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HEALTH INTERACTIVE WITH DR AMINU MAGASHI
The Need to Reform Nigeria’s Health Sector (Part Two)
It took me a while to write the concluding part of this discourse, more or less because it needed to be realistic in its approach towards ensuring effective and efficient reform processes across the country. I was in Nigeria for Three weeks (March 29th – April 19th 2007) and held discussions with many stakeholders in the health sector and also reviewed documents that explain the process of reform currently taken place in Nigeria . In the part one of this discourse, I had argued that Nigeria’s Health Sector is not meeting even the most basic needs of the populace. It has caused the emigration of many health workers to greener posture and also our leaders at the slightest health provocation desert the shores of Nigeria to seek for care abroad . That, alone serves as an indicator of the sorry nature of our health systems. The Primary Health Care in many states has collapse and Nigeria has one of the worst Under-Five and Maternal Mortality Ratios. Over 50,000 Nigerian women die from child birth every year (equivalent to a plane carrying 140 people crashing every single day) and one in five Nigerian children will die before reaching 5th birthday and only 18% of Nigerian children are fully immunized by their first birthday.
In reviewing and understanding the reform processes better, I visited the secretariat of Health Reform Foundation of Nigeria ( HERFON ) based in Abuja on Thursday , 5th April and held a very useful discussion with its Executive Secretary , Dr Ibrahim Y. Oloriegbe . HERFON as an NGO is providing technical support and advocacy at the federal level toward Health Sector Reform. At the moment, there is a National Health Bill before the National House of Assembly. It is a fusion of a private bill sent earlier and another bill packaged by the Federal Ministry of Health. It has passed first and second reading at the Senate and one can only hope it get to be pass in to law before the MPs pack their baggages on May 29th to avoid another fresh work on it with the in-coming MPs .
In summary, the 55 paged bill aims to establish for the Federation , the National Health System, which shall define and provide a framework for standards and regulation of health services, and which shall
In another development , a Nigerian National Health Conference was convened by HERFON in collaboration with many local and international stakeholders in November 2006 and recommended the implementation of the universally agreed budget allocation of not less than 15% of the total annual budget to health by all levels of government in Nigeria . Take measures to drastically reduce the current very high and unacceptable deaths of women and children due to poor health care services and irrevocably strengthen Nigeria’s current Health Sector Reforms . It is very unfortunate to observe that in many states of the federation, budget to health sector is continuously below 5 %. Other consultation was the meeting I convened of Health NGOs under the auspices of Community Health and Research Initiative in Kano on Tuesday, 10th April. In that meeting, there were many health and social workers , the diversity in the group helped us to understand weaknesses and challenges for health workers unions and civil societies that are also hampering in the reform process. We observed that the networking to advocate for reform among Health NGOs is weak due to suspicion , unnecessary rivalry ,lack of transparency and accountability and majority of our activities are ‘donor agencies’ driven and not making much relevance in policy formulations , implementation and budget monitoring .
Having said all that , we expect the National Assembly before their time expires to pass the Health Care Bill in to law , however that is only half of the struggle . The main task for all genuine advocates, is to ensure its implementation across the three tiers of government. Change agents should be identified all over the federation and be supported with training and flat form to advocate effectively. It is imperative for all of us to know that it will be a Herculean task to create change agents no matter the amount of funding at our disposal .
Another programme that will help to redeem our health seeking attitude and also improve the system is the National Health Insurance Scheme ( NHIS ) which should provides the opportunity for government to redirect its expenditure within the health sector to better finance programmes that are “public goods” as well as provide coverage and access for the underprivileged and those at risks. It should be both implemented at formal and non formal sector. The NHIS should be a mechanism that will be implemented not only at the federal level , but also States and LGAs . Regrettably over the last eight years, the scheme has very minimal success to record and this could not be unconnected with un-seriousness and lack of focus of the successive three Minsters of Health from 1999 to Date . A programme of this nature can not succeed, unless it is being aggressively pursue and strategically packaged .
The Nigerian Medical Association and other health professional unions should see themselves as key stakeholders in the reform process and work to ensure good governance and accountability in the system . However, that can only happen, when their organisational and administrative structure is strengthened and also appraise the problems being faced by the sector and have a strategic plan of action . The struggle should go beyond going for strike anytime their wages are threatened, but by ensuring that the system is overhauled and working well . That way everybody will be on their side when ever there is agitation over salary issues.
The unions in all the 36 states and their national secretariats should reach out to many media houses and establish genuine friendship with publishers, directors and editors, that way , they can influence editorial policies and ensure good coverage of health crises in Nigeria . They should also establish good relationship with Civil Societies and International Development Partners to ensure effective advocacy to policy makers for a better health care delivery system. The unions must endeavour to continuously be insisting to have a representation in committees and programmes created by Federal and State Governments. They should also in collaboration with civil societies learn to be sending petitions, condemn bad governance in Health Sector and drag any non – performing Minister of Health , State Health Commissioners and Heads of Parastatals who abuse their offices and mandate to court , ICPC and EFCC .
The reader will agree with me that most of the activities mentioned above do not require huge financial resources , but a sincere will and fierce determination to make a difference . Other sectors like Power , Water Resources and Education have to also be improved to support health sector reform . The struggle is a life time one and all of us anywhere we are should begin to form alliances and regrouping for the struggle to ensure quality, efficient, effective , sustained and equitable health system across the country . Health is our fundamental human right , but we can only get it , if we demand for it .
Dr Magashi is a Masters Student ( Public Health ) at London School of Hygiene and Tropical Medicine . He can be reached at healthinteractive@hotmail.com or gamagashi@gmail.com
Future article: I am working on “Cost Analysis; Seeking Health Care Abroad”, it will be poste
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