthcare workers in the public health sector with all stakeholders playing their role in a more harmonious way to ensure delivery of quality healthcare services to Nigerians.

Despite the challenges of health human resource in Nigeria, including the extremely hostile workplace environment, I must state unequivocally that medical doctors had profound positive impact on the health sector in 2013.

There is a lot of distraction for the doctor at the moment which has resulted in preventable morbidity and deaths in Nigerian public hospitals. It can be stopped by government through the honest implementation of international best practices in hospital care for patients.  Indeed, there is urgent need for the enthronement of professionalism and international best practices in the healthcare sector, with the duties and responsibilities of the various healthcare providers clearly defined.

National Health Bill
Though the efforts of both chambers of the National Assembly to re-present the National Health Bill for passage and hopefully, accent by the President are appreciated, the slow pace of processing of the bill leaves much to be desired.

Conclusion
The health sector of Nigeria witnessed good and bad times in 2013. While there are viable solutions that can drive greater progress in 2014, including the health sector from the vagaries and bureaucracies of the civil service as was done by removing critical sectors like the judiciary from the civil service, I am optimistic that with the expected passage of the National Health Bill, sincere and improved commitment by the political leaders to good governance and participatory leadership; coupled with the altruistic and constructive disposition of all health professionals, the health sector in spite of the poor allocation to health in the 2014 Federal budget may witness some improvements in the year 2014.