Memo to Tinubu’s special adviser on health

Recently President Bola Ahmed Tinubu made appointments of 20 advisers that will assist him run the country smoothly. Among those appointed is Dr. Salma Anas Ibrahim as his Special Adviser, SA on Health, whose contribution to the health sector in Nigeria spans over 25 years and is a specialist in reproductive, maternal and child health.

Like the blind men that viewed elephant based on their perception, I will like to suggest what I think are the areas the office of the SA will look into and offer her services as she starts the task of advising Mr. President from primary health Care perspectives, which is the cornerstone of Universal Health Coverage.

First is the issue of Reproductive, Maternal, Newborn, Child, and Adolescent Health + Nutrition simply RMNCAH+N. In a report released by World Health Organization, WHO titled ‘Improving maternal and newborn health and survival and reducing stillbirth-Progress Report 2023’, it shows that Nigeria accounts for the 2nd highest number of global maternal and child deaths, in essence, 540 children and women died per 1000 in 2020. Also, the records of National Demographic Health Survey, 2018 on these data is not encouraging.

Though the National Emergency Maternal and Child Health Intervention Centre, NEMCHIC came into being in 2019 to address these, and similar ones were established by states at different times, still we are not where we want to be.

For us to be there, we should do as the WHO director of Maternal, Newborn, Child and Adolescent Health and Ageing, Anshu Banerjee said, that “If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed now so that every woman and baby – no matter where they live – have the best chance of health and survival”.

You are an expert in this area, more so, you facilitated the establishment of RMNCAH+N multistakeholder coordination platform, your new office will do more in finding the missing link which is impeding Nigeria towards addressing maternal and child deaths.

Second is infrastructure. According to the National Strategic Health Development Plan 2018, of the total 34,176 health facilities in Nigeria, 88.1% are primary health care facilities, 11.7% secondary, and 0.2% tertiary.

Considering 70% of diseases can be prevented and/or treated at primary health care centres, and 80% are at different range of dysfunctionality ranging from dilapidation, lack of adequate water, electricity, etc., all tiers of health services could not be provided to its fullest, which is seriously overburdening the already stretched infrastructures at secondary and tertiary level of care.

Also, according to the Executive Director National Primary Health Care Development Agency, NPHCDA, Dr. Faisal Shuaib, he stated that 70% of the Nigerian population rely on primary health care facilities, yet, it is not uhuru in terms of infrastructure.

This area needs urgent attention so that PHC can perform optimally with joint support of government at all levels and partners

Third is One Health. This is a multidisciplinary approach that implements programs and policies through collaboration with various sectors from global to local levels to achieve a better health outcome while recognizing the interconnection between human, animal and environmental health. National strategic plan was formulated for 2019-2023 that guides the nation toward that, but there is need to do more for the system and the nation to feel the impact of its implementation. Also, implementation of the plan will lead to strengthening International Health Regulations core-capacities, and realising the goals of National Action Plan for Health Security, NAPHS, and National Strategic Health Development Plan, NSHDP.

The policy even stated that “Currently, environmental health surveillance has not commenced but there is a proposal to use a similar structure to the IDSR for environmental surveillance in Nigeria. It is proposed that environmental health officers (EHOs) stationed at the local government routinely collect environmental data; send to their state environmental officer (SHO) who compiles data for all the LGAs in the state………”, this had not taken off.

The bulk of success of One Health rests on coordination across all relevant sectors, which to me if there is, is not well managed, more need to be done on this by your office.

Fourth, Human Resource for Health, HRH. This is one of the pillars of Primary Health Care Under One Roof, PHCUOR which is critical to the success of every health intervention. Adequate, competent, and the right human resource will drive every plan of government to fruition.

Many states, like Kano, Kaduna, have developed Human Resources for Health 10-year strategic plan, which if implemented accordingly, will address HRH challenges in those states.

It is pertinent for your office to leverage on the existing progress and challenges in the states to advise Mr. President on what needs to be done to address any identifiable challenges.

Fifth, Quality of Care. This is necessary in order to assess whether or not health care services delivered across all levels of health care are accessible and qualitative. There are many healthcare interventions and services being provided at various health facilities which need to be accessed and evaluated for administrative and planning purposes.

Your office should collaborate with state ministries and primary health care boards for real time data on the quality of care which will guide in making the right decision to Mr. President.

Lastly, policy direction. In the history of health in Nigeria, policy direction of previous government from 1960 to date is tilted towards curative health services than preventive, which beside being costly, it is not yet uhuru, hence, if One Health Strategy will be implemented accordingly, the environmental health aspect of the policy will address aspect of preventive health services, and is central to the success to the other two components of the policy, which are human and animal health.

The Office of SA Health has a critical role to play to advise Mr. President in strengthening primary health care, which the success or otherwise of any health program starts there, which in the long run will shape the future and outcome of health care services in the country, the recent 10-year strategy for re-imagining PHC comes handy.

Mohammed writes from Kano State Primary Health Care Management Board, Na’ibawa, Kano via [email protected]