Concerned about the poor funding of the health sector, members of the World Bank Group, Senate President Bukola Saraki and the Minister of Health, Isaac Adewole, will on Tuesday join other policy makers and stakeholders at the Shehu Musa Yar’Adua Centre, Abuja, for a summit on provision of quality healthcare for Nigerians.
The event, on improved healthcare financing model for a sustained investment in the health sector, is being put together by THISDAY newspaper in conjunction with the World Bank Group.
The theme of the summit scheduled to begin at 10 a.m. is “Moving Nigeria towards Universal Health Coverage through Appropriate Financing.”
Organisers say the summit aims to galvanise discussions on why the country should prioritise financing of the health sector as a bastion of human capital development critical for the achievement of the Economic and Growth Recovery Plan.
President Muhammadu Buhari allocated N340.45 billion to the health sector in the proposed 2018 budget. This represents 3.9 per cent of the total N8.6 trillion budget.
If the appropriation bill is passed as it is, it would imply a three-year consecutive decline in the allocation to health sector
Allocation to the health sector in 2017 and 2016 were 4.16 per cent and 4.23 per cent of the budgets respectively.
This means Nigeria has again ignored the commitment it made alongside other African countries 16 years ago on funding of health care services for its citizens.
Nigeria hosted the Heads of State of member countries of the African Union (AU) in 2001. There the “Abuja Declaration” was made with the leaders pledging to commit at least 15 per cent of their annual budgets to improving their health sector.
Since the declaration, Nigeria has not attained the pledged funding benchmark as the federal government has never voted more than six per cent of its annual budget to the health sector.
The 2018 health budget is in percentage terms the lowest so far.
The budgetary allocation is against the backdrop of recent outbreaks of Lassa fever, Measles, Meningitis and the fight to end polio and high maternal and child deaths.
The country is also beset by poor primary health facilities, lack of functioning cancer machines or treatment centres, poor health emergency responses and low coverage of the health insurance scheme, among other issues.
PREMIUM TIMES bring you live updates of the health summit.
9:51 am – It’s a sunny morning in Abuja, the temperature in currently at 22oC.
Premium Times is at the Shehu Musa Yar’Adua Centre, to bring you live updates on the THISDAY Healthcare Financing policy Dialogue.
The summit on provision of quality healthcare for Nigerians. The Theme of the summit is Moving Nigeria towards Universal Health Coverage through Appropriate Financing.””
9: 53 am – People are beginning to walk into the hall.
9:55 am – Pressmen are also setting up their cameras while more people are taking their seats.
10:25 am – Members of the World Bank Group entering the Atiku Abubakar Auditorium, the venue of the event.
10:32 – The Moderator, Benjamin Obiri, takes the stage. He says the event is starting late because of an event going on in the ministry. They are waiting for the minster.
10: 35- Event has started. Mr. Obiri calls to the podium the chairman of the THISDAY Group, Nduka Obaigbena, to give the opening remark.
10: 36 Mr. Obaigbena welcomes people to the first THISDAY policy dialogue focus on health care.
He said THISDAY had focused a lot on economy and politics in the past, but it is is time to shift to health and social problem.
Three things he says will make Nigeria better – fighting insecurity, inequality and injustice. He says fighting inequality will help fight the insecurity in Nigeria.
Mr. Obaigbena says Nigeria needs to focus more on health and education.
“In the next 12 months this day will focus more on health. this years’s THISDAY award will not honour banks or politicians but people in the health and education sector.”
10:45 am – Olusoji Adeyi, Director Health Nutrition Population of World Bank Group, the keynote speaker takes stage.
He explains the meaning of Universal Health Coverage, UCH. According to Mr. Adeyi, achieving UCH leads to economic growth.
He says Nigeria is too inefficient in managing the health of its people. “70 percent of total hospital expenditure in the country is out of pocket.”
He further used infographics to analyse the funding of the country’s health sector over the years.
“When the health sector is underfunded, UCH can hardly be achieved,” the World Bank official said.
Mr. Adeyi listed solutions to solve financial challenges bedeviling the health sector.
They include: Public accountability for basic health services; credible budgeting of public fund for UCH; Planning, monitoring and evaluating funds for federal and state health ministries; shift to pre-paid healkth financing; out of pocket payments at point of delivery; equipment monitoring among others.
According to Mr. Adeyi, basic essential health services should be free to Nigerians at point of delivery.
Using an Infograph slide, he highlighted the 6 models of health financing.
Using one of the models as an example, Mr. Adeyi said a sovereign country like Nigeria should not depend on the aids it gets from foreign countries to cater for the health of its people.
On health insurance, the world bank officials says Nigeria should consider mixed revenue scheme.
11:20 am – The Minister of Health, Isaac Adewole, gives an opening remark. The remark was read by his aide.
“The National health act was passed in 2016 and followed with policy on improved Primary Health Services,” he said.
He said more than 75 per cent of the population of the country spend out of pocket for health services.
The minister further decried the poor funding of the health sector saying the federal and state government should increase spending on health.
He said the coverage of the NHIS is significantly low because the scheme was pre-designed for the formal sector.
He said Primary health Care in the country lacks basic amenities. equipment and drugs.
He further gave an insight on the benefits of implementing the National Health Act. “Now is the time for implementing the National Health Act.”
The minister had an interview with PREMIUM TIMES in January 31 said all parts of the act has being implemented except the Basic Health Care Provision Fund, a position the Nigerian Medical Association refuted.
He also spoke on scheme for increased funding for health.
As the aide was reading the speech, the minster walked in.
11:37 a.m. – the minster takes the stage.
Mr. Adewole stresses the need to emphasise on infrastructure.
“There is a lot to gain in investing in social services, health and education.”
He says putting the bulk of the blame of health care delivery on only the federal is wrong.
“The states commissioners should also be held accountable.”
The minister further tasks the media to hold the states accountable for poor health delivery in the country.
He thanked THISDAY newspaper for organising a summit for discussion on health financing.
He said the health ministry will partner with THISDAY.
11:43 a.m. – Moderator takes stage again, introduces first panel discussants.
11:44 a.m. – Panel discussion on private sector partnership.
11:46 a.m. – A Panelist, Femi Odunoye, Health Advisor for Shell explains how the Shell company engages in health coverage of its employees.
Uche Orji, CEO Sov. Investment Authority says healthcare is one of the five areas of focus for his company.
Mr. Orji says the company is working with teaching hospitals and federal hospitals to improve health coverage.
“We are partnering with about 10 hospitals in the country in terms of equipment and quality health care”, Mr. Orji said.
Chidi Izuwah, CEO, Info. Con and Reg. Commission, a panelist, explains why there is low partnership of the private sector on Health.
He says the problem we have on health is under-funding. He explains the difference between finance and funding.
According to Mr. Izuwah the private sector can play a key role in financing health sector while the federal government takes care of the funding.
“When there is an assurance funding is provided, there is need for provision of pool resources replicated in all states and villages”, he said.
He also spoke on laws of contract for private partnership on health.
He says there is no problem with the law but creating an enabling environment for private sector partnership.
12:05 a.m. – Another panelist, head of a Health Management Organisation, HMO, speaks on the structure of the NHIS.
He says the scheme has been structured to take care of federal civil servants. He says 99 per cent of federal civil servants are covered under the scheme.
“What is expected is that states and local governments should take cue,” he said.
He, however, says the informal sector is under-covered.
He says the the structure of NHIS was not followed the way it was constructed since inception in 2005.
He passed the bulk of blame relating to poor coverage on the regulators.
His comments come amidst several complains of the health insurance scheme. No fewer than 450 petitions have been sent to the National Assembly by frustrated Nigerians. The complaints ranged from lack of attention by hospitals, delayed attention, low drug dispensing to enrollees in the scheme and sometimes rejection of patients because of the inability of HMOs to meet their payment obligations to hospitals.
Last June, calls for investigation into the activities of the scheme prompted a public hearing at the floor of the House of Representatives on how N351 billion was spent by the scheme since inception 13 years ago.
According to the newly reinstated Executive Secretary of the scheme, over 90 per cent of Nigerians eligible for the scheme have not been covered.
12:19 a.m. – Second panel discussion on public financing for health.
Panel discussants including the health minister, Isaac Adewole, and the Senate Committee Chairman on Health, Olanrewaju Tejuoso, take stage.
12:24 a.m. – The Minister of Health speaks on revitalization of 10,000 primary health centres across the country as proposed by the government.
He says about 4,000 PHCs has being revitalised.
He decries the fact that a large part of the revitalised PHC is done by foreign investors.
He says the government is on the road towards revitalizing 10,000 PHCs in the country.
He lists the PHCs revitalised by foreign investors.
The minister urges the states, local governments and private sector to key in.
12:31 p.m. Senator Olanrewaju Tejuoso speaks on the Abuja declaration.
He decries that Nigeria is yet to provide up to five per cent of its budget on health.
He says the National Assembly is proposing to amend the National Health Insurance Scheme, NHIS.
The Senator had in December said the Senate is reviewing the National Health Insurance Scheme (NHIS) Act to make healthcare delivery affordable in the country. He said the move was part of efforts by the legislature both at the national and state levels to ensure Universal Health Coverage (UHC).
12:38 am – Senator John Owan Enoh speaks on the underfunding and inefficiency of the expenditure of the health budget.
He explains how the health budget has been inefficiently funded.
On the Basic Health Care Provision Fund, Mr. Enoh says there is no provision yet for it in the 2018 budget. He says “we are quite hopeful that will be done before the budget is appropriated.”
He further says inclusion of the Basic health Care Fund is not the main issue but its implementation.
12:45 am – Another panelist, Olusoji Adeyi, Director Health Nutrition Population of World Bank Group says Basic Health Care Provision Fund should be prioritised.
He reiterated his earlier comment that Nigeria should not rely on aid from other countries to fund its health care system.
12:54 am – Hon. Betty Apiafi, a panelist, says the National Assembly just passed the residency bill which will hopefully improve residency training in Nigeria and thereby reduce incessant strikes by resident doctors.
In his closing remark, Mr. Tejuoso says he and the minister of heath should be held accountable if enough fund is not allotted to health in the 2018 budget appropriation.
12:58 am – Panelists takes questions from participants.
A participant, Mike Egbo, asks “how do we ensure discipline, trust in execution of health funding and financing?
Another participant asks “How sure are we that all Nigerians will be covered in the new arrangement of the NHIS?
A female participant asks, “How do we make sure that the money put into health by private sector is properly utilised?
Ikenna Nwakamma, a participant, asks, “How do we finance local technology, manufacturers, actors to improve health?
Remi Adeseun asks, “How are we sure that Basic Health Provision Fund is included in the 2018 budget?
A panelist asks, “How can we leverage on technology to ensure improved health service delivery?
A panelists asks, ” How can we stem the tide of medical tourism in the country? What is the ministry of health doing to ensure establishment of the National Cancer Research Centre?
1:16 pm – Panelists take time to answer questions thrown at them by the participants.
Senator Tejuoso in response to questions on Basic Health Provision Fund says if we do not achieve this, there is no point in introducing any other law to Nigerians. He says the lawmakers will make sure the provision is included in the 2018 budget. He also says old people will be included in the new arrangement of the NHIS.
Mr. Adeyi, a World Bank Official, also responds to questions. He stresses the need for proper family planning so as to check the increasing rate of the population of the country.
The Minister of Health, Mr. Adewole, responds to questions on establishment of Cancer Research Centre. He says over the years, Cancer machines have being bought and installed but they broke down because it was badly managed. Mr. Adewole says in the new structure for cancer facilities, the Health Ministry is being cautious in putting people that will manage cancer equipment for cancer facilities.
In his closing remark, the minister says the health sector is underfunded and under performing.
He further thanked the management of THISDAY newspaper for putting up the summit.
He says there is more to be done going forward. He says he will inaugurate a committee for health funding management.
He says if the Basic Health Care Provision Fund is implemented, the National Assembly has done the country proud.
He further calls for partnership from government, public and the private sector.
He decries poor participation of the states in health financing of the country.
He also speaks on local drug production in the country.
“Since we came on board, we have deliberately patronized local drug producers”.
The minister also urges Nigerians to prioritise family plan so as to have children they can cater for.
1:37 pm – Goodwill messages.
Clement Uwaifo, Permanent Secretary, Ministry of Health, in his goodwill message said the ministry has been interfacing with the private sector to reduce out of pocket spending for health delivery for Nigerians.
He further thanked the THISDAY Newspaper and the World Bank Group for putting up the innitiative.
Eniola Bello, Managing Director, THISDAY newspaper reads the communique and vote of thanks: He says although investment in health leads to economic growth, Nigeria has invested little in the health sector.
He also says implementing the national health act is the way forward to achieving universal health coverage.
Recommendations: Government should invest more on health; Government should implement Basic Healtrh Care Provision Fund.
He says government should also enagage the use of more private partners to futher service delivery within the health sector.
With that, Mr. Bello brought the session to an end.