Experts urge Nigerian citizens to push for improved healthcare

NPHCDA, CJID, PHCAs Nigerians plan to elect a new set of leaders in 2023, citizens have been urged to make issues of health security and financing key subjects of conversations in their interactions with candidates.

This was one of the major recommendations offered by health experts and officials at a health dialogue session organised by the Centre for Journalism Innovation and Development in partnership with PREMIUM TIMES.

Themed: “Primary Health Care Financing; Role of State and Non-state Actors,” the event which was held in Abuja, Nigeria’s capital territory, had in attendance representatives of the National Primary Health Care Development Agency (NPHCDA), World Health Organisation (WHO), Federal Ministry of Health, Bill and Melinda Gates Foundation, International Human Rights, National Youth Inclusive Initiative (NYII), Connected Development (CODE), Electoral Hub and New Life Mental Health Relief and Care Initiative, among many other participants.

Participants said Nigerians must begin to push for healthcare as a priority and ensure accountability from relevant government agencies, noting that the health sector needs to begin to do things differently and use more innovative platforms to get the needed results.

They also raised concerns over inadequate financing of the nation’s primary healthcare sector.

Challenges with PHC financing

In her presentation on “PHC Financing: the Role of Government in Achieving Optimum PHC Performance”, a Director at the National Primary Healthcare Development Agency (NPHCDA), Ngozi Nwosu, noted that the complex and fragmented institutional arrangements between the local, state and federal governments constrain the delivery of public health services in Nigeria.

To address this constrain, Ms Nwosu said the NPHCDA initiated the Primary Health Care Under One Roof (PHCUOR) in 2011 to unify all structures and programmes at the state and local government levels towards ensuring efficient service delivery for proper accountability within a decentralised system.

The director also pointed out that the majority of the country’s health expenditure is funded through out-of-pocket payments with little financial protection and inequitable access to health services.

She noted that the low quality of care received at PHCs is caused by poorly equipped health facilities, gaps in quality service delivery and low data quality.

She added that some of the efforts of the federal government to improve PHCs include the introduction of the National Health Act 2014, the use of innovative and results-based financing approaches for efficient allocation of resources and the introduction of PHCUOR, among others.

New Health Insurance Act

On the new health insurance act, the experts agreed that universal health coverage cannot be achieved through private health insurance alone but through social insurance, adding that there should be financial support for collaborative research from the government to the academic sector in the new Health Insurance Act.

They suggested the need for intentional community participation and education in the new Act, as the community needs to get involved to institute accountability mechanisms.

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Regarding innovations to scale up the health care provisions in Nigeria, the stakeholders recommended that the HMOs can partner with telecommunications providers, adding that the NHIS should be integrated into the educational curriculum, either at the primary or secondary level.

Improving PHCs

The stakeholders noted that to make PHCs work, the government must ensure adequate welfare and remuneration of service providers at the grassroots.

The stakeholders noted that there are no adequate resources to sustain the available doctors and healthcare providers and this needs to be addressed.

According to the Nigerian Medical Association (NMA), there were 110,000 registered doctors in previous years but as of April 2022, the numbers had reduced to 55,000.

They noted that the plan must be continuous and sustained advocacy for the communities to be involved.

Health priorities

Speaking on health priorities, the experts noted that the government must first understand the priority needs of the people, citing South Africa, for instance, they noted that the different ministries are grouped in clusters to allow for efficiency in service delivery.

While they noted that in Nigeria, there are overlapping responsibilities among the stakeholders involved, especially between state and federal governments, they also noted that the problems inhibiting the implementation of health policies in Nigeria are foundational, as “we are concerned about the quality of the policy on paper, rather than its implementation”.