Hurdles before Nigeria’s health care in 2016

In this piece, ARUKAINO UMUKORO examines some issues in the health sector which require urgent attention this year

Perhaps, one of the most significant milestones for Nigeria’s health sector in 2015 was that, in October last year; the country was formally delisted by the World Health Organisation from countries that are polio-endemic.

This came after the country successfully maintained its record of having no single case of wild Polio Virus infection since July last year, over a consecutive 15-month period.

During the formal presentation of certificate indicating Nigeria’s polio-free status to President Muhammadu Buhari, at the State House, Abuja, in October, the WHO Regional Director in Nigeria, Matshidiso Rebecca Moeti, who represented the Director-General, Margaret Chan, praised the Federal Government for its efforts in eradicating the disease.

She said, “Lately, there has been growing concern among partners that the financial commitment at the state level appears to be declining and I hope it is not because we have achieved this landmark. Some states did not release funds for the recent vaccination rounds and we know that this will negatively affect the quality of the programme.

“I would request and encourage federal and state governments to continue meeting the financial commitments to sustain the momentum at polio eradication efforts. We have come a long way and we must continue until the next two years when the country will have been certified free and we can turn attention to other things.”

The certificate had a proviso which stated that the Nigeria would be completely delisted from the group of polio-endemic countries if the current efforts were sustained till 2017.

Nigeria had been one of the only three countries still endemic to polio. Today, only two countries— Pakistan and Afghanistan— remain endemic for the disease–the smallest geographic area in history.

In his response, President Buhari said Nigeria would ensure it maintained its status. He also noted that the polio virus had taken a toll on the country in terms of human and material resources.

He said, “As you are aware, our efforts to eradicate this crippling disease started in 1998. It has taken a lot of toll on our country in terms of human and material resources. We are, however, not relenting as we are determined to achieve our collective goal of saving our children from further paralysis from polio.”

Nevertheless, experts have noted that combined efforts towards the eradication of polio in the country should be extended to other areas of health care in 2016 — eradicating other epidemics and strengthening the country’s disease surveillance and control systems.

But some have pointed out that the country’s health sector may be ill-equipped to tackle such issues head-on, unless the nation’s primary health sector is totally revamped.

In an interview with SUNDAY PUNCH, the President, Society for Public Health Professionals of Nigeria, Prof. Michael Asuzu, noted that the country’s health sector was bedevilled with problems such as poor access to public health care and a general lack of health facilities; while diseases such as diabetes, tuberculosis, HIV/AIDS were still major issues.

Asuzu said, “Another thing worthy of note is that we have a new administration in power, which so far is talking about doing things right. President Buhari has so far appointed competent professionals as Minister for Health and Minister of State for Health, and hopefully they would bring in some new changes into the system in the New Year (2016). The new health minister knows we have to rebase our health system. We were extremely lucky with the Ebola issue.”

Chief among Asuzu’s concerns are the country’s unstable primary health care system, and the general access to health care for Nigerians.

Asuzu noted that an effective and a functional primary health care was the bedrock of any country’s health care system. This, he said, must be totally revamped to strengthen the nation’s health sector in 2016.

He further said, “Without a functioning primary health care, the secondary health care system would not work because it would be an inverted pyramid that would collapse on it. Health ministers in the past have tried their best in this regard, but we still have a lot of work to do. Primary health care should be our priority. With the current ministers, we hope things would improve, and the country would have a working primary health care system, so that the secondary and tertiary health care systems would also function better.

Asuzu also said this would go a long way to reduce maternal and infant mortality in the country.

Nigeria has one of the highest rates of maternal and infant deaths in the world.

In the same vein, the National President, Association of Medical Officers of Health in Nigeria, Dr. Yahya Disu, said the country’s health sector, which he said witnessed the good and the bad in 2015, needs an urgent overhaul in the New Year.

He further said the country needs to urgently fill the vacuum created by the significant reduction in donor funding for national health programmes last year.

He said, “For several years, there has been heavy reliance of donor funding for national health programmes, for example HIV/AIDS funding, but some international donors have withdrawn or are withdrawing their support. This would be a major problem in 2016, because health burdens would significantly increase, how do we cover the gap created by these donors?”

Disu also highlighted the poor access to primary health care and the lack of health insurance coverage for many Nigerians, as major issues that need to be addressed by the country’s health authorities in 2016.

He said, “The primary health care is the bedrock of our national health system, and it determines the performance of our health system. It is the alternative for many Nigerians, but it is still not reachable to a lot of them that can’t afford basic health care because it is not working.

Other issues Disu pointed out were the perennial problems of poor health facilities, and inadequate manpower, especially in the primary health care system, as well as incentives for its workers.

He further said there was need to improve health care governance in the country to avoid duplication of functions and services among health agencies across the federal, state and local government levels.

This may be the reason why Dr. Peter Ogunnubi pointed out the several cases of industrial actions and bickering among health unions in the country as some of the sour points for the sector in 2015.

Ogunnubi, a former Publicity Secretary of the Lagos State chapter of the Nigeria Medical Association, said although general strikes by different cadre of health workers in the country was less in 2015 when compared to 2014, he hoped that 2016 would put to rest the issue of strikes by health workers across the country.

He said, “Although majority of these industrial actions in 2015 were pockets from various unions, bordering on the reneged promises of the Federal Government on allowances, or in some instances, these allowances were paid by government and some Chief Medical Directors (allegedly) refused to implement it.

Early last year, in February, the Joint Health Sector Union called off the two-month strike it had embarked upon since November, 2014, which stemmed from disputes over the implementation of the agreement with the government, based on improved welfare for health workers.

Ogunnubi added, “Aside from the JOHESU strike, there was also a total strike by doctors and health workers at the Yaba Psychiatric hospital, while health workers at the Federal Medical Centre Owerri, also went on strike. But there were no issues of general (nationwide) strike as in last year.”

The medical doctor urged the government to employ the principle of collective bargaining with all the unions to prevent such issues this year.

He said, “You don’t bargain with different members at different times, it is not ideal. Collective bargaining at the roundtable with every member of the team, doctors, nurses and pharmacists and so on, is better. Also, a court of arbitration should be set up by the government to liaise with health unions, so they would act as negotiators between government and the unions. This would reduce strike, and foster better communication between medical unions and the Federal Government.”

Ogunnubi further said residency training for doctors should be fully overhauled. “Nigeria cannot afford to do without specialist doctors. Also, budgetary allocation to health should be increased, and the National Health Bill, which was signed into law, should be implemented,” he added.

Disu added that the efforts towards the eradication of polio in the country should be extended to other areas of health care. He also warned the country to be wary of the threat posed by the Ebola virus disease.

Nigeria was declared Ebola-free by WHO in October 2014. Towards the end of last year, Sierra Leone and Guinea were also declared Ebola-free. However, Disu said the virus could still become a major threat in 2016 as it was endemic in the West Africa region, where thousands have died as a result.

He said, “Nigeria should pay attention to that because it can re-occur at any time in the region and Nigeria is a high risk because of frequent travels within the region. We need to strengthen our national preparedness for epidemic diseases, increase surveillance at our airports, community sensitisation and so on.”

Also, the issue of budgetary allocation to the health sector have dominated discourse for years. This year was no less different, as only N221.7bn was allocated to the health sector, when President Buhari presented the 2016 budget proposal of N6.08tn to the joint session of the National Assembly last year December.

The 2016 figure (health budget) is the lowest in five years.

In 2011, the health budget was N203.34bn in a national budget proposal of about N4.48 trillion; while in 2012, the health budget was N282.77bn from a proposed budget was N4.749 trillion (which represented about six per cent increase over that of 2011). In 2013 and 2014, the health sector was allocated N279bn and N262bn respectively. Last year, the Federal Ministry of Health got N264.5bn.

Disu noted that this amount was not adequate for such a critical sector of the economy.

“Health budgetary allocation is not only a national affair, states and Local Government Areas are also obliged to step up their budgetary allocation to health,” he noted.