By Abdulsalam Baba Mahmud


President Muhammadu Buhari

It can’t be for frivolity that the Chairman, House Committee on Health Services, Honourable Chike Okafor, recently, at the National Assembly, expressed dismay and cynicism over the allocation of 304 billion naira to the health sector in the 2017 budget. Expressing his displeasure, Mr. Okafor said that the funds allocated to the health ministry would not in any way address the all-important needs in the sector.

The lawmaker who spoke at a meeting of lawmakers, health workers, and representatives of donor agencies, where they cross-fertilized ideas on how to ensure the speedy revitalization and repositioning of primary healthcare centres across Nigeria, described the Federal Government’s revitalization programme of about 1, 000 primary healthcare centres as one of the fundamental and critical needs in the sector.

It can’t be misconstrued as grandstanding that the NASS has resolved to jerk up the N51 billion (capital expenditure) budgeted for the health sector in the 2017 Appropriation Bill to N100 billion. According to a source, the move by the lawmakers is to ensure that funds are made available to efficiently revitalize 10,000 primary health care centres across the country.

Again, the committee Chairman on Health Care Services, Chike John Okafor‎, during a stakeholders’ meeting of Primary Health Centres Revitalization Support Groups, maintained that Nigeria risks running into serious health challenges in 2017 if nothing was done to upwardly review the budgetary allocation to the sector.

Identifying rural women and children as those that will be terribly affected, Hon. Okafor said: “the current provisions for the revitalization of primary health centres is not commensurate with the current challenges. The budget proposal provides N3 billion for revitalizing 1,000 primary healthcare centres in 2017, while the Federal Government plans to collaborate with states and local government areas to revitalize and make functional 10,000 centres nationwide by 2019.

“However, it is not clear how an average of N3 million would make a healthcare centre functional with the current widespread disrepair of infrastructure across the country. The amount allocated grossly understates the need in the country to achieve better health outcomes at the primary level.”

Okafor, who represents Ehime Mbano/Obowo/Ihitte Uboma Federal Constituency of Imo State, concluded that the major problem in the health sector was funding and that if the public health centres were revitalized, the pressure would reduce on the tertiary health centres, adding that the country requires about N100 billion to ensure that healthcare centres were in good standing.

It was definitely not a futile venture organizing a ‘Retreat on the Significance of Health for Development’ at the Pan African Parliament, for members of the health and appropriation committees of the Nigerian Senate and House of Representatives, in Midrand, South Africa, last November. Before hosting the retreat, the lawmakers took into cognizance the relationship between healthcare and economic development as well as the role of human capital in achieving developmental goals, especially in emerging democracies of Africa andwere concerned that the modest economic progress made by African countries has been impeded by the prevalence of HIV/AIDS, tuberculosis, malaria and maternal deaths, among others. These are further worsened by natural disasters, rise in insurgency and political unrest.

They were further worried by the failure of many African countries to meet up with the minimum requirement of allocating 15% of total annual budget to health as outlined in the Abuja Declaration of 2001, which has resulted in a marked health statistics underperformance across the continent and were committed to improving public health by increasing access to good quality, safe and effective medicines. They were further Interested in achieving the health-related targets of the Sustainable Development Goals (SDGs) and above all, cognizant of the need to strengthen the effectiveness of health budgeting and spending in Nigeria.

Senate President Saraki

Senate President Bukola Saraki

Following the presentations made by critical stakeholders and opinion experts at the retreat, the lawmakers observed the followings: (1) The poor state of health sector in Nigeria is attributable to policy inconsistencies, inadequate funding and insufficient health statistics which hamper effective planning. (2) Legislations are essential to support health policy outcomes. (3) Effective funding and legislative oversight of the health sector are essential to the transformation of Nigeria’s health sector. In this regard, legislators and legislative committees have a role of monitoring national budget performances and ensuring that budgets address key health issues. (4) Budget scrutiny by parliaments is essential for both equitable and efficient use of scarce resources. (5) Effective engagement with the private sector is essential to meeting health targets and ensuring national development. (6) An enabling regulatory environment is important for the greater and beneficial private sector engagement to deliver quality, safe and efficacious medical products and technologies to the African communities, and (7) Regional and global partnership is critical to harmonizing medical products regulation.

Little wonder, in a communiqué after the retreat, the legislators resolved that: That there shall be increased appropriation by the National Assembly to the health sector in 2017, in line with the Abuja Declaration of 2001 which recommends that a minimum of 15% of the total annual budget be dedicated to health; that the National Assembly will ensure that the provision of the National Health Act, 2014, which stipulates that 1% of the consolidated revenue fund be dedicated to the health sector is adhered to in the 2017 budget; that the National Assembly will improve its oversight of the health sector and health expenditure spending, and ensure judicious management of resources allocated to health, particularly given the decline in oil revenues; that greater political will is needed to accelerate resource allocation to health, and ensure that the sector is among the top five priority areas in the national budget; that government must provide an enabling regulatory environment as well as a model for public private partnership to ensure the delivery of quality, safe and efficacious medical products and technologies; and that the National Assembly will initiate a legislation to make NHIS mandatory to all Nigeria, which ensures that all Nigerians are able to access with ease, at least primary health care facilities.


Minister of Health Prof Isaac Folorunso Adewole

Others are: That the National Assembly will support government’s proposal to build 10,000 primary health care centres across the country in the 2017 budget; that there should be an increased funding for all professional and regulatory agencies and councils; that greater coordination of health intervention efforts is essential to ensuring accountability, and guarantees that health funding reaches the intended beneficiaries; that Nigeria should encourage the harmonization of drug regulations across the ECOWAS sub-region, and, subsequently, the continent as a whole; and that the National Assembly will ensure the domestication of the NEPAD and Africa’s Health Policy-AMRH and Model Law in Nigeria.

Beyond dispute, it is actually not injudicious that the Pharmaceutical Society of Nigeria (PSN) also decried the allocation for healthcare in the 2017 budget. In a statement, President of PSN, Pharm. Ahmed Yakasai, who maintained that the N81.3bn naira in the proposed budget compared to 2016 was not enough, added that the proposed spending in the health sector was a far cry to the recommendation by the World Health Organization (WHO).According to World Health Organisation and African Heads of States, during the Abuja declaration, 15% of the total expenditure of a state should be spent on healthcare, because of the importance of good health to a nation’s well-being, productivity and life expectancy. The 4.15% budgeted for healthcare in 2017 even though higher than the 3.65% of 2016, is still less than one third of what is expected by any country according to WHO.

The PSN Boss stressed that the implementation of the National Health Act by the Federal Government would go a long way to cushion the effect of 4.15% budgeted for healthcare in 2017 and help to truly safeguard the health of Nigerians.

Similarly, it wasn’t a hyperbole or political gimmick when President Muhammadu Buhari, at a public function recently, said: ”the provision of quality healthcare service will reverse the poor health indices in the country. I am hopeful that our women will no more be dying needlessly during childbirth; our children will no more be dying needlessly as a result of vaccine preventable diseases or common ailment; access to healthcare will not be limited because of lack of money to pay.”

To cap it, it couldn’t have come at a better time that the stakeholders’ retreat on immunization, health financing and the National Health Act, urged the Federal Government to allocate six per cent of this year’s budget and 7.5 per cent of the 2018 Budget to the health sector, with a view to attaining 15 per cent by 2026.At a one-day legislative retreat held in Uyo, Anambra State, they recommended that the House of Representatives should collaborate with the Senate to allocate adequate funds for immunization, family planning, nutrition, maternal and new-born child health services in 2017.

Meanwhile, it was not knocks all the way for the government, with regard to the 2017 health budget. The Country Representative of World Health Organisation (WHO), Dr. Wondimagegnehu Aemu, and the Deputy Director of Family Health Department at the Ministry of Health, Dr. Ovuoraye John, recently commended the revitalization programme, noting that it would tremendously address the challenges of manpower and equipment faced by the centres.Also, two Non-governmental Organisations (NGOs), Connected Development (CODE) and ONE Campaign, praised the FG for increasing funding for the healthcare sector in 2017.Mr. Hamzat Lawal, the chief executive officer of CODE, said that the increase was necessary, as it would help tackle the crisis facing the health sector and ensure economic development.“The 2017 budget presentation brings hope for citizens – mostly people in rural communities. Public healthcare investments remain a key ingredient of development, poverty reduction and human capital development. We also pledge to support the government by working with the community to ensure that this money is actually spent well and transparently”, he added.

On his part, Mr. Edwin Ikhuoria, of ONE Campaign, who said the increase depicts progress and should be welcomed, added that emphasis should be placed on citizens in the rural communities that are bedeviled with serious health challenges in the face of the current economic crisis. He said: ”Putting more money into Nigeria’s healthcare will not only boost the economy but will change people’s lives, particularly the poor, who are living in dire circumstances especially during this recession. ONE applauds the budget increase in capital health projects as a step in the right direction – by emphasizing on primary healthcare and fighting malnutrition.”

It would recalled that Nigerians, at a town hall meeting with Senator Bukola Saraki, on December 1, 2016, organized by ONE Campaign and CODE, had asked for government to take more measures to increase transparency in the health sector, the implementation of the Health Act and the development of the primary healthcare system, especially in rural communities where there is low or no access to healthcare facilities and provisions.

In another vein, the incessant strikes by doctors and health workers, medical tourism, low budgetary allocations, brain drain, poor research culture, and a host of other issues, according to experts, are also serving as major drawbacks for Nigeria’s healthcare sector.

A clinical psychologist with Gray Havens Medical Centre, Port Harcourt, Dr. Alphonsus Kalu, believed not a few Nigerians have died because they were unable to access treatments due to strike actions by either medical doctors or other health workers, adding that for every strike action in hospitals, patients, whose tax payers money are used in running healthcare suffer the most, and in most cases this has resulted in deaths or irreversible health damages. A report indicated that in 2016 alone, resident doctors of 25 teaching hospitals across the country went on strike to press home their demands. Similarly, the Joint Health Sector Unions (JOHESU) embarked on a nationwide industrial action to also press home their demands, and other associations as well went on strike at one point or the other.

Brain drain, no doubt is another drawback, judging from the prevailing glaring realities. Of the over 80, 000 Nigerian medical doctors registered with the Medical and Dental Council, available information suggests that no more than 21, 000 are currently working in the country due to the quest for better working environment and greener pastures. Lamenting the situation, a medical doctor, Adebayo Tunde-Vincent, said that Nigeria may not boast of 10, 000 (doctors) in the next 10 years with the level of doctors’ exodus out of the country due to ”poor remuneration and conditions of service”, adding that Nigeria presently has less than 21, 000 doctors practising in the country, while over 22, 000 were currently practicing in the United Kingdom and several thousands in the United States.

Tunde-Vincent noted that if the country wanted the best out of its doctors and other health workers, remuneration and other conditions of service must be upgraded, considering the importance of their responsibilities.

According to WHO, for a country to optimally provide for its citizens, there must be at least one medical doctor to six patients. For Nigeria to achieve this, experts say the country needs at least 280, 000 professional medical doctors, as against the less than 30, 000 currently practising.

Furthermore, discouraging medical tourism might just be another way to address the healthcare debacle in Nigeria. This is in the wake of this shocking revelation: India’s medical association’s annual reports for 2014 show that in 2012 alone, 18, 000 Nigerians obtained medical visa, and about 47 per cent of outbound medical tourism from the country goes to India, totaling about $260 million.

Also, a former director of Planning, Research and Statistics, Federal Ministry of Health, Dr. Ngozi Azodoh, disclosed that public officials who travelled abroad for medical care in 2014 alone expended N198.95 billion ($1 billion) of tax payers’ money. However, experts have argued that if such moneys were expended and re-invested into the country’s healthcare system, it would go a long way to shaping the system remarkably.

There is also the malady of poor research culture. A professor of virology, University of Massachusetts, Prof. Kelvin Dimeji, wants Nigeria to up its game in medical research development, as this would help in providing better and accurate information in tackling some diseases affecting the citizens and Africa.  ”Malaria and some other health burdens are part of the challenges we must solve through research and developments. A lot of Nigerians are dying from diseases that, if adequately funded, vaccines may be available for”, he said.

In a lecture at the 1st Annual Primary Health Care Lecture, organized by the National Primary Health Care Development Agency (NPHCDA) on December 8, 2015, with the theme, ‘Primary Health Care: Realities, Challenges and The Way Forward’, Professor Eyitayo Lambo said that given the high burden of infectious diseases and the related morbidity and mortality in Nigeria and the fact that about 70% of the population live in rural areas, making PHC the cornerstone of our national health system a step in the right direction.

The former Minister of Health implored President Muhammadu Buhari to aggressively explore with relevant organs of government, some innovative ways of financing health services, especially primary health care, adding that development partners should help provide more medium-to long-term support to health, especially primary health care, through ‘basket funding’.”I urge the National Primary Health Care Development Agency to support the creation of a PHC sub-account of the National Health Account, and use that as part of the basis for the development and implementation of a comprehensive policy on PHC financing in Nigeria. It is germane and patriotic that civil society and the media lead the health-advocacy vanguard, as well as the anti-corruption and abuse-of-office crusade vigorously and sustainably, even as the Federal Ministry of Health should expedite action in reviewing and articulating the national policies on health financing and developing/implementing the corresponding strategic plans”, he added.

It is a public knowledge that a strong and effective PHC will be crucial to our journeys towards universal health coverage, attainment of set-targets of the Sustainable Development Goals, especially the third goal, and consequently make our people healthy, so that they can be well-positioned to drive the engine of economic growth. All concerned stakeholders, therefore must act without further ado.

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