Health Sector: After PATHS What Next?By Segun Imohiosen
In the last six years or thereabout, precisely in September 2002, Partnership For Transforming Health Systems, PATHS, has been in the forefront of public health education and support systems with special interest on safe motherhood, reduction in child’s death and drug to the nation with a strong presence in the communities, more like the avant-garde to the grass root in some states of Nigeria. Precisely Jigawa, Benue, Kano, Kaduna, Enugu, Ekiti states and the Federal Capital Territory (FCT) respectively.
The focus is avidly directed to a goal of improving the health status of the poor in Nigeria, measured in terms of progress towards the Millennium Development Goals (MDG). The thrust of the programme subsumes the improvement of the delivery and use of effective, replicable, pro-poor health services for the management of priority health conditions. To this end, the programme has operated four outputs to be able to realise the goals: strengthened government stewardship in health policy, planning and financing, improved systems for effective management of health services in both public and non-state sectors, better quality preventive and curative services for common health problems established and made more accessible to the poor and better informed consumers on their entitlement to good quality and affordable health care and better able to prevent and manage priority health problems.
The concern as it were is to facilitate and encourage the reduction if not cut in totality maternal mortality rate that up to the time it made her entrant to the country has been on the rise. There is no doubt PATHS has successfully carried out its activities with utmost professionalism and total involvement by virtue of the diverse models employed in reaching out to the people. The programme is delivered through a consortium of five other partners, Life Sciences Partnership (HLSP) which is the lead Agency. While the other partners are Health Partner International (HPI), John Hopkins University, Centre for Communications Programmes (JHUCCP), Liverpool Associates in Tropical Health (LATH) and GRID Consulting Limited.
As PATHS formally brought her activities to a close on Tuesday, 10 June, 2008, it was a moment of testimonies and encomiums on the successes recorded by the programme, the (DFID)-funded £55 million health systems support programme. It closed out with a formal ceremony that featured awards to high performing stakeholder organizations.
However, in the course of the ceremony, the fake drug matter was brought to the fore by NAFDAC which is the regulatory agency that has had to work very closely with PATHS. Congruously, NAFDAC got an award at the end of programme ceremony. It should be noted that fake and unregistered drugs have remained one of the evil against humanity through terminal disease and early death. There is no doubt that in no distance past the country witnessed highest incidence of fake and counterfeit drugs that were not only sold in pharmacies but also hawked in commercial buses and in unhygienic environments.
The drug distribution system in the country was also so chaotic with drug barons calling the shot and destroying the lives of innocent citizens. It was a period when the market was flooded with toothpastes without fluoride; packaged water from the well, non-iodized salt, expired processed foods, confectionaries preserved with toxic chemicals; bread baked with potassium bromate and cosmetics laden with harmful chemicals. It was at that stage of confusion that one of the regulatory bodies on human health and safety was reorganized and restructured.
The good news is that the menace is being controlled through aggressive campaigns and effective monitoring of the products in the country through the regulatory health institution, the National Agency for Food and Drug Administration and Control (NAFDAC) with support from other stakeholders and development partners.
One of such partners, Partnership for Transforming Health Systems (PATHS), the DFID-funded health systems support programme formally closed out its programme in Nigeria after some years. At the closing ceremony which was emotional testimonial session, the successes of PATHS in Nigeria were highlighted.
The PATHS has contributed positively in the campaign against fake drugs through public enlightenment campaigns and provision of free medication. It was testimonies galore at the date for closing ceremony recently.
In her testimony, NAFDAC Director-General, Prof. Dora Akunyili, said that PATHS was instrumental to the reduction of fake, counterfeit and unregistered drugs in Nigeria acknowledged PATHS’ role in its successes as a food and drug regulatory agency. She added that the success with fake drugs dates from 2003 when PATHS began exploratory discussions with NAFDAC on how to improve its capacity for regulating the food and drug industry. The report of the scoping mission also formed the basis of the DFID/WHO sponsored baseline survey of the incidence of fake and counterfeit medicines in circulation in Nigeria in 2004. It was followed with an all-out campaign to rid Nigeria of the menace of fake, counterfeit, substandard and unregistered drugs.
Represented by a director in the NAFDAC, Prof. Akunyili also disclosed that a survey report of the campaign against unwholesome drugs in 2006 showed a substantial reduction of the menace. Fake drugs had dropped from about 41 per cent to 16.7 per cent, while unregistered drugs reduced to 19 per cent from 68 per cent in 2001.
Due to collaboration with PATHS some states in the country have developed an effective Health Management Information System (HMIS), which has impacted on planning, resource allocation and general health delivery. PATHS has succeeded in facilitating capacity building in various states’ ministries of health which further help motivate HMIS workers. One of their most successful programmes is the Deferral and Exemption (D&E) initiative in the health system, where rural dwellers and poor people have benefited from the safety net through health services and drugs free of charge and occasionally on credit.
Interestingly, the programme has been able to put its feet on the path of renown in public health in Nigeria by virtue of the consistent and concerted effort exhibited in carrying out its activities playing active role by supporting the government through health sector reform which has been the driving thrust for support towards government stewardship role at the federal and national level. Support to the Federal Ministry of Health in the development of its National Health Policy, HSR Programme document, Public/Private Partnership Policy, Health Promotion Policy, Reproductive Health Behaviour Change Communication Strategy and Health Sector Reform Advocacy Kit are some of the highlights at this level. Others are the Human Resources for Health Financing Policies and a National Integrated Maternal Newborn and Child Health Strategy. There are other things done by the programme in the public health matter like IMPACT which is the Improved Management through Participatory Appraisal and Continuous Transformation, it’s a methodology in peer performance appraisal.
Professor Eyitayo Lambo, Dr. Shehu Sule of the Federal Ministry of Health, dignitaries, stakeholders and other international consultants from the UK and the US graced the occasion and attested to the success recorded so far in the programme as being part of it and its activities over the years. It was a moment of high commendation for Caroline Vanderick, the Programme Manager and Martha Ossei the National Communication Adviser of PATHS. There were other beneficiaries at the programme who got one award or the other such as Kaduna State, where PATHS started working two years ago, won an award for being the State Most Committed To Counterpart Funding Releases and got N70 million to boot. Some of the other awards were: Highest facility utilization-Ekiti State, best Public-Private Partnership in Emergency Obstetric Care -Enugu State, Safe Motherhood Initiative-Jigawa State, Sustainable Drug Supply System-Ekiti State, Most Transforming Institutional Reform-Jigawa State (Gunduma Health Systems) and Enugu State (District Health System)
The Federal Ministry of Health was also recognized. It won an award for The Most Used Model Beyond PATHS.
The truth of the matter in all of this is the success recorded so far by this programme in all of the places where they have worked. PATHS at this point could be referred to as a project successfully completed in Nigeria. However, with regards to the success recorded by PATHS partnership in the health sector, what next?
Segun Imohiosen National Press Centre, Abuja |