Thanks for joining us once again as we continue to bring you crucial parts of the 2019 National Health Dialogue.
The two-day health dialogue, now in its second edition, arose from the need for home-grown solutions, innovations and political commitments to bridge funding gaps in achieving UHC in Nigeria.
The annual event is organised by PREMIUM TIMES , its sister organisation PTCIJ, dRPC-PACFaH@Scale, Nigerian Sovereign Investment Authority (NSIA), International Society for media in Public Health (ISMPH), Project Pink Blue and the Nigerian Governors’ Forum (NGF).
On Tuesday, various stakeholders including the health minister, Osagie Ehanire, discussed issues affecting the health sector and proffered solutions to them.
Today, Nicon Luxury Hotel in Abuja, the venue of the event is beginning to welcome health professionals, government officials and journalists – gathering for the final day of the dialogue.
Keep refreshing this page to get instant updates from today’s dialogue.
Zubairu Jide Atta, a polyglot, speaks Hausa, Yoruba, Pidgin English, passable French. He is the Master of Ceremony for today’s dialogue.
Formerly, the UN Women, Strategy Advisor, Country Rep for Nigeria and ECOWAS, Mr Atta is keen on evidence- based decision making.
He kickstarts today’s conversation by asking for the recap of yesterday’s dialogue.
Introducing the first panel discussion, the technical expert said he threads with caution when calling people’s name “to avoid mispronounciation”.
He then brings on stage the first panel discussants.
Panel one: Financing UHC in Africa; Nigeria’s comparative experience
This panel is Powered by dRPC-PACFaH@scale, one of the partners in the event.
The discussion is powered by dRPC-PACFaH@scale. one of the partners in the event.
The Partnership for Advocacy in Child & Family Health at Scale, PACFaH@Scale (PAS), is a social accountability project which aims to strengthen the capacity the capacity of Nigerian Civil Society Organizations (CSOs) at national and state levels to hold decision-makers (in the executive and legislature) to account to comply with commitments in child and family health, policies (laws); financial obligations and to bring down regulatory and administrative barriers to effective and efficient service delivery. PAS is anchored by the development Research and Projects Centre (dRPC) and implemented by a coalition of 23 indigenous health NGOs and professional associations. The project is also supported by 2 government partners working to develop champions with the executive and legislature.
This panel is moderated by veteran journalist, Moji Makanjuola.
She said the panel would be discussing various factors Nigeria can leverage on to improve and sustain the drive for UHC.
Speaking first, Emmanuel Meribole from the department of planning research and statistics at the health ministry said there is need to tap into funds from sources other than the annual budget.
Such sources, he said include the Basic Health Care Provision Fund (BHCPF).
The official, however, decries the poor monitoring of health indices in the country saying it is a major constraint to UHC.
Mrs Makanjuola introduces Garba Buluma, an official of the National Primary Health Care Development Agency (NPHCDA).
Giving his background, the moderator expresses delight in having Mr Buluma in the panel because “he was once an Almajiri but went ahead to become a medical doctor”.
He said Mr Buluma’s story is that of hope that should inspire “our kids in the streets”.
Speaking, Mr Buluma said for Nigeria to achieve UHC there should be good governors.
“If governance is fixed, there will be 80 per cent success in the health sector”, he notes.
“Everything revolves around good governance and finding a way to maximise the funds available.
He speaks about the federal government’s Primary Health Care Under One Roof.
The PHCUOR policy was brought on board as a watershed to reduce bottlenecks in the delivery of Primary Health Care (PHC) services by integrating all PHC services under one single authority – the State Primary Health Care Board (SPHCB).
But for shortfalls in implementation and execution, there was no shortage of ideas when the policy was approved by the National Council on Health in 2011 and later backed by the National Health Act (2014).
It mandates every state to create SPHCB as a single management body to control all PHC services and resources especially funding, staff enrollment, payment of salaries and maintenance.
Every year, a scorecard exercise is concurrently done across the 36 states where the policy is being implemented to continuously review successes and identify the shortfalls in applying PHCUOR.
The assessment conducted by the NPHCDA in collaboration with the Development Research and Project Centre (DRPC), covers the State Ministry of Health, SPHCB, three selected Local Government Health Authorities (LGHAs) and one PHC in each of the three selected LGHAs in the State.
Meanwhile, Mr Buluma advocates for robust and holistic implementation of the program.
He describes PHCUOR as a one way ticket to solve challenges facing PHCs across the country.
Mohammed Ube is on this panel to represent NIPSS, Nigeria’s foremost thinkthank organisation.
He starts by giving a brief background of NIPSS and how it operates.
NIPSS – National Institute for Policy and Strategic Studies (NIPSS) based in Kuru, Jos, North Central Nigeria is a policy formation center for bureaucrats, private sector leaders, Army officers, and medium-rank and senior civil servants, which was founded in 1979.
Most policymakers in Nigeria have attended the NIPSS. Notable graduates of the NIPSS include Ibrahim Babangida, the former Nigerian Head of State, and Nuhu Ribadu, the anti-corruption campaigner.
Each year, the institute develops a policy plan for the country. It reports directly to the office of the president and is being supervised by the vice president.
This year, NIPPS has a mandate of charting a roadmap that will help the country achieve UHC through better funding mechanism.
Meanwhile, Mr Ube said the NIPSS has undertaken several study tours to ascertain the various challenges to funding UHC in Nigeria.
PREMIUM TIMES reported earlier in the year how the NIPSS undertook a study tour of PHCs in selected states in the country.
The captain said the study encountered three major challenges – the need for more money, more health, and more professional hands.
He said the institution looked at the challenges from three different dimensions –
1) Who is to be covered?
2) How to finance UHC?
3) How to implement UHC?
On who is to be covered, he said the institute encountered a challenge of getting accurate data and statistics of the country’s population, health indices, health facilities, “how many pregnant women we have among others”.
On raising funds, Mr Ube said the government is confronted with so many competing demands other than health.
On how to implement, he says the constitution appears to be silent on specific roles of different actors.
He gave several examples where the state and federal actors are not working in sync, saying it is a major impediment to UHC.
Lydia Dsane-Selby, the CEO, NHIS in Ghana is now speaking.
NHIS in Ghana
Ghana introduced a Mobile-based Renewal Application System for the country’s NHIS in June.
The system allows enrollees to renew their membership from the comfort of their homes with the aid of mobile wallet-enabled phones.
The system has boosted enrollment, the Ghanaian authorities said.
The West African country has covered more than 50 per cent of its population.
Meanwhile, Mrs Dsane-Selby said her country has been raising domestic resources for UHC for the past decade.
“Fee were introduced after we had an economic downturn. There was a special levy of two and a half per cent VAT on all goods and services.
“These monies were gathered and put in the pool of funds for health insurance. 20 per cent of the funding was also raised from premiums of 39 cedes max.
“Stray tax has also increased funding”, she explains.
She also explains how the Ghanian government introduced a biometric ID cards which is used to identify active members enrolled into the scheme.
The Ghanian official said the enrolment card is used as a benchmark of getting assess to public services.
“If you want to stay on campus in the university, you must have a National Health Insurance Card.
“Everybody in Ghana should enroll. That is our plan but coverage is still a challenge we are facing”, she notes.
The official said a majority of enrollees can access their plan through their mobile phones at home. She, however, said authentication and verification is also another challenge.
She also alludes to funding challenges, a situation Mrs Sebly said “is tempting her scheme to dip hands into the ‘government’s pot’.”
The moderator reaffirms her previous position that health should be seen as an investment and not an expenditure.
“Its a global issue and we need to find a way to make health a national issue. We have the money, what we need is action,” she adds.
Beatrice Gatuma, the UHC lead, AMREF Kenya is now speaking.
She explains how Kenya has been driving coverage of health insurance in the informal sector through alternative options.
She said Rwanda set a good example with their communty health model. She said the East African country is leveraging on technology to drive health insurance in rural areas.
AHAIC 2019: Learning health insurance from Rwanda, Ethiopia and Kenya
Rwanda and their neighbors, Kenya were lauded for advancing UHC through various health financing mechanisms, during the Africa Health Agenda International Conference 2019 (AHAIC) held in Kigali.
In Rwanda, community-based insurance has provided “the modern social security we want for our people”, Rwanda’s Minister of State for Primary Health Care, Patrick Ndimubanzi had said.
Rwanda’s health insurance scheme is financed by both the national government and individuals through insurance and fees for services.
Members pay annual premiums at a flat rate based on their economic status, regardless of individual health risks, which can then be used for discounted treatments at community health centres.
Health insurance became mandatory for all individuals in 2008; in 2010 over 90 per cent of the Rwanda population was covered.
In 2012, only about four per cent was uninsured.
This scheme increased the number of women delivering in health facilities from 50 percent in 2010 to 90 percent in 2015, Mr Ndimubanzi noted.
In Kenya, government appeared to have a larger plan of achieving UHC by 2022.
UHC hospital insurance pilot project is currently being tested in four regions troubled with high disease burdens.
Since the launch in December 2018, the government has offered free basic healthcare services to all citizens holding a UHC card — which required the presentation of national identification to regiter — and covers anyone in the household under 18.
“Today, 75 percent of all residents [in the pilot counties] have been registered and are holding a UHC card,” Rashid Abdi Aman, chief administrative secretary at the Kenya Ministry of Health, had said.
He explained that health programmes requiring registration may need to be adapted for those who lack identification papers.
The official says inadequate data remains one of the universal challenges to health insurance.
She said the right data will empower people more to demand adequate health services.
“With data you will know how deep is the insurance coverage and what you can obtain when you are covered?”
Mrs Gatuma stresses the need for leveraging alternative sources of funds and leveraging on technology.
Mr Meribole harps on the need for intersectoral collaborations to drive funding for UHC and health insurance.
He also advocates for synchronisation of federal, state and local government levels to drive progress.
He says the issue of awareness for health insurance should be addressed. “People should begin to see health insurance as a major way to address out-of-pocket spending.”
Effective State-level Health Insurance Initiatives: Challenges and Prospects.
This panel, powered by the Nigeria Governors Forum is moderated by Chiedo Nwankwor, a lecturer.
Health insurance has been globally recognized as the fastest route for any country to achieve Universal Health Coverage.
Nigeria launched the National Health Scheme in 2005 – the same year with Ghana.
Today, only five per cent of Nigerians have health insurance, while Ghana’s scheme has covered over 50 per cent of its population.
The failure of the NHIS to deliver heralded the quest for the establishment of State Health Insurance Schemes (SHIS).
Experts believe SHIS offers each state a more feasible platform to manage their own homogenous cultures and context in taking health insurance to the last citizen.
Lagos, Niger, Delta, Anambra are among about 20 states that have begun implementation.
Having SHIS is a major criterion for states to enjoy the Basic Health Care Provision (BHCPF).
The structural set up that follows the establishment of SHIS provides a near-ideal structure needed for the BHCPF in a more transparent and accountable manner. Therefore, for states to access the fund, they must establish their SHIS among other criteria.
But as it is with NHIS – currently dogged with multiple challenges – if the establishment is not backed with proper implementation plan, the SHIS will not succeed.
With the foregoing, this panel intends to discuss the prospects and challenges of implementing the SHIS especially with regards to the disbursement of the BHCPF.
Executive Secretaries of Anambra, Kano, Delta, Osun and Bauchi are on the panel to discuss the pecularities in implementing SHIS in their respective states.
Speaking first, Simeon Onyeamaechi, CEO of the SHIS in Anambra said the state made health insurance compulsory to avoid making mistakes made in the implementation of the NHIS.
He said the state used an “adoption model” where philanthropists in the state pay for health insurance of his/her family; village members and adherents.
He said the model helped the state to boost coverage. “Over 72, 000 people has enroled into the scheme in just seven months”.
Ben Nkechika, Executive Secretary Delta said the state embarked on proper consultation of the informal sector before launching the scheme.
“We had a meeting with all the groups in the informal sector – okada riders; artisans; petty traders; commercial vehicle drivers etc. From the meeting we did a baseline assessment report.
“We had meetings with okada riders and asked them what they want and ot helps to determine what we want. We did an analysis of a baseline assessment report.
“It gave us an idea of how many people are willing to pay, how many people want to enrol, the structure of health facilities and personnel that will be responsible for providing care.
“The standard of the PHCs were also assessed and the professionalism of the care givers. We did all this to ensure that at all times we can give value for the money people pay for insurance.
“The key thing that came out from these assesment is the “willingness to pay”. We had to change the premium we were pojecting before based on how much people told us they are willing to pay.”
Mr Nkechika said the state also embarked on partnerships with the private sector.
“Some abandoned PHCs were taking over by private organisations through the Public Private Partnership PPP”.
The official said the state employed laison officers who went around educating and creating awareness about the scheme, how much they can pay and all.
Osun SHIS boss, Adeniyi Samuel Ngini, said the journey of health insurance in the state started with the establishment of state health insurance agency.
He said the state worked with development partners that helped in developing the structure and benefit packages that helped in setting the scheme.
His counterpart in Kano, Mansur Mustapha Dada, said his state adopted a socio-cultural program that helped stabilise all the ‘misconceptions’ about health insurance.
Halima Mijin Yawa of Kano SHIS also explained how the state adopted a broad-based socio-cultural program backed with data.
Mr Onyemeachi from Anambra said in the mapping of stakeholders for health insurance, “let us get rid of people that have the mentality that citizens cannot provide”.
“Every community in Anambra has produced a millionaire who is willing to pay for health insurance”.
Chinwe Oreh from the NGF said the forum developed a scorecard to check standards for health implementations such as SHIS.
Mr Nkechika of Delta harps on the need for nationwide awareness especially in the informal sector.
Panel two ends.
The Basic Health Care Provision Fund (BHCPF) as a pillar for health resources and quality Primary Health Care
What is BHCPF?
The BHCPF is the fundamental healthcare funding provided by the National Health Act. It was included in the national budget for the first time in 2018 since the Act was signed in 2014.
It provides for not less than one per cent of the Consolidated Revenue for healthcare funding.
When passing the 2018 budget in May, the National Assembly earmarked N55 billion for the BHCPF, as stipulated by the Act. Funds from donor organisations and other sources also form part of the BHCPF.
Only 25 per cent of the 2018 BHCPF was, however, released amounting to N13.7 billion.
The BHCPF is aimed at providing adequate care and services at the Primary Healthcare (PHC) level, mostly for the vulnerable population, so as to reduce out-of-pocket expenses.
“Money will flow from the CBN to NHIS to NPHCDA to NCDC (Nigerian Centre for Disease Control) down to the PHCs,” said the former health minister, Isaac Adewole, in an interview with PREMIUM TIMES last year.
Ifeoma Onyebuchi from the PPDC, a civil organisation monitoring said there is need for a holistic implementation of the BHCPF “with an honest feedback that will fuel investmet of more funds.”
She said there is need for government to have strict sanctions for defaulters.
The BHCPF is intended for the 36 states and the FCT but only states that meet the eligibility criteria can access the fund.
Apart from providing a counterpart fund of N100 million, the Act provided that states must establish a state Primary Healthcare Development Board and State Health Insurance Agency to access the fund.
“Issues around financial monitoring and commitment is key,” Ms Onyebuchi notes.
Dale Ogunbayo agrees with Ms Onyebuchi on need for proper implementation.
Mr Ogunbayo is a medical consultant and public health advocate.
He decries the “poor, late and non-release of the BHCPF.”
The 2020 budgetary proposal presented by President Muhammadu Buhari last Tuesday provided for the BHCPF in the statutory transfers, which are the first-line charges in the proposal.
The N44.5 billion proposed is however lower than the N51.2 billion and N55 billion provided in 2019 and 2018 which were not under the statutory transfers.
Mr Ogunbayo said apart from demanding more health funds, there is a need for accountability.
PREMIUM TIMES reported how the medical expert ahead of this event explained how citizens can lead the demand for accountability.
Mr Ibama said quackery needs to be tackled to achieve the full potentials of the BHCPF in the PHCs.
“Every professional council has a regulatory council that regulates the practice so they need to do that judiciously.
“It is the responsibility of these bodies to raise awareness on the issue of quackery.”
Mr Ogunbayo said Nigeria needs to borrow a leaf from what is happening in Ghana health insurance.
“We need to learn how to prepare our investment plan for programs in the health sector then use that to argue our case with the government,” he added.
As the question and answer session was about to commence, the moderator of the panel, Onaoluwa Abimbola Ajayi, an author, reminds the audience that “we running behind schedule”.
“We should continue this conversation online,” the health advocate said as she wraps up the panel.
Gendering Access to Healthcare in Nigeria
Vivienne Ihekweazu stresses the importance of this national dialogue, noting that Nigerians “should make out time to discuss their health issues”.
She is the program director of Health Watch, a platform that reports health in Nigeria.
“As much as people rate the health sector as important, they are yet to start making it a priority.
“We need to start holding out officials to account,” she notes.
Presentation by the Nigeria Sovereign Investment Authority (NSIA)
A short video documentary in honour of late Stella Adadevoh is being presented to the audience.
The presentation is made in remembrance of late Adadevoh for her bravery that warded off the dreaded Ebola epidemic from Nigeria.
Dapo Olorunyomi, Publisher of PREMIUM TIMES, had in his welcome remark on Tuesday’s dialogue advocated for special honors for the late health worker.
Mrs Adadevoh was the lead consultant physician and endocrinologist at a private hospital in Lagos when an Ebola patient arrived the country from Liberia.
The medic and three of her colleagues contracted the dreaded virus while treating the patient, and ensuring he did not leave the hospital.
Their efforts helped stop the virus from spreading in the heavily populated Lagos.
Panel four: Gendering Access to Healthcare in Nigeria
Vivienne Ihekweazu stresses the importance of this national dialogue, noting that Nigerians should make out time to discuss their health issues.
She is the program director of Health Watch, a platform that reports health in Nigeria.
“As much as people rate the health sector as important, they are yet to start making it a priority.
“We need to start holding out officials to account”, she notes.
Ngozi Monye is another panelist on the final panel of this event.
She is the Chief Consultant, Lifestyle Medicine at National Hospital. Mrs Monye wants more awareness to be created on how people can live healthy to avoid falling sick.
“Your sleep pattern, nutrition, social condition should be put into serious consideration,” she said.
She said the quest for UHC starts from Primary Health Care which begins with “you”.
Titiola Akindeinde agrees with Mrs Monye.
She said it is important to run checks on your health regularly.
Mrs Akindeinde is the program manager, Policy Development Facility, Phase 2.
“If Nigeria does not deliver better healthcare then we are failing,” she notes.
Mansur Dada, the Executive Secretary of the Bauchi State Health Insurance Scheme, wants health facilities to be created closer to the people, especially women.
He also wants facilities to have adequate female staff financial access.
Mr Dada said an active SHIS is necessary in the drive for UHC.
Adeniyi Oginni, another SHIS executive secretary, agrees with his counterpart from Bauchi.
“We need to keep in mind, geographical location and access in planning for family planning,” he says.
Taking another dimension, Mr. Oginni, the SHIS boss in Osun State, wants family planning commodities to be provided for women even without the consent of their husbands.
Presentation by the Nigeria Sovereign Investment Authority (NSIA) by Uche Orji
Mr Orji is the MD and CEO of the NSIA.
He begins his presentation by explaining how NSIA works.
Earlier this year, PREMIUM TIMES reported how the NSIA announced the investment of its $1.5 billion seed capital in the development of key infrastructure to create wealth and grow the economy.
The official outlines various programs the agency is running.
He says NSIA is responsible for the construction of the second Niger bridge. Mr Orji said the agency only invests in areas of national interest and that was why they ventured into health.
“Though the health sector is a national issue, it has a lot of challenges affecting it,” he notes.
He said most Nigerian doctors are leaving the country in droves to other climes because of poor remuneration. He said the treatment of cancer is poor.
He outlined several programmes NSIA is investing on in the health sector.
“We are focusing on tertiary health care,” he said. “We are also investing in Cancer machine at the LUTH cancer centre.”
The official also listed 13 other programmes the agency is working on, including specialised training for nurses.
Mr Orji ends his presentation to a round of applause.
Presentation of draft communique of National Health Dialogue 2019
Highlights of discussions as presented by Tobi Oluwatola.
Inability of NHIS to cover Nigerians
Poor data and statistics
More policy implementation
Poor knowledge of various health insurance programmes
Centralisaton of NHIS
Additional funding for BHCPF
Increased capacity building
Free cancer screening
Tax on tobacco
Collaboration of civil societies
Political commtment by president and governors
Media employing news story approach
Mr Oluwatola tells the audience that this is just a highlight of the communique. “The main communique will be shared with you when its ready” he notes.
He urges partcicpants to send feedbacks and contact us at firstname.lastname@example.org
Closing remarks by PREMIUM TIMES editor-in-chief, Musikili Mojeed.
Mr Mojeed calls on stage the partners of the newspapers in organising the event. He thanks them for investing and partnering “with us”
He signals the end of the annual dialogue.