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The appointment of two new ministers for Nigeria’s health ministry marks the beginning of another chapter which Nigerians will be eager to monitor closely.

The two ministers President Muhammadu Buhari named on Wednesday to run the affairs of the health ministry for the next four years are not new to the sector.

Osagie Ehanire served as minister of state in the same ministry in the preceding federal cabinet while Olorunnimbe Mamora, the new minister for state, is a medical professional and a former lawmaker.

The task of a minister of health is a difficult one in Nigeria due to the myriad of challenges bedevilling the sector.

The ministry is one of the most complex in Nigeria, with over 100 parastatals. Every tertiary health institution has its own board and management.

But experts believe Mr Ehanire understands the system, the challenges and bottlenecks – having worked closely with his predecessor, Isaac Adewole, the immediate past minister.

Shortly after their inauguration on Wednesday, the new ministers reported at the Federal Ministry of Health office in Abuja where they gave a hint on their plans for the health sector.

Addressing journalists, Mr Ehanire promised to overhaul the secondary and tertiary health institutions in the country in order to reduce medical tourism.

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“We need to expand the health coverage, particularly the primary healthcare centres to achieve universal health coverage. We want to improve healthcare, especially hospitals and also improve health security in the country,” he said.

While observers are expecting Mr Ehanire to continue with the agenda he pursued with his predecessor, Mr Adewole – which is the revitalisation of facilities in the sector in the last four years – they also pointed out other areas that need urgent attention.

Here are five priorities experts interviewed by PREMIUM TIMES urged the new ministers to immediately address:

Primary Health Care policies

The disease burden will drop drastically if the challenges affecting primary healthcare are addressed properly, said Mohammed Dogo, a former Executive Secretary of the National Health Insurance Scheme (NHIS).

Nigeria’s primary healthcare centres (PHCs) barely function despite billions allotted to them over the years, especially due to mismanagement.

Several attempts to address these challenges did not produce a commensurate result.

In January 2017, President Buhari flagged-off a scheme to revitalise about 10,000 PHCs across the country. But more than a year after the plan was kicked off, PREMIUM TIMES’ investigation found that very little work had been done.

Mr Dogo said there are enough policies to transform the system if properly implemented.

According to researchers, 80 per cent of deaths in rural communities across Nigeria are due to poor implementation of Primary Healthcare policies.

“The problem is with implementation,” said Mr Dogo while urging the new minister to review the several laws, policies and programmes on PHC intervention and chart a clear road map for implementation.

Mandatory health insurance

PREMIUM TIMES last week quoted the new executive secretary of NHIS, Mohammed Sambo, as saying that Nigeria cannot achieve Universal Health Coverage if health insurance remains optional.

Millions of Nigerians continue to face health challenges because they cannot afford quality care. Health insurance has largely been ineffective in the country.

Despite billions spent on the NHIS since 2005 when it took off, millions of Nigerians still lack access to quality healthcare.

About 70 per cent of Nigerians pay out-of-pocket for healthcare while the few enrolled into the scheme complain of inadequate service delivery.

Several players in the health sector have been calling for an amendment of the NHIS Act to make the scheme compulsory for all.

A bill to repeal and replace the NHIS Act was passed by the 8th National Assembly in April and forwarded to President Muhammadu Buhari but he has neither signed it nor declined assent.

The bill when made law would make NHIS compulsory. Stakeholder advised the new minister to assembly an advocacy team to urge President Buhari to sign the bill into law.

This newspaper reported how Rwanda was able to achieve 90 per cent coverage through a compulsory health scheme.

Health insurance became mandatory for all individuals in 2008; in 2010 over 90 per cent of the Rwanda population was covered. In 2012, only about four per cent was uninsured.

Basic Health Provision Fund

The new minister should keep his predecessor’s radical implementation plan for the Basic Health Care Provision Fund (BHCPF) across states.

The BHCPF is one per cent of the federal government Consolidated Revenue and contributions from donor grants set aside to fund the basic health needs of Nigerians. It was approved by the National Assembly in 2018.

The BHCPF is meant for providing adequate care and services at the PHC level, mostly for the vulnerable population so as to reduce out-of-pocket expenses.

The National Health Act created three gateways for the disbursement of the fund.

The NHIS is supposed to receive 50 per cent while the National Primary Health Care Development Agency (NPHCDA) gets 45 per cent. The remaining 5 per cent was meant for outbreaks and emergency responses.

“Money will flow from the CBN to NHIS to NPHCDA to NCDC (Nigerian Centre for Disease Control) down to the PHCs,” Mr Adewole, the former health minister had said in an interview with this medium last year.

To access the fund, states must establish their State Health Insurance Schemes (SHIS) among other criteria. While 14 states are yet to comply, 22 including four pilot states, have met the requirements.

Experts said the focus must remain on not just supporting states to meet requirements, but to provide basic amenities and manpower in health facilities receiving the funds.

“The health ministry should first of all ensure that PHCs are in order before disbursement”, said Chika Offor of the Vaccine Network for disease control.

She said there should also be transparent mechanism for disbursement to avoid mismanagement.

End rivalry among health workers

Obioma Obikezie, a health consultant said paying attention to the inter-professional rivalry in the public health sector should be among first steps by the new health minister.

JOHESU, a body of health workers apart from doctors, has been on a warpath with the Nigerian Medical Association (NMA) over the years especially because doctors oppose most of their welfare demands.

Mr Obikezie said the situation has compromised public sector productivity and “robbed our health care consumers of the basic service they seek from our public clinics and hospitals.”

In Wednesday’s maiden press briefing, Mr Mamora, the minister of state, said ending “undue” internal rivalry among health workers and finding solutions to demands and welfare of health professionals which has resulted in strike actions are among major plans of the new team.

End ‘Brain Drain’

A 2017 poll by the Nigerian Polling Organisation (NOI) found that over 90 per cent of medical doctors in the country intend to seek employment opportunities abroad because of low job satisfaction, poor remuneration and high deductibles from their salaries.

A few weeks ago, NMA cited worsening insecurity in Nigeria as one of the reasons for mass exodus of doctors.

“When we list factors causing ‘brain drain’, we are not just talking about facility and remuneration. Some are leaving because they feel very insecure,” said Ekpe Phillips, the NMA chairman Abuja Branch.

He said it is worrisome how doctors are being kidnapped regularly in the line of their duty.

The new minister is advised to work closely with government and security operatives to ensure safety of health workers.

Oluwaseun Ayotola, a general practitioner, said there was a need for the minister to address the issue of medical brain drain by creating incentives for health workers to stay.

He also urged the minister to employ more health workers, saying that the numbers of doctors, nurses and laboratory scientists are insufficient to cater for the nation’s vast population.

Mr Ayotola urged the minister to evolve initiatives, policies and ensure investment in infrastructure and equipment toward discouraging medical tourism.

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