President Muhammadu Buhari recently launches three intervention programmes in the health sector; all geared towards improving health indices across the country
By Kazeem Akintunde
It was three programmes rolled into one. The Launch of the National Strategic Health Development Plan ll, (NSHDP) 2018 -2022; the roll out of the Implementation of the Basic Health Care Provision Fund, BHCPF, as well as the disbursement of funds to states under the Saving One Million Lives, SOML. These are three separate programme that could stand alone.
But Professor Isaac Folorunso Adewole, the man at the helm of affairs in the health sector in the country believes in killing three birds with one stone, and he pulls it off brilliantly.
Dateline was January 8, 2019 and the venue was the Banquet hall, Presidential villa, Abuja. Indeed, the mood inside the villa that morning was convivial as guests; both local and foreign took their seat as early as 9am awaiting the arrival of President Muhammadu Buhari.
Though he was represented by the Minister of Budget and National Planning, Senator Udoma Udo Udoma, seven state Governors and six deputy Governors were on hand to be part of the epoch making event.
The Chief celebrant of the day, Health Minister, Professor Adewole was in a happy mood throughout the event as speaker after speaker spoke of the tremendous achievements of the former Vice Chancellor of University of Ibadan, has done since he took over the mantle of leadership of the Nation’s health sector. And with the three programmes, his ratings have gone a notch higher.
While launching the programmes, President Buhari said that the NSHD and the BHCPF were geared towards achieving Universal Health Coverage. He also alluded to the fact that his administration had provided N55 Billion to cater for BHCPF in fulfilment of the National Health Act 2014 which stipulated that 1% of the consolidated revenue shall be allocated to the health sector.
He added that international partners such as The World Bank, Bill and Malinda Gates Foundation and USAID would also contribute to the Basic Healthcare Provision Fund.
To ensure sustainability, the President assured that transparency and accountability mechanism had been put in place to ensure that there was no corruption in the use of the fund. According to him, the first six states to benefit from the Basic Healthcare Provision Fund are Abia, Niger, Osun, Katsina, Yobe, Edo and the FCT. Other states are to be included before the year runs out.
The journey towards the development of the second National Strategic Health Development Plan 2018-2022 was long and tortuous. Work began on the second Health Development Plan after the expiration of the First National Strategic Health Development Plan 1 (2009 to 2015). Its primary purpose was to enable the Federal Government implement policies that are geared towards improving health indices of the nation.
The NSHDP 11 was endorsed at the 61th National Council on health held in Kano State in June 21th 2018 and at the federal executive council on September 5, 2018.
Its vision is to guarantee a healthy and productive nation while the mission is to ensure that the Nigeria populace have access to comprehensive, appropriate, affordable, efficient, acceptable and quality essential health care provided through a strengthened health system. It is expected to cost N6.071 trillion over a period of five years. The overall expected results are to significant reduction in morbidity and mortality. Indeed, what the plan intends to achieve include amongst others, is a reduction in maternal mortality rate from 576/100,000 to 400/100,000 life birth representing 31% reduction.
Neonatal Mortality Rate, NMR from 39/1000 to 26/1000 life birth representing 33% reduction towards the attainment of global target
Under 5 Maternal mortality from 120/1000 to 85/1000 life birth representing a reduction of 29% towards attainment of global target
The second leg of the day’s events was the roll out of the BHCPF which is a fiscal instrument to support the improvement of health outcomes across the country. Designed with women and children as its primary focus, it is also designed to take care of Nigerians residing in the rural areas where services are the least and coverage lowest while also using both the private and public sector as source of funds.
Although Primary Health Care, PHC is supervised at state level function and has been clearly articulated in several policy documents, there has always been the need for the federal government to be involved to ensure equality in access to public goods such as immunization commodities. Expectedly, the BHCPF with funds flowing directly from the CBN to the participating PHCs would ensure adequate health coverage for most Nigerians as it is expected to achieve the following:
At least 1 functional health facility per ward offering quality health services 24 hour 7 days a week for free, will go along way of closing the gap between rich and poor as well a jump start to tackle geographical in accessibilities for health services
One functional PHC per ward concept will offer one of the fundamental right of communities to free health, which is basic primary health care contributing to keep human settlements safe from diseases, resilient and suitable for development.
One functional PHC per ward concept also fosters employment and development, reduces inequities absolutely critical for creating sustainable cities and communities
A functional primary health care system is an ideal setting to implement a 10-year framework of on sustainable consumption and production in relation to the pharmaceutical sector publicly financed leading opportunity for growth and sustainable development
To achieve that, funds for the programme are to be warehoused at the CBN, while in implementation, the NPHCDA will get 45%, NHIS-50% while 5 % will be for emergency services.
To access services at any participating PHCs, each beneficiary will receive an Identity Card and with it access services such as free malaria treatment, free ante-natal care, free labour and delivery care including caesarian section and emergency obstetric and Neonatal care. Free family planning services, free treatment for childhood illness such as acute respiratory infection, diarrhea, Dysentery, Vitamin A treatment of xerophalmias and measles, prevention and management of acute malnutrition, free screening and referral for non-communicable diseases such as hypertension and diabetes.
Adults are also expected to enjoy free malaria treatment as Tuberculosis as well.
The BHCPF is funded with N55.1b in the 2018 Budget with additional $2m and $20m grant from Bill and Melinda Gates Foundation (BMGF) and GFF of World Bank. There is a promise of additional support of $75m from BMGF over the next five years. Hopefully, the BHCPF will address system inefficiencies and ensure sustainability of funding for Health Care.
As stated by Adewole in his address, his vision is to ensure Universal Health Coverage to all Nigerians irrespective of their social status.
This is a programme that rewards states that prioritise high impact health intervention and achieve results. The main objective is to achieve wider coverage with these interventions. Funded with support from the World Bank, the first disbursement under the programme took place in 2016 where states across the country got $55.5m while the first performance based disbursement took place in November 10, 2017 with a total of $93.374m. The second performance based disbursement took place in November 19, 2018 and a total of $109,288m was disbursed and it was the fund that was disbursed by Mr President on January 7.
The main objective of the saving One Million Lives (SOML) initiative to facilitate rapid development by states of the Primary Health Care System. This will provide the opportunity for each state in Nigeria to achieve Universal Health Coverage (UHC) individually. The SOML-PforR’s is focused on improving primary healthcare and increasing insurance coverage especially for the most vulnerable in society.
States are expected to utilize the funds to: facilitate improvement in six key indicators of Maternal & Child Health
Immunization Coverage (Penta-valent 3)
Bed net use by children under 5
Vitamin A supplementation
Family planning (Contraceptive Prevalence Rate)
HIV testing during pregnancy (EMTCT)
Skilled birth attendance
And based on their performance for the most part of last year, states got the following amount of money: Abia-$660,000, 00 Adamawa-$7,105,000,00 Akwa Ibom, $120,000,00, Anambra-$160,000,00, Bauchi-$620,000,00, Bayelsa-$960,000,00, Benue-$160,000,00 and Borno-$13,637,500.00
Others are Cross River-$160,000,00, Delta-$160,000,00, Ebonyi-$160,000,00, Edo-$160,000,00, Ekiti-$120,000,00, Enugu-$160,000.00, FCT-$9,393,000,00, Gombe-$1,965,000,00, Imo-$660,000.00, Jigawa-$ 5,649,500.00 and Kaduna-$160,000,00
Others are Kano-$8,176,000,00, Katsina-$80,000.00, Kebbi -$160,000.00, Kogi-$160,000.00, Kwara-$160,000.00, Laagos-$160,000.00, Nasarawa-$7,548,000.00, Niger-$6,454,000.00, Ogun -$460,000.00, Ondo-$1.972.000.00, Osun-$20,547,000.00, Oyo-$160,000.00, Plateau- $160,000.00,
Rivers-$ 960,000.00, Sokoto-$660,000.00, Taraba-$2.927,500.00, Yobe-$29,007.000.00, and Zamfara-$426,500.00. This amounted to $122,348.000.00 given to all the states of the federation to improve health indices at the state level.
Has rightly pointed out by Professor Adewole: ‘We have laid the policy foundation for achieving Universal Health Coverage in Nigeria, we are at the dawn of a new era as we deliver health to all Nigerians especially to the poor irrespective of location in the country.
It is hoped that the three programmes launched by President Buhari would take Nigeria’s health sector to the next level in the coming years.
Akintunde is the Special Assistant, Communication and Strategy to the Honourable Minister of Health
*Photo : Professor Isaac Folorunso Adewole