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At World Health Assembly, Nigeria Confronts Challenges of Healthcare Financing, MDGs

 At the just concluded WHO’s World Health Assembly (WHA) in Geneva, Switzerland, issues of health care financing, health-related Millennium Development Goals (MDGs) resurfaced as Nigeria navigates through means of finding solutions to some of the challenges, Paul Obi who attended the conference writes

In modern health care service delivery, many nations have tinkered with the idea of government being the sole provider of funds to the sector. Most countries have had to look at the private sector as a reliable partner in financing health care service delivery.

According to the World Health Organisation (WHO), healthcare financing is very critical for reaching universal health coverage. Health financing assist in no small measure in bringing closer universal health coverage to the masses and even the vulnerable. At home, experts believed that Nigeria cannot treat her way out of the current health crisis if government continues to be the single contributor to the nation’s health funds.

The roadmap to a better healthcare system must see private investment as a strategic ally. This must be driven by private financing as well, experts argued.  In 2010, WHO postulated that the way to ensure better healthcare for the poor was to key into private healthcare financing. The importance of healthcare financing can be attained through “raising funds for health; reducing financial barriers to access through prepayment and subsequent pooling of funds in preference to direct out-of-pocket payments; and allocating or using funds in a way that promotes efficiency and equity. Developments in these key health financing areas will determine whether health services exist and are available for everyone and whether people can afford to use health services when they need them,” WHO observed.

Therefore, effective healthcare financing will not only resolve health crises but will also address issues of poverty. And with the growing concern on the increasing level of poverty, scaling up health care financing and reaching the target goals for health-related Millennium Development Goals (MDGs) can go a long way in tackling abject poverty in developing countries. This objective was one of the primary focuses of the 2014 WHO’s World Health Assembly (WHA) in Geneva, Switzerland last week.

Declaring open the summit, WHO Director General, Dr Margaret Chan, decried the high level of social inequalities and its attendant consequence to efficient healthcare service delivery. “Our planet is losing its capacity to sustain human life in good health” she told the assembly. Chan informed the gathering that “health is a smart investment. It brings measureable results, sometimes remarkable results,” she said.

The WHO DG noted that though research by the Lancet Commission stipulates that “returns on health investment are now higher ”countries should be wary of overt private investment. She added that, “one particularly disturbing trend is the use of foreign investment agreements to handcuff governments and restrict their policy space.” The WHO itself has expressed confidence on what market dynamics can add to the improvement of health to citizens. Nevertheless, the organisation has been very cautious in the complete handing over of healthcare delivery to private investors.

“We learned that markets cannot sell something to people who cannot pay. Childhood immunization programmes deliver vaccines at no cost to recipients. The massive free distribution of bed nets coincided with dramatic drops in malaria cases and deaths. But we also learned that policies matter as much as money. Countries with the same level of resources achieve strikingly different health outcomes. The right policies, especially when they make equity an explicit objective, make the difference,” she stressed.

In all of these, the questions to ask with regards to Nigeria as Chan rightfully did are “will economic growth be accompanied by a proportionate increase in domestic budgets for health? Will countries put policies in place to ensure that the benefits are fairly shared?” Chan asked. But Nigerian Minister of Health, Prof. Onyebuchi Chukwu, who had a good showing at the summit was quick to defend Nigeria’s budgetary allocation to the health sector.

Chukwu said it will be more explicit to measure government spending on health on the basis of per capital, adding that “I prefer we relate to per capital, the WHO said if a nation spends $40 on a person, such country is on track,  I prefer it should be on per capital rather than percentage.” The minister explained that “we have not properly sat down to calculate how much we are spending on health. But you know that through Sure-P, government is spending on healthcare, if government spends on water, sanitation, it is equally spending on health,” he said. Chukwu, while speaking as a prelude to a meeting on healthcare financing at the 67th World Health Assembly (WHA) in Geneva, said Nigeria has performed credibly well as budgetary allocation to the sector is now higher than previous years.

“In Nigeria, though we are still spending less than 35 per cent, let’s be reasonable, there are immediate needs now in Nigeria that if you ask Nigerians what is the most pressing need, they might not mention health, some of them may say it’s security, some may say it’s power, it has to be taken in the context of the current priorities,” the minister submitted.
Similarly, Minister of State for Health, Dr Khaliru Alhassan, noted that efforts are in top gear to foster “integrated planning that is in line with healthcare financing in order to ensure strategic implementation of health programmes in the country.”

Alhassan at a side meeting in the conference stressed that what is most needed at the moment is to properly harness the resources for optimum results. Also speaking, Permanent Secretary, Federal Ministry of Health Linus Awute observed that, “the issue of percentage on budgetary allocation must have something preceding it; that is why it is being advocated that the private sector should be involved. All the same, funding is always going to be an issue,” he said. Awute assured of government readiness to prioritize healthcare financing, stating that, “the required alliances with other sectors must have to be formed; collective planning must now be the order of the day.”

That notwithstanding, Nigeria faces daunting challenges in the area of healthcare financing. Annual budgets have continued to plummet with no sign of being increased. With the flow of foreign investment to Nigeria, how then can government key in and provide an enabling environment for investors and at the same time make healthcare accessible and affordable for citizens? Director of International Cooperation in the ministry, Dr Ngozi Azodo, told THISDAY that government would continue to work hand-in-hand with foreign investors and international donors to ensure that healthcare financing is given priority. Azodo maintained that the new approach in the ministry takes foreign investors in the key health sector as golden eggs. Speaking to THISDAY, Sen. Chris Ngige said the National Assembly would continue to provide the impetus that improves healthcare funding in the country. Ngige who was at the Geneva summit as part of the Nigerian delegation contended that the recent passage of the National Health Bill by the senate was in consonance with that resolve. But a workable plan in that direction must take into account foreign investment, donors, and accountability with domestic funding in line with accessible and affordable healthcare for all. Thus, universal health coverage becomes a key factor here. Though Nigeria was represented at key sessions by Chukwu and the Executive Secretary of the National Health Insurance Scheme (NHIS), Dr Fermi Thomas, the need for judicious use of the funds available also forms the fulcrum of healthcare financing.

On health-related MDGs, Chukwu at a side meeting of the Commonwealth Health Ministers forum said “despite acceleration” it is not certain if Nigeria can meet the targets. But the good thing, Chukwu explained was that “even if we did, going by the target, there will still be much to do post-MDGs” adding that “as we approach the 2015 target date, we need to quickly consolidate on what to do in the post-MDGs agenda.” To realize these objectives, a basic component towards unraveling this logjam in Nigeria’s health sector is an efficient primary healthcare system. In that light, Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr Ado Muhammad, told journalists that given the enormous achievements Nigeria have recorded in maternal-child health, the global community is now willing to support Nigeria’s primary healthcare system for better outcomes.

He said the support was hinged on Nigeria’s continuous excellent performance in preventing further spread of polio virus, improvement in maternal-child health and immunization, stressing that  “these are progresses that are globally acknowledged.” According to Muhammad, “we held several meetings; most of the meetings were tailored towards seeing how the global community coul support primary healthcare outcomes. It became very obvious that Nigeria was being commended for the various achievements recorded, we secured global community support and extracted commitment to the tune of $35 million to fast track government efforts in achieving the Millennium Development Goals (MDGs). In the same token, Co-owner of the Melinda Gates Foundation, Melinda Gates, acknowledged that since the “baseline year for the MDGs, the number of children dying has gone down by 47 per cent. This improvement is even more impressive if you account for population growth,” she maintained.

Director General, National Agency for Foods and Drug Administration and Control (NAFDAC), Dr Paul Orhii, also spoke on other topical health issues that are crippling into Nigeria. He said the growing concern over obesity and high sugar intake was being taken into account in order to reduce cases of obesity in Nigeria. Orhii stated that plans were underway to regulate sugar intake in order to fight obesity in the country.

Also, the 67th world health assembly witnessed presentations from the Senior Special Assistant to the President on MDGs, Dr. Precious Gbenol,  Dr Ibrahim Kana of the Ministry of Health, the President of Nigerian Medical Association (NMA), Dr Lawrence Obembe, and Prof. Azuzu of the University of Ibadan, among others.

In conclusion, as most countries expedite action in meeting the healthcare needs of their populace, Nigeria must device several means of financing and funding the health sector. The cheering news with this new drive is the ongoing Public Private Partnership (PPP) spearheaded by Chukwu and other key stakeholders. This drive also championed by the Chairman of Dangote Group, Alhaji Aliko Dangote, Jim Ovia, Tony Elumelu, Dr Muhammed Ali Pate and others is a good omen in all ramifications. But there are concerns and fears that when government hands over the health sector to investors, chances are that good health care for ordinary Nigerians will surely be for the highest bidder. They argued that the health of any sane nation is not a turf for capital accumulation.  Or an arena for capitalists to display their muscles.

These are the challenges policy makers must consider in dotting the ‘i’s and crossing the ‘t’s in terms of healthcare financing and private investment. At the moment, the federal government has to go a step further in deepening primary healthcare in rural communities. That is lacking in many respects.  Some state governments have failed woefully to transform their healthcare system. An intervention from the federal government is necessary to turn things around. And the best way to address these inadequacies lies squarely on universal health coverage. It is a dream that Nigeria has to achieve or allow it to ravage her citizens. Most of the answers to Nigeria’s healthcare challenges are in the hands of the policy makers. What they do matters a lot.

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