The 2021 annual Legislative Summit on Health may have come and gone but the three-day high-level meeting made significant contributions towards addressing innovative policies and funding alternatives for Nigeria’s quest for Universal Health Coverage (UHC).
Held at the Transcorp Hilton in Abuja, Nigeria’s capital, this year’s summit witnessed unarguably the biggest gathering of law and policy makers, health advocates and government officials.
About the Summit
The quest of achieving UHC by 2030 which forms the central target of Sustainable Development Goals (SDG) 3.8. birthed the Legislative Network for Universal Health Coverage in Nigeria.
The idea was initiated by a coalition of lawmakers, health advocates and health ministries with support from developmental partners.
The network held the first summit in 2017 and brought together, for the first time, legislators from the country’s 36 states, state houses of assembly speakers, clerks, chairs of health and appropriation committees in the National Assembly, to negotiate better funding, policies and laws to drive UHC.
The summit had since then become an annual ritual except in 2020 when it could not hold due to the dreaded coronavirus pandemic.
This year, the approach to ensure that health security is prioritised and the pursuit of UHC is unhindered, formed the focus of the gathering.
Held between May 23 and 25, this year’s theme aptly describes the purpose: “Universal Health Coverage (UHC) and Health Security (HS): Two Sides of a Coin for an Efficient Health System.”
The journey so far
The summit, which kicked off with an opening session, had the Chairman, Senate Committee on Health (Secondary & Tertiary), Ibrahim Oloriegbe, setting the tone for the conversation.
Mr Oloriegbe, who doubles as the chairman of the Legislative Network for UHC (LNU), presented a paper titled; “The Objectives of the Legislative Network for UHC – How Have We Fared?”
He said the overall objective of the summit is to effectively leverage statutory functions of the legislature for improved health financing, toward effective and efficient utilisation of the resources for UHC.
Mr Oloriegbe in his presentation reviewed the progress made with the work-plan developed at the 3rd summit in 2019 as well as the achievements and challenges since the launch of the first LNU in July 2017.
He highlighted seven achievements from the summit to include: Implementation of the Basic Health Care Provision Fund (BHCPF) guideline in line with the National Health Act; Earmarking the BHCPF from Service-wide vote to first line charge, and increased budgetary allocation through the intervention of legislators.
The senator said about 34 of 36 states have enacted legal frameworks providing financial risk protection on healthcare as a result of LNU engagements.
He said the network helped in building the capacity of legislators nationally to harness and align their statutory functions to achieve UHC goals and nutrition objectives.
However, the setbacks, he said, include insecurity, scarce resources, COVID-19 restrictions and global economic downturn, which he noted brought about a grossly declining donor funding.
Juliana Abude-Aribo of the Legislative Initiative for Sustainable Development (LISDEL) gave an overview on how subsequent summits can be funded and sustained.
Participants were confronted with the reality of the challenge COVID-19 contributes to the setback towards achieving the UHC, especially when the senate president, Ahmed Lawan, on Monday, gave his remark at the opening ceremony.
Mr Lawan was represented by the deputy chief whip of the senate, Aliyu Abdullahi.
While the COVID-19 outbreak in Nigeria appears to be deescalating, concerns have long shifted to the economic downturn, plummeting oil and commodity prices and an imploding tourism sector occasioned by the several restrictions that had been put in place to contain the disease.
The latest global resurgence of infections in India and some European countries is currently threatening vaccination efforts across the globe and further exposed inequalities in the distribution of vaccines in developing countries like Nigeria.
The Senate president said the summit is another opportunity to review the condition of “our health system especially as the facilities were inadequate to cope with the outbreak of Covid-19 pandemic.”
He said the summit will open new frontiers for improvement and resources putting UHC back on track by tackling the impact of COVID-19 on health service delivery.
In his own opinion, Mr Abdullahi called for a constitutional amendment to give autonomy to local governments.
“The local government system is dead and this is why most Primary Health Centres (PHCs) are non-functional”, the deputy chief whip said, noting that it is high time “we gave life back to the LGAs”.
Participants the summit called on national leaders and actors to urgently consider strategies to rebuild resilience to such crises as pandemic preparedness and health security, especially by raising the bar for health security financing and accountability mechanisms for coordinated, well-planned responses.
With a tropical climate, population density, socioeconomic realities, and high cross-border movement, Nigeria is particularly a hotbed for infectious diseases.
Speaking, the Vice President, Yemi Osinbajo, emphasised the importance of setting aside special funds for public health emergencies.
Represented by the Minister of State for Health, Olorunnimbe Mamora, Mr Osinbajo said the COVID-19 pandemic had exposed the vulnerability of the country’s health system and the importance of preparedness, diagnosis and response mechanism.
He noted that public health security requires proactive and reactive measures to minimise the danger and impact of acute public health events.
“One of such proactive steps was to ensure that there are funds set aside always and which can be made available whenever there was a public health emergency,” he said.
Mr Osinbajo said the legislature must ensure that adequate budgetary allocation is made for ‘preparedness activities’.
He noted that reactive and response activities must include ensuring the continuity of routine services such as immunisation, family planning and keeping sight on other diseases like malaria.
Chike Ihekweazu, the Director General of the Nigeria Center for Disease Control (NCDC) in his presentation said the country should leverage on lessons from COVID-19 to improve health security.
“The legislature must be seen as champions for health security and must represent the interests of Nigerians,” Vivienne Ihekweazu, director of Nigerian Health Watch said
“People do not want disruptions to their lives, however we remain at continued risk from the current and future pandemics.”
The technical sessions at the three-day event focused on identifying possible funding channels for health.
Olumide Okunola of the World bank moderated a session on raising funds through pro-health taxes.
Pro-health taxes are imposed on products that have a negative public health impact (e.g., taxes on tobacco, alcohol, sugar-sweetened beverages, fossil fuels).
According to the World Health Organisation (WHO), these taxes result in healthier populations and generate revenues for the budget.
Experts said taxation on alcohol could either be ad valorem or specific. While ad valorem is a percentage of the price of the good and is more complicated to administer, specific taxes on the other hand are levied as a flat amount per physical unit of the good. They added that specific rates are less demanding and efficient.
Mark Abani, member of a committee advising the government on raising tax, urged pressure groups to liaise with the legislature to finetune laws and policies for generating pro-health taxes.
Mr Oloriegbe agreed that pro-health taxes would likely boost UHC targets.
The following were proposed during the session: “Money realised from these taxations should go into the UHC system; leakages against healthcare services should be blocked; there should be open and transparent spending of funds meant for healthcare; aside alcohol, sugar and tobacco, other areas such as mining were identified.”
On its part, a secretary of the Ministerial Committee on Basic Health Care Provision Fund (BHCPF) who was identified simply as Chris, gave an overview of the BHCPF’s benefits.
He said BHCPF is aimed at providing adequate care and services at the PHC level, “mostly for the vulnerable populations, so as to reduce out-of-pocket expenses.”
He added that the National Health Act 2014 created three gateways for disbursement of the BHCPF, which according to him, include; the National Health Insurance Scheme (NHIS) which receives 50 per cent of the fund; the National Primary Health Care Development Agency (NPHCDA) which takes 45 per cent, and the Health Ministry to receive five per cent for outbreaks and emergency responses.
But according to him, in 2018, out of the N55.1bn allocated, only 50 per cent was released.
The director of NPHCDA, Faisal Shuaib, and Mohammed Sambo of the NHIS, explained how the funds were being utilised through the gateways.
The chairman, Senate Committee on Primary Healthcare and Communicable Diseases, Chukwuka Utazi, appealed to lawmakers to move a motion for an increment of the BHCPF from one to two per cent.
Quest for UHC
The chairman, House Committee on Health Care Services, Tanko Sununu, highlighted some impediments to achieving UHC in Nigeria.
He said lack of implementation, accountability, transparency and corruption are some of the major factors.
The chairman, Nigeria Commissioners for Health Forum, said funds appropriated to the health sector have not been transparently utilised.
The country director of PharmAccess Foundation, Njide Ndili, noted that the private sector has a major role to play.
Mr Ndili explained how Nigeria can leverage on innovative technology to boost UHC.
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