The need for holistic health sector reform

Nigeria still suffers from low level of health development and fall far below the standard of health when compared with countries at a similar level of development.

Thus, the need to reform the health sector in Nigeria has been a major preoccupation of the current and previous governments while, on the other hand, since the 1990s, the link between health and sustainable development has elicited enormous concern.

This is based on the belief that economic and social progress can neither be secured nor sustainable if sufficient investments are not made to protect health status of Nigerians.

After all, it is unarguable that Britain’s early industrial breakthrough was largely due to the mastery of high mortality and morbidity as a result of improvement in nutritional status and conquest of many contagious diseases from the late 18th century onwards.

Good health strengthens development because it increases productivity, fortifies peoples capabilities, increases savings and investments, and promotes positive behaviour.

Likewise, social development, especially in the field of education, has been associated with improved health status through improved nutrition and reproductive health.

The recognition of the mutual relationship between health and sustainable development has informed the introduction of several reforms by the Nigerian governments aimed at improving healthcare delivery in the country.

Yet, many Nigerians lack access to formal healthcare services. Of greater concern is the fact that health indicators have worsened over the years. The World Health Report ranked Nigeria 187 out of 191 countries for health service performance, a situation that has not changed much since 2000.

In fact, the country’s poor health indicators and health status over the decades, and now, indicate that the desired results of implemented programmes have not been achieved.

But, going forward, indications are that these desired results, namely, to provide basic, accessible and affordable medical care for Nigerians, will be achieved.

To realise that objective, therefore, administration of President Muhammadu Buhari has inaugurated a Health Sector Reform Committee to commence the development and implementation of a Health Sector Reform programme for Nigeria.
Yes, past administrations have, in their own ways, initiated measures to address the lingering health problems but those measures proved, largely, unsuccessful to meet their targets because they were disjointed, uncoordinated and implemented in an unwholesome manner.

Federal, states and local governments all initiated and executed their individual programmes, with little or no regard to the others. Agreed, Nigeria is a federation, but cooperation, coordination and implementation in the area of implementation of basic healthcare programmes could not have hurt or impinge on the system.

Of course, it is the realisation by the current administration of this need to work together that, mainly, indicate that the new initiative will work. In the newly inaugurated approach, Buhari has ordered the Osinbajo-led committee to collaborate with the state governments and the FCT administration to make the plan health reform a success.
The Buhari initiative is sequel to a Health Sector Diagnostic Review Report developed by a consultant, Vesta Healthcare Partners, which worked together with the Federal Ministry of Health.

The committee will undertake a review of all healthcare reforms adopted in the past two decades and lessons learnt and factor them into the development of the new Health Sector Reform Programme.
The committee which is set up for a period of six months, under the chairmanship of Vice President Yemi Osinbajo, has members drawn from private and public sector healthcare management professionals, development partners, representatives from the National Assembly as well as the Nigeria Governors Forum, Dr Ifeanyi Okowa, Governor of Delta State ; Dr Osagie Ehanire, Minister of Health; Mr. Alex Okoh Director General BPE; Ibrahim Abubakar, a Professor in Infectious Disease Epidemiology at University College London and Director of the UCL Institute for Global Health, among others.
Vesta Healthcare Partners and Bill & Melinda Gates Foundation are to serve as resources persons and have observer roles in the committee.

However, as members of the committee settle to start work, it is important for them to address, crucial issue of corruption. They should recall that previous health sector reforms were, in many respects, constrained by corruption. Corruption occurs when public officials, who have been given the authority to carry out goals, which further the public good, instead, use their position and power to benefit themselves and those close to them.

Corruption is, without doubt, a pervasive problem affecting the Nigerian health sector. Evidence abounds on the negative impact of corruption on health and welfare of Nigerians and, unarguably, corruption remains an enormous drain on resources needed for developmental programmes, including health.
The Nigerian health sector is, particularly, vulnerable due to several factors such as bribery and conflict of interests among officials in the health sector. Government officials use discretion to license and accredit health facilities, providers, services and products, thereby opening the risk of abuse of power and use of resources. The resulting corruption problems, include among others, use of government resources for private purposes.
The implication of corruption problems is that not all the money appropriated for health programmes in the country end up being spent effectively. About half of the funds and materials provided for health efforts in the country never reached the lowest levels where they are needed most.

For instance, the mosquito treated nets, which are meant to be given out free, are sold to the patients in some health institutions in the country. This has brought to the fore the issue of accountability and transparency.
There is no doubt that lack of accountability and transparency creates opportunity for corruption. There are three components of accountability, namely, a measurement of goals and results, the justification or explanation of those results to internal or external monitors and punishment or sanctions for non-performance or corrupt behaviour.

Unfortunately, these components are either lacking or are not strictly adhered to in Nigeria’s health sector. This can be attributed to the fact that each component of the three tier governance federal, state and local governments is involved in the provision of health care, which results in chaotic coordination, poor communication and lack of accountability.

The investment Nigeria wants

President Muhammadu Buhari, this week, in Abuja, charged members of the new board of the Nigeria Sovereign Investment Authority (NSIA) to make more investments that support economic diversification, as global oil prices are projected to drop to around $40 per barrel by 2030.

Inaugurating the third board of the NSIA at the State House, the President said the present administration was committed to implementing long term projects and programmes that create jobs for Nigerians.

He said the full impact of most of the strategic projects started under his watch will only be felt long after he had left office.

He described the appointment of the nine-man board as a call to duty, action and performance, adding that they were eminently qualified for the job.

Buhari said: ‘‘This government operates on the agenda for long term change which we all agree is inevitable. Change happens whether you are ready for it or not. As representatives of the Federation, you are required to continue to drive the performance of the Authority to deliver benefits to all Nigerians.

Still, the members should know, and bear in their minds, that with developed economies declining and emerging ones on the rise, Africa is fast becoming a highway for global brands.

Most available and authentic indicators not only see South of the Sahara as the fastest growing area, but equally point at Nigeria, regardless of its unbelievable indices of poor governance, high unemployment rate, poverty and underdevelopment.

Rich in biodiversity, mineral resources, oil, gas, and cheap manpower, Nigeria has an estimated population of 200 million people. Import-dependent and investor-attractive, it is however, anxiety-laden if its variegated domestic insecurity and infrastructural deficit is put into consideration.

Largely relying on a mono-economy of crude oil since the ‘70s, the country appears blind to, and visibly indifferent to global attraction and shift to cleaner and cheaper energy sources, including economic diversification.

The era of ‘oil is ready, food is ready’, is almost over. Only total realistic reformation, as that now envisaged by Buhari, would re-route Nigeria out of the vicious cycle of structural traps, hence stimulating the geometric variable of competitiveness expected in a federal structure like ours.

Such would result in a consistent dialectical economic development, steered by an inclusive diversification empowering entrepreneurial growth, challenge infrastructural deficit, re-evaluate and revitalise the nation’s education system.