#healthdialogue (LIVE UPDATES): Achieving Universal Health Coverage in Nigeria (Day 2)

The day two of the National Health Dialogue organised by the Premium Times Centre for Investigative Journalism, PTCIJ, the Project for Advocacy in Child and Family Health, PACFaH, and the Project Pink Blue continues on Friday in Abuja.

The event is being held at the Shehu Musa Yar’Adua Centre, Central Business District Abuja.

The day one of the health dialogue was chaired by the Vice President, Yemi Osinbajo, and hosted by the Minister for Health, Isaac Adewole.

The keynote address was also delivered by Emir of Kano and former Governor of the Central Bank of Nigeria, Muhammadu Sanusi II.

In today’s event, the Minister of Health, Isaac Adewole; Minister of Finance, Kemi Adeosun; Minister of Budget and National planning, Udo Udoma are some of the distinguished guests expected.

The dialogue has been able to bring together stakeholders in the Health and Development sectors to discuss the challenges and prospects of Universal Health Coverage, UHC, in Nigeria.

According to the organisers, since the enactment of the National Health Act in 2014, there have been several efforts targeted at providing quality and affordable health care for Nigerians in line with the goals of Universal Health Coverage. However, these goals are yet to be achieved.

“The dialogue will recommend actionable strategies for sustainable health care financing.”

PREMIUM TIMES brings you live updates of the event.

Arrival of guest and recap of yesterday’s dialogue

Panel Discussion 4: Primary Health Care Delivery at the state level; panel chaired by state health commissioners.

Commisioner for Health Niger state, Mustapha Jubril, opened the floor. He discussed the operational module of primary health care delivery at the state and federal level.

Mr. Mustapha said most funding for health care delivery was dione by partners and the ministry was more like an infractructure development centre.

“We need to correct this and we are running a one roof PHC and it brings all problems to the agency which falls under the ministry of health.

He said people should be educated to understand the concept of PHC, “Many people see it as free health service.”

Happening Now! Panel 4: Primary Health Care Delivery at the State Level

10.16am: Major topics to be discussed today: Cancer Survivorship: A critical issue in UHC; Interministerial coordination for health sector financing; Media advocacy and accountability: experiences and challenges and the way forward.

10.24am: Participants asking questions as others pay rapt attention.

10.57am: The Commissioner for Health in Nasarawa, Daniel Iya, gave a different view.

“We are trying to provide free health delivery by using UHC to achieve health insurance for the state.”

Mr. Iya said mandatory contribution will help achieve universal health care.

The health commisoner for Bauchi, Halima Mukaddas said the state government of Bauchi decentralised the ministry of health in the state which led to the creation of new boards.

“This allows autonomy and allows more focus on the running of health issues.”

Mukaddas said up to 90 per cent of PHCs in Buachi are now under one roof program.

“What is left is the salaries of the health workers.”

You can send in questions on twitter with #healthdialogue

11.35am: The Niger State official, Yahaya Nauzo, said the state is vibrant and filled with intelligent people. ”

If we are leading in achieving UHC, it is because of this.”

Mr. Nauzo called for collaboration of all the health sectors in the state and federal level to achieve UHC.

Another panelist from Kaduna, Cecilia Marcus, said PHC has never been under one roof until this Buhari regime.

Marcus said the government has already upgraded 225 PHC’s in Kaduna State and there are plans to scale up more facilities and health resources.

Recounting challenges PHCs face in Kaduna, Cecilia said there is no equity in the cadre of human resources in the state. She said staffing of PHCs is a major challenge for PHCs in Kaduna.

“We are trying to employ more human resources to fill in the gaps.”

Mustapha Jubril, the commissoner of health Niger State said Niger is number 6 in the last national scorecard for PHCs in the country.

“We have been able to operationalise most of our PHC’s under one roof.”

Jubril however noted that funding is a major issue in the state.

He said there are 274 PHC’s in the state and they have resources and equipments to function.

“The politics to fund these projects is there on the part of the governor. 15 per cent of the local government funds have been signed to go to the PHCs.”

Jubril said the issue of trust to set up insurance program in the state is another challenge.

Daniel Iya, in his closing remark, said the major problem bedevilling the entire health sector is staffing, especially in the rural areas. Iya noted that more than half of PHC’s in the country do not have a qualified midwife or a nurse not to talk of a doctor.

“If we cannot get adequate and qualified hands to man the PHCs then that is a big problem.”

The commisssioners where advised to convey the deliberations related to challenges faced by PHCs across the nation to other commisioners in other states so as to map out new approaches.

Conclusion of panel discussions. Tea Break.

Arrival of her excellency Dr. Zainab Shinkafa Bagudu, Wife of the Executive Governor of Kebbi State, founder Medicaid Cancer Foundation & CEO Medicaid Radiodiagnostics.

12:45 PM Happening now! Panel 5 begins: Cancer survivorship – A critical issue in Universal Health Coverage.

Investigations by PREMIUM TIMES confirmed that there are only eight radiotherapy machines in the whole of Nigeria. Seven of them are in different teaching hospitals across the country, the eighth being the one at Eko Hospital in Lagos.

The number of cancer patients in the country requiring radiotherapy at any time will stretch the facilities even if all the eight machines are working. But at no point ever have all the eight been fully functional.

Patients thus have to book and await their turns for the procedure. For some, their turns never come before they succumb to the killer disease.

Radiotherapy is one of the key regimens in the painful fight against cancer. A cancer patient often needs the treatment at one point or the other. And experts say it is often better not to start it than to have a break in the sessions.

This panel will be discussed by cancer survivors and technical experts. Stay glued!!!

The wife of the governor of Kebbi State, Zainab Bagudu, also founder cancer control advocate, is the first panelist called on stage.

The calling up of Mrs. Bagudu was followed by introduction of panelists.

12:51 PM Cancer survivors recounts there experience.

Comfort Oyayi Daniel, a breast cancer patient, shared how her left breast was removed.

She said she was asked to bring N6 million for surgery. She said she spent almost two years running around for funds until she met with the organisers of Project Pink Blue who introduced her to Wife of Kebbi state governor.

“When she (wife of Kebbi state governor) met me, she gave me a cheque of N500,000. Pink Blue also introduced me to AIT who now helped in the fund raising,” she said.

She said N17 million was spent on the surgery through combined efforts of Pink Blue and other contributors.

“After the surgery, the doctors said I need radiotherapy and Pink Blue came to my aid again,” she said.

She said her left breast was removed and radiotherapy was conducted on her in Lagos.

She however decried the poor state of radiotherapy machines in the country and poor delivery in cancer treatment in the country.

She said cancer is a deadly disease.

“My fiancee left me as a result of this sickness. I no longer have nails and hair on my head, my legs changed colour but I thank God I am alive and I survived,” she said.

She thanked the Pink Blue Project that orchestrated the fund raising project for her treatment.

Ms. Daniel was diagnosed with an aggressive form of breast cancer (HER 2- Positive) for which she had surgery. Because the cancer had spread to her head and lungs, she needed urgent radiotherapy sessions after the surgery.

But she could not get the service in any of the federal teaching hospitals which have seven of the linear accelerator machines in the country. All the machines there had packed up.

Participants asking panelist questions

Group photo with the panelist and sponsors of the National Health Dialogue

2.15pm: A panelist, Moji Makanjuola, the immediate past national co-coordinator of cancer control in Nigeria, shared experiences of cancer cases.

She said a woman she met had a cancer of the breast which was not properly treated.

“You can not stand the stench coming out from her breast. We took to the Abuja national hospital where she eventually passed on. I have lost three patients to cancer,” she said.

“The major issue about cancer treatment even at the early stage is that treatment is not cheap. We don’t have the adequate facilities and equipment in Nigeria that is why most citizens travel to countries like India and even Ghana for Chemotherapy.”

The bulk of money spent in India if brought back to the country would make us one of the best in cancer treatments in the world. Treating cancer at home will also help psychologically for the patients when they are with their family. ”

Makanjuola called for rehabilitation of radiotherapy machines in the country which are in a poor state.

“We have made verbal and media commitment and campaign to tackle cancer but little have being done practically,” she said.

She said cancer should be treated as top health priority.

Cancer leads to the death of 72,000 people in the country annually, experts say. The number is set to increase given that there are 102,000 new cases each year. For a country of about 180 million people, cancer is gradually emerging as a tropical disease due the dilapidated medical infrastructure and poor financing.

Yet, millions of Nigerians still believe that cancer is a death sentence or a punishment from supreme beings.

2.22pm: In her own contribution, wife of Kebbi state Governor, Zainab Bagudu, said a lot should be done in creating more awareness for cancer because, “people are still holding unto their cultural belief. We need to do this awareness through indigenous ways to help prevent cancer as much as possible.”

Mrs. Bagudu also said power has been a major challenge in setting up of cancer machines.

“Ghana does not have the resources Nigeria has but they have the commitment. That is why they are improving in cancer treatment,” she said.

Gloria Orji, a six-year cancer survivor, recounted her experience.

“I was diagnosed with cancer in august 2010. Cancer is a battle between your body and your cells,” she said.

Orji said strikes by doctors, ineffectiveness of radiotherapy machines were some of the problems bedeviling cancer treatment in the country.

“I am a miracle because during my radiotherapy sessions, I never missed one. Cancer patients have no business dying if the right things are put in place,” she said.

Recounting her experience further, Orji said cancer treatment drains the patient physically, emotionally and mostly financially.

Orji urged the government to have the political will to tackle cancer.

She said NHIS stopped covering cancer in 2016. “even the tumor makers to detect cancer type in the body are no longer covered in the scheme.

“We need to keep talking until something is done because spread of cancer waits for no body.”

2.23pm: A panelist, Taofeeq Ige, stressed the need for more survivors to come on board to push the cancer campaign.

“This will show that people can survive cancer, it will give people hope,” he said.

Mr. Ige, a medical doctor, said treating cancer patients is one of the oddest jobs anybody can do.

“To work on people with all forms of negative situation surrounding them.”

Mr. Ige said cancer patients need hope.

2.26pm: The director of Project pink blue, Runcie Chidebe, said everyone has a duty to hold the government accountable.

Chidebe urged Nigerians to spend more time tweeting about cancer and other health challenges in the country than on hate speech and irrelevant things.

“We dont have any agency that checks people for human insurance but we have more than three for vehicle insurance,” Chidebe said.

“We all have to find a way to make an impact in the health sector. it is time to wake up to hold the government by the hand for accountability.

“The whole of South South does not have a radiotherapy machine.”

Chidebe recounted prominent Nigerians that died of cancer: Gani Fawehmi, Dora Akunyili, Remi Oyo, Sunny Okosun, Mariam Babangida, among others.

A participant asked what were the plans on ground to screen students and youth for cancer so as to curb the disease at the early stage.

In response, Kebbi Governors wife, Mrs. Bagudu said cervical screening for students are underway.

She said more awareness was being created among students and youth on health issues.

“We have set up clubs on cancer and sickle cells in the schools where they are thought all they need to know about the disease and we expect that in the next 4 years more students will be abreast of all health related issues,” she said.

Panel 5 is concluded as panelists take turns to snap pictures.

Lunch Break.

3.03pm: Discussions resume: Panel 6: Media advocacy and accountability – Strategies for achieving UHC

Introduction of panelists: Dayo Olorunyomi, CEO Premium Times newspaper is on stage with other panelists.

Mr. Olorunyomi starts by quoting a section of the Nigerian constitution. He said it is the responsibility of the media to hold government accountable.

He charged journalist to go deeper in investigation especially in the health sector. “We in the media need to take the lead in advocacy for UHC.”

Seember Nyager, CEO,Public and Private Development Centre, PPDC said information is important to ensure UHC. She said procurement processes and budgetting especially for health project should be publicized. “We need to follow the budget and procure processes through until service delivery.”

4:01 PM: Mohammed Suleman, a panelist representing the News Agency of Nigeria, NAN said their should be a collaboration between the media and health ministry. He said Nigerians should take health issues seriously.

Ifeanyi Nsofor, a panelist, recounted his experience when he had his first daughter.

Mr.Nsofor said he spent more than $10,000 in foreign hospitals treating his new born baby. He said everybody in the media should be motivated to do stories and advocate for proper health service delivery.

“We should be selfish when it comes to health because we dont know when we will fall victim,” said Mr. Nsofor who works for Nigerian Health Watch.

For Mr. Olorunyomi, health is a key focus in PremiumTimes.

“We are putting lots of attention on it until we get to where we should be.”

He said if we must fix health, we must fix health journalism.

“Health is a fundamental human right, it is not a myth.

Ms. Nyager said Investigative reporting will help to open more channels and discovery to challenges faced in the health sector.

4:02 PM: A participant asked why health as a human right is not enforceable.

Another participant tasked the media to emphasise more on health. She said little has been done on mental health because of inadequate awareness.

Another participant said the media has a greater responsibility when it comes to health.

A participant said that journalists should be developed with skills on how to report health issues. He said that health workers should open up to the media, “Make journalists to understand ssues of health. If media owners and heads dont collaborate with health workers, health stories will not make the front page.”

Another participant said a mindset of the media should be changed. he said the media should be partners of health projects.

4:05 PM: Mr. Olorunyomi in response to questions said health is human right, that is why we need to fight for it.

In response to questions, Mr. Nsofor said the arrangement of the media makes it difficult to investigate issues.

Ms. Nyager said health will not come to you if you don’t fight for it. She said information sharing is very crucial to the effective media advocacy.

Mr. Suleiman, a representative for NAN said journalists should be used as a tool for heath advocacy.

Mr. Olorunyomi concluded by saying, ” Accountability belongs to the citizens, they are the ones who really need to get the government to put things in place.”

Panel 6 is concluded. panelists take a pose for pictures!!

Commencement of panel 7, final Panel: Interministerial cooridnation for health sector financing – experiences and challenges and the way forward.

Panelists steps on stage: the health minister, Isaac Adewole, represented by Banjo Filani, technial assistant to the health minister on finance, was the first to take the microphone.

4:37 PM: Mr. Banjo, who held brief for the health minister, decried poor funding of the health sector by the government.

Mr. Banjo however said partnerships have yielded more results in the health sector especially on Malaria treatment.

“In the last 10 years, malaria has dropped from 42 per cent to 27 through partnerships.”

Mr. Banjo said the minister of health had to write to the president on how to raise more funds for health and how to spend it.

“This year, capital budget for health has about 70 per cent increase from last year.”

Daniel Iya, Nasarawa health commissioner, in his own contribution ,stressed the need for collaboration between the health sector and other sectors, “especially the stakeholders because it is important in the aspect of funding.”

“There is need to increase the interrelationship between the ministry of health and states.”

4:49 PM: Mr. Filani said the outcome of the inter-minsterial committee was to increase the capital expenditure of health and the fund flow for procurement.

He said a PHC is considered gateway to build a proper health system and the financing is very important.

“With the push for UHC, all stakeholders should join efforts to pull funds together.”

Mustapha Jubril, the health commissioner in Niger State, also stressed the need for health funding.

Mr. Jubril said power is key to achieving UHC.

In his submission on interministerial relationship on health concern, Mr. Jubril said every minister should work and act as a health minister because activities of all the ministers are affected by health directly or indirectly.

“Every facility or amenity the country needs, if not well provided, will have an effect on health,” Mr. Jubril said.

Mohammed Jamil-Zakari, commisioner for agriculture in Nasarawa, said agriculture is essential to health because its about people eating eating healthy.

He said there has been collaborations between the ministries of health, agric and commerce. Mr. Zakari however said funding is hindering the progress of such collaborations.

“We need to inject more money to both sectors. No food, No nation. Agriculture is essential to health”, he added.

A twitter user asked how judicious money budgetted for health is used.

4:57 PM: On donor funding, Mr. Banjo said Nigerians in the private sector should key into the health care support space. He said there is need for private sector alliance in the health sector.

In response to how money budgeted for health is spent, Mr.Iya said that tracking needs to be done. He stressed the need that people contracted for health projects should be held accountable.

He urged NGOs and CSOs to track health procurement processes.

On issue of staffing of health care facilities and equal distribution of man power, Mr. Iya decried the inequality in the staffing of health workers. He said some big hospitals in the country are over-staffed while the small PHCs do not have adequate staff.

5:08 PM: Jamil-Zakil in his final submission said there is need for people to know the kind of drugs they take.

He said wrong diagnosis is a major issue eating deep into the fabric of the health lives of Nigerians. He finally submitted that good food is essential for good life.

“When you eat good food, you will be healthy.”

Mr. Jubril also stressed for proper distribution of funds, saying “this is why money budgetted does not bring commiserate result.

“People at different administrative level gets a cut before the funds get to its final destination.”

End of panel discussions.

5:25 PM: Summary of presentations of National health dialogue.

  • Stakeholders should conduct advocacy so health sector can move forwad
  • Inclusion of mental health in NHIS
  • Family planning advocacy should be concerned with health spacing
  • CSO should understand the dynamism of health policies
  • Engagement of community members in health processes so as to hold leaders accountable
  • Equal appropriation of funds.

Vote of thanks to PTCIJ, PACFAR, Project pink blue and other partners. Vote of thanks also went to the Vice President, Yemi Osinbajo; Minister of Health, Isaac Adewole; commisoners, ministers and other stakeholders that graced the health dialogue.

Motion was moved on the communique of the health dialogue.

The Commissioner of Health in Nasarawa State, Daniel Iya, was called to conclude the national dialogue 2017.

Mr. Iya said the national dialogue should be a yearly event.

National health dialogue 2017 ends.

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