Nigeria’s long-anticipated 2023 general election is around the corner and the presidential candidates of the 18 registered political parties have released their manifestos or agenda to convince the electorate on why they should be voted as the nation’s next president.
A manifesto, a publication issued by a candidate or political party before an election, contains the set of policies that the candidate or party stands for and would wish to implement if elected. It is mainly a promise, an implied contract between the people and a political party or candidate, presented to the voters on which basis their votes are sought.
Ahead of 25 February presidential and National Assembly elections, the four leading presidential candidates –Peter Obi of the Labour Party, Rabiu Kwankwaso of New Nigeria Peoples Party (NNPP), Atiku Abubakar of the Peoples Democratic Party (PDP) and Bola Tinubu of the All Progressives Congress (APC), through their manifestos have made lots of promises to Nigerians to be elected.
These candidates have promised to tackle lots of issues, including Nigeria’s degenerating national security, energy, education, economy, women empowerment and most importantly to reform the country’s failing health sector.
The country’s health sector has suffered a myriad of challenges over the years. From brain drain to inequities in health services, coupled with the devastating impact of the COVID-19 pandemic and lack of a functional primary healthcare system, the sector is one of those that require urgent attention.
In this report, PREMIUM TIMES highlights areas of health priorities and analyses the plans of the candidates for reforming the sector if elected as the country’s next president.
Reforming health sector: APC candidate’s agenda
The former Governor of Lagos State and presidential candidate of the ruling APC, Bola Tinubu, has listed as one of his major plans for the health sector, mitigation of brain drain and retaining health workers by improving their welfare.
According to Mr Tinubu’s manifesto which is titled: “The Renewed Hope”, part of the policies to be implemented in making this a reality “include performance-based salary increases, health insurance to cover family members, favourable mortgage or home-ownership plans for health workers, and tertiary education scholarships for their children.”
On Universal Health Coverage (UHC), the APC candidate plans to reform the healthcare system by making UHC a primary objective and central theme of his healthcare reforms.
“By making universal coverage our primary objective, we shall create new jobs and bring greater economic and social development to the Nigerian people,” he said.
As part of efforts to achieve this, Mr Tinubu plans to scale up the National Health Insurance Authority Act, “with the objective of implementing a mandatory health insurance scheme to cover at least 40 per cent of the population within two years.”
He also promised to augment the financial mechanism such as the Basic Health Care Provision Fund and Vulnerable Group Fund to cover vulnerable populations.
Fuel subsidy versus health
Restating commitment to the removal of subsidy on petrol, Mr Tinubu said the funds saved would be used to enhance health coverage for Nigerians.
He said: “In addition to other sources, funds saved by the removal of the fuel subsidy shall be earmarked for use in helping to provide health coverage for pregnant women and children under-five.”
He also promised to partner state and local governments to facilitate the upgrading, equipping and staffing of a general hospital in every local government area, a tertiary facility in each state and a world-class specialist hospital in each geo-political zone.
He said such a network will not only render basic care to a greater number of people but shall also attract medical tourists to Nigeria but did not give a time frame to achieve the one functional general hospital per local government project.
Atiku Abubakar of PDP
A plans to improve access to basic healthcare services through innovations – such as the mobile healthcare delivery scheme.
He said the policy thrust of his administration will be all-embracing and targeted towards a preventive care strategy by creating a clean environment, modernising living conditions, carrying out enlightenment campaigns on healthy living, and supporting with curative care through the provision of state-of-the-art healthcare facilities in hospitals and in rural clinics.
As stated in his manifesto which has been tagged: “My Covenant with Nigerians”, Atiku plans to ensure universal access to basic maternal and child health, reproductive health, immunisation and mental health while also accelerating Nigeria’s transition towards achieving universal access to affordable and quality healthcare services for all by 2030.
According to the manifesto, the former vice president intends to take healthcare professionals to the front line and attract Nigerian doctors in the diaspora to reverse brain-drain. He, however, does not list specific steps he intends to take to reduce the mass migration of Nigerian health workers.
Labour Party’s Peter Obi
On his part, the candidate of LP, Peter Obi, in his manifesto, plans to address the financial resources-depleting practice of medical tourism, by supporting national teaching hospitals to specialise in niche areas of medicine, thus enjoying expeditious faculty and facilities enhancement and the attendant comparative advantage.
In his manifesto titled: “Our Pact with Nigerians,” Mr Obi, a former Governor of Anambra State, said his administration would implement the National Health Act of 2014, and enforce the provision of its Section 46.
He said there would be a “comprehensive mapping of Nigeria’s healthcare system occupational categories, to generate relevant data on human capacity and resources for healthcare training, with a view to reversing brain drain and stopping medical tourism while tapping into our huge diaspora capacity in healthcare.”
Mr Obi does not state how, in practical terms, the mapping of such data will reduce the mass migration of health personnel or the incentives he intends to use to stop such.
Mr Obi also plans to increase NHIS uptake, with a robust healthcare insurance scheme at the basic healthcare level with a goal to provide cover for the 133 million poorest Nigerians including pregnant women, children, elderly people and persons living with disabilities.
He said his administration will generate innovative healthcare financing by encouraging public-private healthcare sector initiatives and implementing special taxes and duty waivers.
The manifesto reads in part: “This will include special incentives to encourage the domestic production of pharmaceuticals, drugs, vaccines and medical consumables.
“The incentives shall also be targeted at boosting research and development in the healthcare system, together with their commercialisation within a process that will be carefully audited, monitored, and evaluated.”
Rabiu Kwankwaso of NNPP
In his manifesto titled: “My Pledge to You,” the candidate of the NNPP, Rabiu Kwankwaso, said he plans to improve and modernise healthcare services in the country.
Mr Kwankwaso, a former Governor of Kano State, said his administration will be committed to ensuring the country’s healthcare system is positively overhauled to ensure humane, effective, efficient, and qualitative service.
“Saving lives and building a healthy citizenry shall be the priority of all our healthcare institutions because health is wealth,” he said
Suggestions for next administration
Ensuring that Nigeria, Africa’s most populous nation, achieves Universal Health Coverage (UHC) should be at the forefront of issues to be addressed by the country’s next president.
To achieve UHC, Nigerians need to have access to quality health services when and where they need them, without financial hardship. These include health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.
Unfortunately, Nigeria has failed to provide affordable and qualitative health care services for its people. Previous efforts made through the repealed National Health Insurance Scheme (NHIS) yielded no improvement as the majority of Nigerians still pay hugely out of their pockets for healthcare services.
About eight out of 10 Nigerians do not have health insurance coverage in Africa’s largest economy, according to a 2021 survey by NOI Polls.
The few persons enrolled in the scheme complain of inadequate service delivery. They say the scheme fails to cover key treatments for serious ailments such as cancer which is very expensive and has left many patients and their families with no option but to sell properties to raise funds.
The scheme, which was in existence for over 18 years and gulped billions of naira, still failed to address the health needs of Nigerians.
As part of efforts to improve the health coverage of Nigerians, President Muhammadu Buhari in 2022 signed into law the National Health Insurance Authority Bill repealing NHIS. However, it still fails to cover serious diseases which claim lives in the country. None of the candidates clearly stated if they would expand the scope of the NHIS to include diseases like cancer and autism.
Health financing, PHC system
To achieve UHC, there is a need to adequately fund the health sector at all levels of government. The country’s health sector has been grossly underfunded and repeatedly failed to meet the commitment made by African leaders to dedicate at least 15 per cent of their annual budgets to the health sector in what is now known as the ‘Abuja Declaration.’
For the first time in the history of health funding in Nigeria, over a trillion Naira was allocated to the sector in the 2023 budget. Despite this, it represented only 5.75 per cent of the overall budget, indicating a shortfall of over nine percentage points to meet the 15 per cent target agreed upon in the Abuja Declaration.
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A review of the budgetary allocation to the health sector in the last 21 years since the Declaration revealed that Nigeria has never met the 15 per cent target. None of the presidential candidates pledges to meet the target.
Inadequate funding of the health sector, leading to poor remuneration of health workers, is a major cause of the brain drain in the health sector. Only Mr Tinubu’s manifesto outlines specific steps he plans to take to reduce the brain drain among health workers; although Atiku and Mr Obi also outline the problem.
Also, without adequate and sustainable funding, Nigeria’s primary health care system where about 90 per cent of the population’s health issues can be addressed, will remain a shambles. Various reports indicate that only about 20 per cent of PHC facilities across the country are fully functional, while the rest cannot provide essential health care.
Some PHCs are faced with challenges like poor distribution of health workers, poor quality of health care services, poor infrastructure and lack of supply of essential drugs.
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