National Health Dialogue: Nigerians discuss challenges, solutions of achieving universal coverage (LIVE UPDATES)

National Health Dialogue
National Health Dialogue

Welcome to the 2019 National Health Dialogue.

PREMIUM TIMES will bring you live updates of this annual event that holds Tuesday and Wednesday.

About 500 participants from Nigeria and other parts of Africa are converging at the Nicon Luxury Hotel in Abuja to advance conversations initiated in the maiden edition of the annual conference two years ago.

Organised by Premium Times Centre for Investigative Journalism (PTCIJ), the Project for Advocacy in Child and Family Health, PACFaH@Scale, the Project Pink Blue and the Nigerian Governor’s Forum (NGF), this event promises to lock citizens and stakeholders in a lively debate that will drive the quest for Universal Health Coverage (UHC) in Nigeria.

Those attending include health practitioners and advocates, as well as political, religious and traditional leaders. The public and private sector and the media will be at the event.

They will discuss the most pressing issues affecting the health sector and co-create home-grown solutions.

READ ALSO: #HealthDialogue: Osinbajo, Gombe Emir, other stakeholders to address Universal Health Coverage in Nigeria

The dialogue intends to raise questions on implications of not positioning health financing as an investment.

Participants will have an opportunity to ask critical questions on various government programmes, policies, laws, and structures with regards to health funding and service delivery.

Ahead of the event, PREMIUM TIMES presented six things participants should expect from the dialogue.

Keep refreshing this page to stay updated!

10:30 a.m. – Event Commences Proper

“Good morning ladies and gentlemen. I will be your anchor for this epic event. My name is Mo…”, the ageless voice of Moji Makanjuola echoes through the walls of the 600 seater conference hall filled to the brim by participants, special guests, panelists and the media.

Mrs Makanjuola, a renowned broadcaster who held her audience spellbound in her 35-year stint at the Nigerian Television Authority (NTA) – with her style of presentation and charisma – is the MC of this year’s annual health dialogue.

Her career rolled off with journalism having trained in Lagos in 1977 and the NTA TV College, Jos, in 1983.

With further training at Voice of America Training School in 1998, she proceeded to American Heritage University of Southern California, USA, where she obtained a BA in media studies.

Though she has retired from active practice, Mrs Makanjuola has continued to contribute significantly to the improvement and developments of journalism in Nigeria, especially in the area of health reporting.

A day before the event, Mrs Makanjuola expressed delight that the media is championing this dialogue to improve health services in Nigeria.

“Who best to do it than the media”, she had told this reporter. “The media has become a strategic tool to improve, investigate and track health interventions.”

After her self-introduction which perhaps was unnecessary, the awestruck audience was left gushing – especially those who knew her in her days.

The soft-spoken veteran then proceeded to ask the audience to stand for the national anthem before the national pledge was recited.

She gives an insight into what brought about the national health dialogue.

She acknowledges several challenges bedeviling the health sector. The moderator believes that there is an urgent need for health prioritization in Nigeria.

Mrs Makanjuola calls on Dapo Olorunyonmi to give his welcome address.

10:52 a.m. – Dapo Olorunyonmi’s welcome address.

Mr Olorunyomi, a frontline journalist, is the publisher of PREMIUM TIMES newspaper.

Dapo Olorunyonmi
Publisher of PREMIUM TIMES newspaper – Dapo Olorunyonmi

‘Dapsy’ as his fondly called is formerly a policy director and the chief of staff to the EFCC, Nigeria’s graft agency where he led the Commission’s crimes prevention and education policy development initiatives on corruption.

He had worked and still working with various media organization across Africa where he has continued to champion the course of journalism.
Mr Olorunyomi starts his remark by acknowledging the partners of PREMIUM TIMES in organising this event.

He thanked them for working tirelessly to ensure the success of the event.

He specifically appreciates the efforts of the Nigeria’s Governors Forum (NGF); PTCIJ; PACFAH@scale and Project Pink Blue.

He believes no nation can attain greatness if they don’t stand on the evidence of healthy citizens.

He eulogizes Stella Adedevoh who died as a “result of her sacrifice when Nigeria was under the scourge of Ebola Virus”.

Ameyo Stella Adadevoh was the Lead Consultant Physician and Endocrinologist at a private hospital in Lagos, Nigeria where she worked for 21 years. She had never seen Ebola before but was able to diagnose and contain Nigeria’s first-ever Ebola patient in July 2014. When threatened by Liberian officials who wanted the patient to be discharged to attend a conference, she resisted the pressure and said, “for the greater public good” she would not release him.

Since Nigeria’s health system was not prepared for an outbreak at the time, she contracted Ebola and died alongside 3 of her colleagues. Her heroic efforts prevented a major outbreak in the most populous African country and served as the catalyst for successful government action to contain the spread of what would have been a major outbreak in a country of more than 190 million people.

Mr Olorunyomi said her birthday is coming up in October 21 and charged Nigerian to celebrate her heroic efforts.

The journalist said late Adedevoh’s bravely should be emulated in the drive for Universal Health Coverage which is the theme of this event.

He said online petition has started in honor of the death of Adedovoh. he said PREMIUM TIMES has subscribed to the petition, urging ever one else to so.

11:00 a.m. – Goodwill Messages

The Representative of the Ambassador of Japan to Nigeria, Imamura Tatsuya, is the first to deliver a goodwill message.

Ambassador of Japan to Nigeria, Yukuta Kikuta
Representative of the Ambassador of Japan to Nigeria, Imamura Tatsuya

He appreciates the effort of the organisers of the event.

He gives an insight into the Nigeria-Japan partnership in strengthening the health sector.

He explains how the Nigerian President Muhammadu Buhari shared his belief in strengthening the health sector during the Tokyo International Conference on African Development (TICAD7).

He said UHC is a “quintessential example of brand Japan” at TICAD7. He said the government of Japan pledged to bring UHC to 3 million recipients in Africa.

The Director-General of the Nigeria Governors Forum (NGF),  Asishana Okauru, in his goodwill message said the Forum is delighted to play a part in the dialogue.

He describes the health indicators in the country as “shameful and disturbing.”

He mentions malaria, mortality rate, HIV and other indices where Nigeria is sitting at the bottom.

Hence, he believes it is important that state and non-state actors spring to action as the theme of the event suggests.

He said UHC is a top priority of the NGF. He announces that the forum is in the process of developing a dashboard that would aid the improvement of access to accelerate UHC.

11:20 a.m. – Lecture by Chiedo Nwankwo – Journey towards achieving SDG 3.8 (UHC) and the paths to achieving success

Africa is falling behind in achieving Sustainable Development Goal (SDG) Three, one of the 17 goals set by the United Nations General Assembly in 2015 for the year 2030.

Chiedo Nwankwo
Chiedo Nwankwo

Achieving UHC by 2030 is the central target of SDG 3.8.

Targets of SDG 3 includes ending preventable deaths of newborns and children under five years of age by 2030.

However, five children under five years of age are still dying from preventable causes every five minutes in Africa, according to the World Health Organisation (WHO).

Nigeria’s national health dialogue, now in its second edition, arose from the need for home-grown solutions, innovations, political commitments and lessons from successes and setbacks of other African countries in achieving affordable health for all.

Mr Nwankwo, a medical doctor, and writer starts her lecture by reeling the various challenges preventing Nigeria from achieving UHC.

She bemoans how the country seems to have neglected its collective role in healthy wellbeing in the country.

Mrs Nwanwko said the vulnerable groups need to be covered by the appreciable amount of health subsidies and insurance.

She said the poor and vulnerable groups should be carried along. “They should not spend the liitle they have and get improvershed in their quest for quality health care”

The health experts begin to dish out statistics on how Nigeria has failed to provide adequate funding for health.

She said Nigeria has failed to meet the 15 per cent Abuja declaration of 2001.

It is the realisation of shortfalls in their health systems that made African governments commit in April 2001 to dedicate at least 15 per cent of their annual budgets to the health sector in what is now known as the ‘Abuja Declaration’.

Sixteen years later, only about seven countries — Rwanda, Botswana, Niger, Zambia, Malawi and Burkina Faso, Togo — have met the Abuja target. In 60 per cent of the countries, the health sector share of total government expenditure is below 10 per cent.

Nigeria that hosted the conference has never voted more than six per cent of its annual budget to the health sector.

The highest percentage since the declaration was in 2012 when 5.95 per cent of the budget was allocated to health.

She said the poor spending on health has huge repercussions on the poor people of the country.

“Nigeria is one of the worst places for maternal, newborn child care in the world”, she said. “The figures are startling”.

She said the bright side to the gloomy situation is noted in the heroic sacrifices made by some health workers in the country.

“Today, we remember late Stella Adadevoh for what she did during the Ebola crisis. Her sacrifices should not be forgotten.”

She mentions other health workers who have positively impacted the health sector.

She, however, alludes that more is needed to be done especially by state and non-state actors in the country.

She reaffirms her initial opinion that for UHC to be achieved, the informal sector needs to be adequately covered.

She says the state has a huge role to play in covering this group.

She concludes her lecture by urging the state to take a bold step in driving change in the health sector.

Mrs Nwankwo admonished others in the private sector to emulate from PREMIUM TIMES in the quest for improvement in the health sector.

Keynote Address by Muhammad Dogo, Former NHIS chairman – Achieving UHC in Nigeria – How feasible is 2030?
Muhammad Dogo, Former NHIS chairman - Achieving UHC in Nigeria
Muhammad Dogo, Former NHIS chairman – Achieving UHC in Nigeria

Mr Dogo starts by reeling out various statistics showing that Nigeria is already offtrack in achieving the SDG goals for 2030.
Achieving UHC by 2030 is the central target of SDG 3.8, one of the 17 goals set by the United Nations General Assembly in 2015 for the year 2030.
Targets of SDG 3 include ending preventable deaths of newborns and children under five years of age by 2030.

“Nigeria is already offtrack”, Mr Dogo said.

Challenges stopping Nigeria from Achieving UHC by 2030

He explains how UHC was brought on board to change the landscape of health funding and service delivery in Nigeria.

The medical doctor said achieving UHC under the current situation in Nigeria is most challenging.

He highlights various challenges to attaining UHC by 2030 in Nigeria.

Implementation: He said various program that would have helped in achieving UHC is mostly not being implemented.

Constitutional Bottlenecks: He said the legal Provisions that should guide the various health policies and interventions have to be reviewed.
“In particular the Nigeria Constitution does not define the place of Health in either concurrent or the exclusive list. Thus, the issues of health are not having a strong constitutional backing.

“This gives way to the 3 tiers of government not adhering to Declarations relating to health matters ie the 2001 Abuja Declaration for the allocation of 15% of the annual budget to health has never been attained eighteen years after. Even the annual budgetary allocations for health across the 3 tiers of government are inadequately cash-backed. This brings us to the issue of funding for health.”

Weak Funding Model: The health expert said the funding models as they are now have failed to give support to the health system that could work for us.
“Thus, the health system has remained very weak over the years. Currently Out-of-Pocket (OOP) contributes around 72.8% with attendant consequences to households as in many cases it pushes families into poverty. Budgetary allocations as earlier discussed are inadequate ie the federal government allocated only 3.8% to health in 2018.

“The health insurance which should collect contributions, pool and purchase services stands at around 5%. The forth model being donations from international development partners is unpredictable, uncoordinated and there is high administrative cost. Additionally, there is donor fatigue.”

other challenges mentioned by the keynote speaker include population overgrowth; Unreliable/inadequate data; high leadership turnover; corruption among others.

Conclusion

Nigeria as the giant of Africa has all it takes to be a major player in the global space. It has its challenges, just like any developing nation. However, the human resource and other resources at its disposal is adequate enough if properly deployed to achieve UHC by 2030.

Recommendations

1) Repeal the current NHIS Act 1999 and enact the NHIC Act 2019.

2) Political will/commitment

3) Increase funding by attaining 15% budgetary allocation by the 3 tiers of government, earmark mobile phone levy and other innovative ways of financing

4) Stabilize the leadership sourcing of CEOs through Due Process

5) Create more public awareness

6) Strengthen the health system through upgrading facilities, improving the welfare of human resource for health

7) Improve the purchasing power of the populace through human capital development and enterpreunueship

8) Look at other non-health issues that have bearing on health through improving intra- and inter- ministerial collaboration

9) Monitoring and Evaluation to capture quality data for health and assess the impact of interventions and outcomes

Other Recommendations: –

Mr. President to assent to the National Health Insurance Commission Act 2019

Advocacy to: – a) Political class at all 3 tiers of government

b) Traditional leaders

c) Religious leaders

Paper presented by Emir of Gombe, Abubakar Shehu Abubakar 111: The role of traditional institutions in achieving UHC for women and children
Emir of Gombe, Alhaji (Dr) Abubakar Shehu Abubakar III
Emir of Gombe, Alhaji (Dr) Abubakar Shehu Abubakar III

The traditional ruler starts by saying his paper will be looking at the concept of UHC vis-a-vis the broader health issues affecting women and examine roles played by traditional rulers in the past and presently.

He explains how the British and other colonialists used traditional rulers in administering, which further helped in improving the health sector.
He said traditional rulers have an advocacy role to play in driving UHC.

 

Nigeria’s vice president, Yemi Osinbajo, represented by Nicholas Audiferren, his chief personal physician, declares the national health dialogue open.

12:30 p.m. – Tea Break
Panel Discussion one: UHC in Nigeria – Challenges and Prospects of the National Health Insurance Scheme (NHIS) in the Formal Sector
This panel is moderated by Gafar Alawode, country director Policy Plus.
Overview of the Formal Sector

Under the NHIS program, the health care of employees in the formal sector is paid for from funds created by pooling the contributions of employees and employers. The contributions paid cover health care benefits for the employee, a spouse and four (4) biological children below the age of 18 years.

In the organised private sector, health insurance is paid for by willing individuals or employers on behalf of employee in organizations.

The rough and rocky road of NHIS

Health insurance has been globally recognised as the fastest route for any country to achieve Universal Health Coverage.

Acknowledging this, Nigeria launched the NHIS in 2005 – the same year with neighboring Ghana.

While Ghana’s scheme has covered over 50 per cent of its population, today, Nigeria can only boast of 5 per cent coverage of mostly the informal sector – civil servants and corporate workers in the private sector.

While millions of Nigerians remain uncovered, the few enrolled are complaining of inadequate service delivery as crisis and controversy continues to beset the scheme.

No fewer than 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.

Calls for investigation into the activities of the scheme had prompted a public hearing at the floor of the House of Representatives on how N351billion was spent by the scheme since inception.

Challenges:

· The Act

The establishment Act of the NHIS is said to be the foundation of all the challenges rocking the scheme.

With a new act, practitioners in the health sector believe the functions of the scheme will be clearly stated.

After protracted and spirited calls for a repeal of the act, the immediate past 8th National Assembly initiated and passed the piece of legislation before it bowed out in June.

Titled “National Health Insurance Act (Repeal and Re-enactment) Bill 2019”, the new bill, when made law is expected to invalidate some aspects of the old law (2004).

They include:

I) Making Health Insurance Mandatory.

II) Subsidising Premium Payments for those who cannot afford it.

III) Stating roles of states which were not clearly stated in current NHIS Act.

IV) The enforcement of the NHIS Act through the implementation of the Basic Healthcare Provision Fund (BHCPF).

V) Limited Regulatory Powers of the NHIS to effectively carry out its functions.

The bill has since sent to President Muhammadu Buhari for assent but he is yet to take a decision.

In his first public address after assuming office, the executive secretary of the scheme, Mohammed Sambo said Nigeria cannot achieve UHC until the NHIS is made compulsory.

Jonathan Eke, a representative of NHIS executive secretary, said despite the myriad of challenges and setbacks bedeviling the NHIS, Nigeria can still achieve UHC even in the next five years with the right political commitment.

“The template is already there with us in the NHIS”, he said. “what is needed is a strong political commitment.”

Mr Alawode, the moderator shifted to the former NHIS boss, Mr Dogo. He was asked to give his opinion on whether Nigeria can achieve UHC in next five years.

He responded by alluding to the need for CSOs as well citizens to get a credible commitment from the government.

Another panelist, Mr Godwin said there is need interactions with HMOs and hospitals. “There is need for NHIS to mobilize technology to drive UHC.”

Questions from Participants

A participant mentions several challenges in the NHIS for the formal sector. He says cancer among other important ailments are not yet covered. He asks the NHIS representative what they are doing to address several loopholes in the scheme especially when health insurance is yet to be made compulsory.

A participant from Lagos asks NHIS if they will support state health insurance.
He said the major challenge to health insurance is that there is no clear cut link between federal and state health insurance.

Responding to a question on different programs NHIS is running, Mr Dogo said there is ignorance on what and who the NHIS is supposed to cover.

He listed several programs the NHIS is running including programs for vulnerable groups and school. He believes there is a need to create more awareness about NHIS.

He describes NHIS as the magic bullet for the enrollees which everybody should enjoy.

Mr Eke in response to a question said NHIS covers cancer on 50 50 cost-sharing. “On radiotherapy, we are working on covering that too.”

Panel Discussion Two: Cancer Control in Nigeria: Sustainable Strategies from Primary Health Care to Tertiary Referral Centres.

This panel is coordinated by Project PINK BLUE, a cancer awareness organisation for free cancer screenings, support to people battling with cancer, patient navigation, advocacy, fundraising for cancer patients, cancer research and psychological support.

The organisation, in 2018, won the World Cancer Day Spirit Award.

The moderator taking turns to introduce the panelists including Nigeria’s health minister, Osagie Ehanire.

Sarah Shiminebiu shares a touching story of her painful battle against breast cancer.

The moderator of this panel Olumide Okunala, a Senior Health Specialist, Health in Africa Initiative, International Finance

Corporation/World Bank said from Sarah’s story, government health care failed her because she was unable to even get a common screening service.

Mr Okunala said Sarah’s touching story should be used to guide interaction during the panel discussion.

He said Nigeria spends so low on cancer and emphasizes that screening and radiotherapy are disproportional.

Cancer in Nigeria

Earlier in February, the World Health Organisation said an estimated 116,000 new cases of cancer and 41,000 cancer-related deaths were recorded in Nigeria in 2018.

Cancer is one of the leading causes of death worldwide as new cases and deaths from the disease keep rising. In Nigeria, the painful killer has continued to claim our mothers and daughters due to high cost and inadequate radiotherapy treatment which has been the bane of cancer patients.

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

Today, Nigeria could only boast of eight government-owned radiotherapy machines located in different areas in the country.

Unfortunately, many of the machines have broken down and those functional are not functioning at full capacity.

Most have broken down as a result of overuse, old age and lack of proper maintenance, and cannot get fixed due to lack of spare parts and relevant technical expertise.

Experts have advised Nigerians to modify their lifestyles to prevent the ailment as access to treatment is not countrywide yet.

Mr Eke, representing the NHIS executive secretary in the panel explains what the scheme is doing to cover cancer.

A representative of the wife of the former of Oyo state, Florence Ajimobi who is the founder of Access to Basic Medical Care, a foundation with the aim to screen people with cancer explains how they are helping people like Sarah with screening.

Gloria Orji, President of Network of People Impacted by Cancer said what is on papers are not what on grounds.

She said though NHIS covers cancer but most times the drugs are not available. Ms Orji says those drugs are 80 per cent of the time not available.

“The thing about cancer is that you are living in a world of your own and that is the reality.”

She said her support group guides cancer patients on how to follow there treatment up. The health advocate said there is however a need to cautious in handling cancer patients because they can withdraw at an anytime.

Minister of health, Mr Ehanire said one major problem with cancer treatment in Nigeria is not strong beginning with NHIS.

He said if we are not strong we have to be fast. “One thing about cancer is that once you detect it you have to start treatment immediately to avoid spread”.

He also said the prevention of cancer is one of the best ways to avoid it. The minister notes that one way to do that is by avoiding unhealthy habits that causes cancer.

Mr Ehanire stresses the need for proper awareness of the battle against cancer. He cheers Sarah for being able to identify that she is having a cancerous growth timely.

The official says health workers should also have the index of suspicion in detecting cancer.

He preaches more prevention, noting that all the funds needed for cancer care are yet to be provided as the country has other competitive demands than health.

The minister said the Nigerian government placed taxes on alcohol and cigarette to reduce the chances of people getting cancer from such products and also derive funds for health intervention.

He said the minister is planning to cover cancer screening with BCHPF.

Sarah, the cancer patient who shared her experience earlier said she would like screening to be free.

The minister responded by saying the health system in Nigeria is a work in progress.

Panel 3: Health insurance – Engaging the informal sector for maximum performance

Panelists

Challenges of health insurance in the informal sector

Early this morning, on his way to cover this event, this reporter took out time to ask three taxi drivers at Jabi garage, the commercial the nerve of Abuja, Nigeria’s capital city if they are aware that they can purchase health insurance for themselves and their families at a reasonable cost.

They are barely aware and for the most part, the mention of health insurance appeared to conjure up thoughts of exorbitant costs and fears of fraudulent diversions of their hard-earned “daily bread”.

This is largely the stack reality of the idea of health insurance in the informal sector in Nigeria.

The idea that one can pay for health and wait to use it, when he or his family falls sick, is still alien in this sector.

And if the act to make NHIS compulsory for all Nigerians, it will be almost impossible to convince those Taxi drivers in Utako or Mama Iyabo selling beans in Wuse – to enroll in the scheme.

The best shot to pull in the informal sector is currently being taking the states.

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.

But as it is with NHIS – currently dogged with multiple challenges – the establishment is not backed with proper implementation plan even though many states insist on a compulsory health scheme to pull in the informal health sector.

Joshua Olufemi, the program director of PTCIJ said there is a need for the government to understand the huge potential of the informal sector in health insurance.

He begins to explain how journalism can play a role in creating awareness and promoting the need for the market women and the Taxi drivers in Utako market to key into health insurance.

The official said the journalist has an important role to play but the challenge is that there is not enough data and statistics available to interrogate the issue.

“We don’t have a database of all the HMOs in Nigeria and all the diseases in the country.”

He said the government needs to prioritize data collection. Mr. Olufemi, a data expert, however, noted that journalists also have to improve their data collection skills.

Jake Padel, CEO albino foundation also stresses the need for more data to improve catchment of the health sector.

Mr Olufemi urged heads of informal sector heads to take advantage of a health tracker developed by PREMIUM TIMES to demand accountability when they subscribe to health insurance programs.

Structure of the Informal sector Insurance

The Informal Sector Programmes are made to cater to groups such as students, communities, and people working in non-formal occupations. It includes two programs.

The programs in the informal sector include:

The Tertiary Institution Social Health Insurance Programme.

The Community Based Social Health Insurance Program.

vulnerable Group Social Health Insurance Programs.

Physically Challenged Persons Social Health Insurance Program.

Children Under Five (5) Social Health Insurance Program.

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