Key medical practitioners say govt paying lip service towards attainment of Universal Health Coverage

In 2018, Nigeria’s healthcare system witnessed series of unpleasant events. Alleged corruption, industrial action, poor allocation and delayed release of budgeted funds, to infrastructural decay in primary healthcare centres and low access to good medical care were the mainstay of the sector.
There were disease outbreaks and the high casualties recorded from the incidences were linked to poor emergency response, poor disease surveillance, and absence of infectious disease centres in most States nationwide. Chioma Obinna spoke to top medical practitioners about Nigeria’s health sector performance in 2018. The experts are unanimous in their verdict that Nigeria is still far from achieving Universal Health Coverage, saying government’s continued lip service to health. Excerpts:

No facelift or uplift in healthcare –  Dr Francis Faduyile,

President, Nigeria Medical Association

One would have  expected that in 2018, Nigeria would  expand Universal Health Coverage but we have not been able to get that right. We expected more enrolees in the National Health Insurance Scheme, NHIS, rather we had a lot of issues with the office of the Executive Secretary.

In the Teaching Hospitals, there were fewer industrial disputes,  and cutting-edge technology is not yet in place.   Generally, I will score health very low for 2018.

The health sector has been underfunded and underutilised and there has not been any facelift or uplift in the sector.  We have not been able to cater for the health needs of the country.

Importantly, the State governments are not doing enough in terms of health of the citizenry.  We should not forget that the primary and the secondary health care is at the purview of the State and Local Governments,  only  tertiary healthcare is within the purview of the Federal government. Generally, it is still not a pass mark.

To improve the sector in 2019, first, State governments should come out with an action plan towards improving the health of the people.   The budgetary allocation to health has been terrible right from the Federal level, worse with the States and at the Local government level is almost not in place.  Government needs to be interested in the health of the people. A healthy nation is a wealthy nation but we are paying lip service to the health of the people.

https://newlive.vanguardngr.com/2018/12/nigerias-dire-medical-care-challenges-the-need-for-corporate-intervention/

We need more people in the NHIS, either in the federal level or at the state-owned health insurance schemes so that we can achieve Universal Health Coverage and stop out-of-pocket payment.  We need the government to be interested in the primary healthcare system where we are expected to do more of preventive healthcare like immunisation and health education. diseases.

For instance, vaccination has been at the lowest ebb.  Yellow fever is ravaging a large number of people in no less than seven states. You will be surprised that we don’t have adequate yellow fever vaccines so these are things we want to be looked into in terms preventive care and then see how we can institute better technology driven curative management.

Nigeria’s health system performance unappealing — Dr Osahon Enabulele,

Vice President, Commonwealth Medical Association

There have not been
changes in the health sector on most fronts.  On funding, it is still the issue of budgetary constraints and budgetary release even in the face of the legislation.  We are still nowhere in terms of enforcing regulatory framework for health, either at the regulatory or implementation of the National Health Act, which is still moving very slow.

The health human resources is even worse now than where we were coming from.   In terms of the enormous brain drain that drives the health landscape to the extent that we have a minister who, rather than address the problem was proffering options of farming, tailoring and catering etc, and that shows the level of an abysmal situation in the sector.    It is completely unappealing.

Even in other variables in terms of system performance, aggregate performance in the national and state levels, we are still not where we are supposed to be.

In terms of performance in 2015, I do not think it has really changed even in 2016 and 2017 performances.

I think there is enough to be done to address a lot of these parameters which drives efficient and health performing health system including finances, infrastructure, health human resource, regulatory framework and other variables and when all these variables are not in an optimal performance, then you can imagine the aggregate performance of the health system.

This is why the health system performance in Nigeria today even in 2018 is still unappealing.   I will score the sector below 50 per cent.

In 2019,   I  want the government to be clear about political commitment to health because without political commitment all other variables will not receive the required attention. Government should be  clear in their thoughts on why healthcare should be prioritised.  So the first step in 2019 is  appropriate reflection on  governance of  the health system.

Make a new pledge towards the development of the health sector and all other variables should have a reflection or manifestations of that pledge they need to take in 2019 in terms of budgetary allocation for health. The 2019 budget allocation to health does not  give cause for joy.  It is still  abysmally low – less than 5 per cent.

It gives impression that it is a government that has failed to keep up its campaign promises for health.  Consistently they have failed with the promise of allocating 15 per cent to health.    I think they should also address the issue of infrastructural decay.

By now we should have established Centres of Excellence in the six geopolitical zones.

For instance radiotherapy – it is completely unacceptable that people travel a long distances to  access care.  The government should begin the year with sincerity.   Instead of complaining about the inadequate fund, they can start by setting up referral points in the six zones to reduce Nigerians trooping to America, and India.

The government must have a strategic plan in revitalising the infrastructure and no ad-hoc plans only when the election is coming up.

The  government must do something to address  brain drain because it has injured our healthcare system.  The regulatory framework must be right.  I hope after 2019 elections, whoever comes in will not begin to dissolve all the Boards.  Also, there is a need to upscale the operationalisation of the National Health Act.

As I speak, there is no quality standard as defined by the National Health Act that has been churned out by this government four years after the passage and becoming a law. The regulatory process must be strengthened in 2019 and the issue of primary health care needs to be addressed.

Poor performance due to non-implementation

of policies – Dr Saliu Oseni Chairman, Nigeria Medical Association, Lagos State branch

I think the healthcare
system is still very poor because we have not done much to improve it. We have failed to implement policies on  ground. We have policies, but what we have most times is that those policies are not being applied or monitored.

We all know what happened about the NHIS and the uproar with the Executive Secretary and what he had brought out about his findings when he got there.

For instance,  the real reason why the health insurance scheme failed is not that it was not funded, it was because the fund was not put in the right places.

It is not because there were no rules to guide disbursement of money, but because the people that were supposed to monitor were flaunting the rules. So it is important for  government to create bodies that will monitor policies and ensure that those policies are followed.

Healthwise, indices are still very poor. We need to look at the policies, review them and ensure that they are implemented.

“It is vital that we bring out all the policies, look at them in the incoming year, and give a timeline of reimplementation and we have continuous auditing.

We should also have these things publicised, then the public, too, has a lot of work to do.

They are spending the taxpayer’s money and should be accountable.

The Federal government should go back and look at the NHIS and stop politicising whatever is around it. Look at where things are wrong and correct the; punish whoever deserves to be punished, because if you are given money to help the public and  you divert the money, you are as bad as a murderer.

So in those countries where they turn public embezzlement into a death sentence, you may think they are wicked but  truth is that those people that are diverting the money are killing more people than the murderers.

So it is important that we look at all these things, but if we don’t have the public talking, civil servants cannot do it.

Budgetary allocation to health is still too low — Dr Saheed Babajide

– Chairman, Medical Guild

We are far from  getting
the health system right. We are not there yet. The allocation to the health system is still very poor. We have not got to where we ought to be. In terms of allocation, it is zero.  In terms of disease outbreaks and emergency response, we are not there.

This is because Nigeria is not a serious country.  How can we have only one infectious disease hospital?

At least, Nigeria needs one infectious centre in each of the six geopolitical zones. The idea of transferring victims from State to State can even spread infections.

You don’t need to take patients, for example from Irrua to Lagos.  If we have infectious hospitals all over, some of these diseases can be contained.  Another major, problem is the rivalry in the system, it is time the government brought all professionals together and address the issues.