Health Interactive with Dr Aminu Magashi

Health Interactive with Dr Aminu Magashi

World Bank and health related MDGs

On Monday , 13th December , 2004 , stakeholders from both Government and Civil Societies, had a consultative meeting with the officials of World Bank at Shagalinku Hotel in Kebbi State, over the new World Bank Project for partnership with the Government of Nigeria. The Project titled 'Country Assistance Strategy, ( CAS ) is billed to stretch from 2005 to 2007 .The meeting involved 9 states of Northern Nigeria (Kebbi , Sokoto, Zamfara, Kano , Kaduna , Nasarawa , Niger , Jigawa and Katsina). In attendance were the executive governors of Jigawa and Kebbi states, in persons of Alh Saminu Turaki and Alh Adamu Aliero respectively, whereas others were represented by their Secretaries of state Government, and Commissioners. 14 representatives of civil societies were in attendance, this writer was present at that august gathering.

The consultation meeting was obviously an attempt by World Bank to shift from its hitherto arrogant approach of dishing out prescriptions to member nations, without involving stakeholders and consultations before an intervention is carried out. These sentiments and feelings were repeatedly mentioned and shared by many stakeholders, especially from the government during the opening ceremony. Issues highlighted were the need for the World Bank to carry states along in designing and implementation of its programmes, and projects should be result oriented, with the hope that the meeting would not be a mere talk shop and paper work, and lastly World Bank was encouraged to help and assist in shaping the thinking of Nigerians towards sustainable development .

The Country Assistance Strategy (CAS) is the World Bank business plan and document for assistance in Nigeria , and it is going to utilize the Millennium Development Goals (MDGs) as indicators, and this is being designed in partnership with Governments at various levels, Department for International Development (DFID), UK and in consultation with a wide range of stakeholders. The purpose of Nigeria’s CAS is to achieve development results by supporting Nigeria’s sustainable economic growth program (such as NEEDS), assisting Nigeria to attaining of the MDGs, which came into existence as a result of the Millennium declaration of 2000, signed by 189 countries including Nigeria, and they are accepted as a frame work for measuring development progress .The principles for development assistance in Nigeria’s CAS will be focus on results, leverage on comparative advantage and selectivity. The three selective result packages of the CAS would be to improve basic services for human development, improve environment and services for non oil growth, and enhancing transparency, accountability and participation for better governance. On the result packages , my concern today will be centred on improved basic services which focus on efficient service delivery for human development in selected states , e.g. Health, improved access to HIV/AIDS prevention , care and treatment , focus on children and improved data , analysis and bench marking, to enhance social impact (demand and supply).

While I commend the World Bank for taking time off to organise a consultation meeting for its new project, CAS, I sincerely hope it was not a waste of time, and the Bank will incorporate if not all, some of the recommendations provided by stakeholders. In this way Nigerian’s will put in their best for its implementation. To begin with , one of the cardinal principles of CAS is to assist Nigeria in achieving Millennium Development goals ( MDGs). Attainment of such goals will be a Herculean task, looking at past experiences of so many goals which even before reaching the target, became mere slogans. Amongst them are , Health For All By The Year 2000, Housing For All ,Vision 2010 , Capé Town Declaration On Measles And Roll Back Malaria .There are three directly health related MDGs, MDGs 4, 5 and 6, that focus on Reducing Child Mortality, Improve Maternal Health and Combat HIV/AIDS, Malaria and other diseases, respectively. MDG 4 is aiming at reducing the child mortality by about 66 %, and MDG 5 is looking at reducing maternal mortality rate by 75 %, and MDG 6 is looking at combating HIV/AIDS, and reducing its prevalence among youths by 25 %, and halting the effect of malaria and other diseases. All these are expected to happen by the year 2015. Looking at these ambitious goals , one will feel sorry for Africa and Nigeria in particular, because many of the African states lack the wherewithal and coherent plan to implement such, rather they are pitiably waiting for institutions like World Bank , DFID, and other development partners to come to their rescue.

The CAS document has among its components, Children, it is hoped that business as usual should not be adhered to , which is typical of what development partners and their government collaborators are currently doing, a window dressing approach to the plight of Nigerian children. The problems of children need to be looked upon from the angle of what are the factors causing the high infant and under five mortality rates, which are among the highest in the world. Understanding the problem will ensure developing programmes that will ensure the reduction of the mortality rates. Addressing one particular disease while abandoning others will never be the solution to curtail the problems, the approach should be integrated in such a way that one programme supports another one towards achieving the goal 4.
On the issue of goal 5 which attempts to reduce the maternal mortality rate by 75 %, it is very disheartening to know that in some states , the rate has reached up to 2000 per 100,000 life births. Women die every day due to preventable complications of pregnancy, labour and puerperum. The maternal health sector is in terrible shambles, and is in dire need of support to capacity building and training of staff to manage such places, facilities for emergency obstetric services, and a wide range of awareness creation, towards the importance of antenatal care. I believe if the World Bank is serious about Safe Motherhood, CAS should be able to support states and LGAs towards improving the maternal health sector.

World Bank as we all know is a partner of Roll Back Malaria project, that was launched in Nigeria in April 2000. Unfortunately halving the malaria burden by 2010 in Nigeria, has remained a mirage and a fantasy, and the reason is not far fetched, Government of the day and its Roll Back Malaria partners (WHO, UNICEF, World Bank, UNDP and DFID) are more interested in selective approach of marketing and distributing Insecticide Treated Mosquito Nets, though not free of charge to the populace. As I mentioned many times on these pages, 5 years into the intervention, we are not even closer to the reduction by 25%. If the World Bank is serious about CAS, the financial institutions should provide credit and grants to states towards environmental sustainability, amongst others, like providing good drainage system and clearing of contaminated gutters and refuse dumps, and good town planning. That way, Nigeria and Africa can celebrate achieving Roll Back Malaria and MDG 6. Lastly on HIV/AIDS the approach should be supporting states to be involved in the Anti Retro Viral Drugs Programme to ensure reduction of HIV prevalence among youths by 25 %. One area which the CAS document has omitted, is focusing on Youths which are the most vulnerable groups to contract HIV/AIDS. There is the need for programmes tailored towards reduction of youth unemployment rate and redundancy. Overall, I hope at the end of the day, the consultation would not be a mere talk shop, but a forum that will achieve its desired aim of consultation and partnership towards implementing CAS.

Dr Magashi is the Executive Director , Community Health and Research Initiative , Kano , Nigeria and can be reached at healthinteractive@hotmail.com