To bridge financial gaps of Child and Family Health, the Nigerian delegation at the 2019 Africa Health Agenda International Conference (AHAIC) is holding a session this afternoon, the second day of the event.
PREMIUM TIMES reported that the Development Research and Project Centre (DRPC) in collaboration with the National Institute for Policy and Strategic Studies, NIPPS led the Nigerian delegation for the conference holding at the Kigali Convention Center in Rwanda.
Themed ‘2030 Now: Multi-sectoral Action to Achieve Universal Health Coverage in Africa’, the three-day event is co-hosted by Amref Health Africa and the Ministry of Health of Rwanda.
Speakers at the opening ceremony of the conference yesterday included Diane Gashumba, Minister of Health of Rwanda; Githinji Gitahi, Group CEO, Amref Health Africa among others. They expounded the urgency of accelerating efforts to reach Universal Health Coverage (UHC) in African countries by 2030.
According to Bill and Melinda gates Foundation, Nigeria is one of the most dangerous places in the world to give birth and 4th country with the worst maternal mortality rate.
This is majorly because of poor funding for health.
Nigeria hosted the 2001 conference now known as “the Abuja Declaration”, where African leaders pledged at least 15 per cent of their annual budgets to their health sectors.
But this is yet to become a reality today in Nigeria. The highest percentage since the declaration was in 2012 when 5.95% of the budget was allotted to health.
Also, the joy that the Basic Health Care Provision Fund – a major funding mandate of the National Health Act was added to the 2018 annual budget was short-lived.
To date, funds appropriated under the 2018 and Q1 of the budget for BHCPF have not been released. Also, the BHCPF has not yet been made a Statutory Transfer, meaning there is no guarantee of its continuity.
On the other hand, the National Health Insurance Scheme (NHIS) which is supposed to lead the charge in reducing out-of-pocket spending on health services is Stifled by administrative, legal, political and technical encumbrances coupled with a poor social accountability implementation framework.
It is against this backdrop that the Nigerian delegates led by DRPC and NIPPS would be holding today’s panel session.
Nasirdeen Usman, the Secretary General of the Alumni association of NIPSS, would head the panel discussion themed ‘Unlocking the potentials of Universal Health Coverage as a domestic resource base to meet child and family health funding gaps in Nigeria’, by 3:45pm. at AD 4 hall inside the Kigali convention centre.
A series of strategic engagements and panel discussions would follow until 5:10p.m. when organisers planned to wrap up the session.
Those expected to participate in the session among others include Enyantu Ifenne, Chairperson NHIS; Dogo Muhammad Waziri, Past Executive Secretary NHIS; Kyauta Bulus Tanyigna (NIPPS); Nneka Orji-Achugo, Health Economist at the Nigerian Federal Ministry of Health among others.
Lanre Tejuoso, the Chairman, Senate Committee on Health is also expected to be at the session.
Follow this page for extensive live coverage of the event.
3:50 Kigali Time: 2:50 Nigerian Time – Nasirdeen Usman, the Secretary General of NIPPs, the anchor of this afternoon’s session takes stage.
First to be welcomed on the high table by Mr Usman is Mr Tejuoso who played a significant roll that saw to the approval of the BHCPF in the Nigerian budget for the first time in 2018.
He was followed by Mrs Ifenne, the chairperson of the NHIS governing council and Mr Mohammad-Dogo, a former Executive Secretary of the scheme. Other panelists are now on stage.
Mr Usman starts by reeling out the grim statistics of the NHIS coverage in Nigeria. He says only 5 percent of Nigerians are covered under the NHIS. Of that 5 percent he said only 4 are in the formal sector with only one percent in the informal sector.
“It is as bad as that. In view of this we want to interrogate why we still have serious deficit in our journey to Universal Health Coverage (UHC).
He says Nigeria is falling behind in achieving the 15 percent commitment of the Abuja Declaration.
The first part of the discussion starts with the policy angle of achieving UHC.
Kyauta Bulus Tanyigna of the NIPPS sets the ball rolling on the policy discussion.
Mr Tanyigna, a professor says the role of policy in achievoing UHC is very fundamental. He goes down memory lane when president Abulsalami Abubakar signed policy for the UHC. The coming of teh Olusegun Obasanjo regime he said heralded the inception of the NHIS.
He says all these where achieved through policies but “we are yet to make reasonable progress in implementation.”
He speaks about the percent allotted to health in the Nigerian annual budget. He listed some African countries that have achieved the 15 per cent Abuja declaration.
He says through good policies, the 15 percent benchmark is achievable and can also chart the road-map in achieving UHC.
Senator Tejuoso speaks for the first time. he says to achieve UHC has been a tough road in the senate. he says there so many unimplemented laws in Nigeria.
He explains the pivotal role he played in the implementation of the National Health Act. “first of all I had to educate and lobby my colleagues on the need for health financing. I started with the senate president. i told them let us consider the Basic health Provision Fund.
“In 2016 and 2017, nothing happened, but in 2018 pur advocacy amplified. With help of PACFAH we formed what we called the legislative network. We were able to bring in so many legislators and it was the game changer.”
The BHCPF is the fundamental funding provision under the National Health Act and was appropriated for the first time in the 2018 budget since the Act was signed in 2014.
It provides for not less than one percent of the Consolidated Revenue for health funding.
The federal government earmarked N55 .1 billion for the CRF to the basket fund of the BHCPF, while the Bill and Melinda Gates Foundation contributed $2 million, out of which $ 1.5 million has been released.
The Global Financing Facility (GFF) has also committed $20 million to the fund, while the Department for International Development (DFID) is also putting 50 million pounds sterling over the next five years.
Though approved in the budget and a plan for its implementation ‘rolled out’, the fund is yet to be fully released and it again restored the argument over non-implementation of the Act to the front burner.
The fund is expected to help revive the health sector, especially primary healthcare centres (PHCs) many of which have been abandoned across the country.
The fund is also envisaged to help reduce out of pocket spending on health care through the NHIS.
DRPC played an advocacy role that led to putting the BHCPF into the budget.
The senator said apart from legislation, the executive needs to also play a major roll in the implementation and release of the BHCPF.
“Up till now, the BHCPF is yet to be released and if it’s not released how can we now advocate for it to be added in subsequent budgets”, Mr Tejuoso queried.
He also explains the implementation manual developed for the BHCPF.
3:17 pm Nigerian time – Discussions now on Implementation.
Mrs Ifenne has been the chairperson of the governing council of NHIS since it was inaugurated March last year.
She says the problem is also from the act. She says the scheme lost its way on the way. “NHIS is now in the dark. It is supposed to be the finance enabler but missed its focus.”
She also blames the structure of the Nigerian government as the major cause of poor finance and system of the country’s health sector. Mrs Ifenne says the NHIS is supposed to be compulsory and public inclined.
3:24 Nigerian Time: Muhammad-Dogo, the former E.S speaks on challenges and experience in technical know-how in terms of strategic implementation.
He says this session presents an opportunity for him to speak about the NHIS seven years after he left.
The reign of Dogo-Muhammad, a medical doctor at the NHIS came to an end after Abdurahman Sambo was appointed to take over from him in February 2012.
He goes down memory lane on how he was appointed as NHIS boss. He says he was not the first ES of the agency. He says there are four executive secretary of the scheme before him.
The former ES says upon his assumption of office, he identified 24 problems which he said 23 of them were treated.
“The only one I did not do is the act and that has been the problem of the scheme up till now.” He says the act alters the foundation structure of the scheme.
He says the act was written by the HMOs who are the major problem stifling progress in the scheme.
“NHIS should have been made compulsory. The distribution of our health resources is skewed. Before the NHIS can act, we must have a very strong health system. We have a weak health system.”
With the kind of system we have, Dogosays we cannot sustain 100 percent of coverage in NHIS.
It was because of what Nigerians go through in the quest for often expensive medical care that brought about the establishment of NHIS.
However, since its establishment 13 years ago, a majority of Nigerians are yet to be covered under the scheme.
The embattled executive secretary of the scheme, Usman Yusuf said last year that over 90 percent of Nigerians are not captured under the NHIS.
Many have traced the relatively poor coverage to the structure of the scheme which has been tainted with financial irregularities which had gone unchecked even before Mr Yusuf took over in 2016.
In fact, many described the arrangement of the scheme as skewed against the people.
NHIS deals with two major operators; Health Maintenance Organisations (HMOs) and Health Service Providers (HSPs). The agency disburses money to the HMOs every three months who in turn pay the health service providers monthly for health services of enrollees.
But there have been complaints that the scheme is unable to relieve Nigerians of their health finance burdens as a result of which people still largely spend out of pocket for health care.
At least 450 petitions were sent to the National Assembly by frustrated Nigerians in 2017. 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.
Mr Dogo gets emotional. He says it hurts him to see that NHIS have always been in the news for the wrong reasons.
“Since inception, the NHIS has not been able to live up to expectation but that does not mean there are not people who are passionate about the scheme.
“All I have built in the scheme now goes down the drain. It hurts. I was supposed to be given a second term in the scheme but I was not retained. Now see what is happening in the scheme.”
Orji-Achugo, the Health Economist explains the plan of the Ministry of health in implementing the BHCPF.
She says the design for the manual of the BHCPF is comprehensive enough to drive progress for the UHC progress.
3:47 pm. Nigerian Time: Participants throws questions at the panelists.
A participant says shes thoroughly disturbed that NHIS has not lived up to its mandate 14 years on.
Another asks if there are proper data management system for the Nigerians covered under the NHIS.
3:57 PM Nigerian Time: Panelists speaks on way forward, answers questions raised by participants.
Mr Tejuoso speaks on how the youths can drive progress for UHC. He stresses the need for collaboration with youths.
On data, The senator says every health institution must have a certificate of standard. the ministry of health is yet to develop that, he adds.
He also speaks on the plenary on reviewing the NHIS act in the national assembly over a year ago. He says workers of the scheme protested against repelling of the act as at then.
Mr Mohammad-Dogo says the easiest way to get Universal contribution and coverage running is through the BHCPF.
Also on the way forward, Mrs Orji-Achugo says the national health account is another system that will drive progress. She also reiterated how the BHCPF design will drive progress of the UHC.
She also said stresses the need for private sector inclusion in the drive for UHC. She asks NIPPS to also help develop a workable plan.
Mr Tanyigna of NIPPS says the institute has a leverage of meeting and giving reporting its findings yearly to the president directly.
NIPPS – 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 General Ibrahim Babangida, the former Nigerian Head of State, and Mallam 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.
Tangiya, a professor says delegates of NIPPS at this health conference will make their findings at the event a focal point in what it will present to the president later in November.
“we are keeping tabs to everything we are learning here”, he noted.
4:15Pm Nigerian Time: Event wrap up – Mr Usman, the moderator who doubles as the director of studies at NIPPS takes stage. Thanks both participants and Panelists.
4: 30PM Nigerian Time – Participants networking, taking group pictures after the seesion.