Last week, at the 60th National Council on Health, NCH, the Minister of Health, Professor Isaac Adewole spoke about the need to fast track economic recovery and growth of the nation’s health sector.
Adewole, in a chat with Sola Ogundipe, noted that the capital budgetary allocation of N71.1 billion for 2018, is an improvement over 2017 during which N55 billion was allocated. However, the Minister seeks more investment to health financing. Excerpts:
2018 Health budget
The health budget is priority but health cannot stand in isolation. We need to look at health in the context of the overall national development. If you asked me if I want health without water or electricity, I would say no.
There are critical sectors that are also important. For instance, if Nigeria remains in recession, then health cannot really survive and if government decides to invest in other sectors in order to take Nigerians out of recession, it will be supported.
If you asked me if I am satisfied with the health budget, my answer is that I cannot be. I would be happy to have all the money in the country dedicated to health. Health is overtaking education in terms of capital but what I would want to see is both health and education moving forward.
I’ll be prepared to even allow education to have more than health because when people are educated, their lifestyle changes and they respond better and you can talk to them about health prevention.
Education boosts health. Water, food and agriculture also boost health. When people are educated, I do not have to preach to them to go and immunise their children, so education is the vaccine for poverty, ill health and oppression.
2017 and 2018 Health budgets
It is too early to assess the 2017 budget that was passed in June 2017 and the first quarter release done in September. You cannot assess on just one quarter release. What government plans to do is to ensure that we implement about 50 per cent of the budget for 2017 so that we can carry the rest into 2018.
This is desired to streamline the budget year from January to December, so in assessing the 2017 budget, the plan is to try to ensure nothing is left out.
The 2017 and 2018 budgets are similar because we recognise that we need to carry over many things.
NCD Step Survey
They are health promotions for the geriatric group and provision to do a Step Survey in the budget. This was last done in 2000, so for 19 years, Nigeria has not had data on hypertension and other NCDs that we are worried about, but now, we want to do a nationwide survey to even let us know what situation we are having. It is known as an NCD Step Survey and it is in the 2018 budget.
The fact that there are cases of NCDs in different parts of the country does not mean there are epidemics. These disorders are always there and we would need robust statistics to support the fact that an epidemic is in place. However, we expect that there would be an increase. Many NCDs are related to age. The older you are, the higher the likelihood that you would have hypertension, diabetes and cancer, so as more Nigerians are living longer, as we become wealthier and people change their lifestyle, exercise less and eat less healthy foods, there is a chance that would happen.
So we know it is like a prediction that epidemic of NCDs are likely to happen and are actually happening all over the world. Each country would transit from communicable diseases to NCDs but we must also be on the look out for trauma cases. It is part of the price to pay for development.
A new cancer screening machine has been installed and ready for work at the National Hospital, Abuja. We are likely to have a second one by the end of December 2017 in the same hospital.
We met one machine that was in the crate for three years, it is now installed. They are training people on it because it is a brand new machine with a lot of electronic gadgets. We are expecting more people to be trained on it.
The original plan was to flag off the machine last week, but we said let us wait two more weeks so that the operators are comfortable with the machine and all the electronic data.
The plan is for the eight health centres of excellence to have at least two machines over time, but we said by the 1st quarter of 2018, we would have two each.
We have also repaired the Linear Accelerators in Sokoto and Enugu and they are now working. The University College Hospital is one of those to be upgraded. What the UCH needs is a treatment planning machine which we would get for them.
Investing in PHCs
The country has about 30,000 Primary Health Centres and if we can make about 10,000 functional, we would be fairly okay. The World Bank has revived about 1,400, the DFID is working on 950, and the European Union signed agreement to do 774 in three states apart from what the states themselves are doing. For instance, Kaduna has done 254. We are going round to document, and at the end of the day, we are going to have even more than 10,000.
Even the World Health Organisation has taken it up as an issue that to achieve Universal Health Coverage, UHC, we should use primary healthcare as a platform.
We are highlighting the need to invest in the PHCs. Last year, we made provision for 110 PHCs. The budget for PHCs in 2018 is N21 billion compared to N19 billion in 2017. In addition, the Federal Government released N3.5 billion for measles, giving a total of N22.5 billion.
Challenges in Health sector
The Health sector is very challenging. For one, we need to give it the priority it deserves. We need to ensure more resources are attached to health; we need to ensure that the various actors work together, minimise strikes and address all. We need to encourage Nigerians to invest in health.
I was in a hospital in the US and saw endowments. We cannot see things like that in Nigeria. It is as if we want the government to do everything. We have many wealthy people who can also help.
I wish to invite such people to contribute and build on health by appreciating what they have done for society, but they should invest more in health.
Health insurance is good, but it is an imperfect system of running healthcare. The surest way of insuring healthcare is direct public health funding through taxation and allocation. That is the only one that is certain, but in many countries, we have both.
The reality is that Nigerians should pay tax. Many Nigerians do not pay tax. Nothing is free, someone must pay for it. We pay probably one of the lowest taxes in the world after some of those countries that do not even pay tax such as oil-rich Arab countries.
We must not only talk about sharing the National cake, how can we put more money in there? How can we grow the National income beyond oil? So when that cake becomes bigger, then we would have better share.
Unfortunately, the abortion law in Nigeria is complex because it penalizes the offender and the offended and as such, that is why nobody would readily report. Secondly, the law is not implementable. No one would come forward and say they have done abortion. Those who go to do abortion give fake names. If what we do not want is abortion, that law is bad because no one would report.
We have made success towards malaria elimination and reduced the burden by increasing the number of those sleeping under Insecticide- Treated Nets, ITNs. What is interesting is that poor people use ITNs better than the rich. Our real commitment towards malaria elimination is to reduce malaria-related mortality by 2020.
We are modest in our target by saying that by 2020, no Nigerian should die from malaria. We don’t want to eliminate malaria, but eliminate deaths.
The global target is 2030. We are being careful and that by 2025, Nigeria should be able to say that at least we are at the elimination stage so that we now have five years to mop up so that by 2030, we can join countries that are saying we have done away with malaria.
We have not recorded deaths in the last 14 months but the international committee is a bit unhappy because they thought we are relaxing and they are also not happy and are even anxious about the scare of Monkeypox because they believe it could set us back and even cause apathy at the state level.
That is why I have told the Commissioners of Health that we need to wake up. An international committee is not going to certify us until we meet some very tough criteria. Before, we thought certification was going to be free, but now we have to earn it.