The Minister's Agenda


Below is the text of the speech made by the Minister of Health, Professor Babatunde Osotimehin at his 1st meeting with donor/partners working in the Nigerian health sector who have organised themselves into a committee called the Health Partners Coordination Committee (HPCC) that held recently.

It provides interesting insights into his plans…

Pity that the Ministry does not have a website…else this seminal speech might have been on it….but I am sure they are working on it.



Honourable Minister of State for Health,

Honourable Minister of National Planning,

Honourable Minister of Foreign Affairs,

Permanent Secretary,

Directors and Members of the Top Management of FMOH,

Chief Executives of Parastatals,

Your Excellencies, Head of International Agencies/Partners,

Members of the Press,

Distinguished Ladies and Gentlemen

1. It is my pleasure to address you all at this meeting of Health Partners Coordination Committee (HPCC). I welcome you all and I sincerely thank you for honouring our invitation at a very short notice. This is my very first meeting with Development Partners as the Hon. Minister of Health. I am therefore taking this opportunity to introduce myself and the Hon. Minister of State for Health, to you and to kick start our sincere desire to interact more closely with you.
2. As you are all aware, the HPCC is a statutory forum that provides the Federal Ministry of Health and her International partners/donor agencies the opportunity to interact on issues of importance and concern to all stakeholders in the Nigerian Health Sector.
3. This meeting offers me a great opportunity to present the agenda and direction of the Federal Ministry of Health in under the new dispensation.
4. It is a well known and indeed an over-flogged statement that the Nigerian health system and the health status of its citizens are poor with overall health system performance struggling in the bottom among member states of the World Health Organization. The reasons for this dismal performance are also well known, and these include:

1. Inadequate stewardship function of government
2. Fragmentation of health service delivery
3. Inadequate, inefficient and inequitable health financing
4. Mal-distribution of health workforce
5. Poor infrastructure in health care delivery system
6. Poorly motivated workforce
7. Inadequate utilization of the private sector and a
8. Health Ministry that is not structured to provide needed leadership and stewardship roles

5. While there have been some efforts in the recent past to address these challenges and to reverse the trend (the most recent being the Health Sector Reform Programme 2004-2007) only very modest achievements have been recorded.


6. To address the challenges confronting the Nigerian Health system and to lay a foundation for a sustained reform of the system, in line with current and emerging challenges, the new leadership of the Federal Ministry of Health is adopting the following strategic agenda in order the deliver on the Human capital development programme of the president’s 7 point agenda. The overall theme and slogan for this strategy and the fulcrum of the change is “Working Together to Improve Our Health”. The elements of our strategic focus are:
1. Enhancing the Stewardship role of the Ministry:

The Ministry will work hard to change the current perception role of that of service delivery to that which provides the much needed enabling environment and leadership for all stakeholders to contribute to the goals and objectives of the health sector optimally.

2. Revitalize the Health System with Emphasis on Delivery of quality health services through Primary Health Care and strengthen referrals with Secondary and Tertiary Institutions to reduce the disease burden and improve the health status of Nigerians.

The Ministry will work with the new management of NPHCDA to reposition and assist the agency to provide leadership in this regard. On its part, the Ministry will engage in proactive advocacy with all relevant stakeholders, particularly with States ad LGAs, civil societies, communities and agencies on key reform issues of the PHC system in Nigeria.

Given the urgent need to interrupt the wild polio virus in Nigeria and to control measles and other vaccine preventable diseases, the Ministry will lead the concerted efforts of all stakeholders through the NPHCDA, high risk states, LGAs and our development partners to ensure the eradication of the virus in the shortest possible time.

3. Enhancing Financial Resource Mobilization through the expansion of the NHIS and other Public Private Partnership (PPP) arrangements:

It is obvious that the public sector alone cannot adequately finance and deliver health care services. We will explore more vigorously how the public and private sector can share the financing, risks and benefits of projects, initiatives and plans. And because PPP has grown worldwide as a tool for management and financing, we would be calling on your assistance to help build requisite skills of practitioners within the Ministry, to inform them of new capacity building activities such as the exposure to the Global PPP Core Learning Program that the World Bank Institute and other multilateral partners are planning to deliver sometime in 2009. We are ready and willing to explore other available health care financing opportunities. The Ministry has set up a PPP Unit to oversee, promote and monitor all PPP initiatives.

4. Enhancing the Coordinating Role of the Ministry and its interface with states and Local Governments.

There are some significant peculiarities of the health sector that must be addressed for the Ministry to deliver on its mandate. Some past efforts at identifying the problems revealed the Ministry as an institutional arrangement that is inadequate for “management effectiveness, human resource distribution, transparency and efficiency”. The new leadership at the Ministry intends to work sincerely and transparently with all major stakeholders to examine all the past efforts at repositioning the Ministry to deliver on its mandate with a view to making recommendations for effecting the needed changes.

5. Human Resource for Health:

For the Nigerian Health System to provide the much needed improvement in its overall performance, the requisite human resource must be available in the right quantity, mix and distribution. There is a challenge regarding the skewed distribution of the workforce in the urban areas compared to the rural areas, the private sector as against the public and the south more than the north. In this regard, the FMOH has developed a national Human Resource for Health Policy and a national strategic plan to guide its implementation

6. Strategic Information Management and Research:

One of the key weaknesses in the Nigeria’s health system is the lack of data to guide planning, resource mobilization and effective implementation of policies and programmes. A strengthened Health Management Information system is necessary to provide this
needed data and the Federal Ministry of Health will take urgent steps to strengthen HMIS.

7. Communication and Public Relation Management:

For the successful implementation of the strategic agenda of the new leadership, it is important to mobilize and galvanize public support for increased personal responsibility for health through utilization of preventive and health promotive services. The media will be crucial in this role. The Ministry will utilize several media to ensure that timely and comprehensive evidence based information about its activities are made available to build broad based understanding of and foster acceptance and support for the new strategic agenda of the Ministry and government programme as a whole.

7. For the avoidance doubts, the above elements of our stewardship over the next 24 months or so are also being worked into the much broader and long-term national strategic health development plan.

National Strategic Health Development (Framework) Plan (NSHDP):

8. You will recall that last year we started the process of developing a costed National Health Investment Plan. At the same time, we were embarking on a parallel initiative, a follow-on program to the Health Sector Reform Program (2003-2007), as the health sector contribution to NEEDS2, this was just before NEEDS2 was re-christened by Government as the National Development Plan (NDP). The 2 initiatives: Health Investment Plan; and the Health Sector/NEEDS2 initiatives have now been harmonized into the preparation a National Strategic Health Development Framework and Plan (NHSDP) process that us being lead by the Federal Ministry of Health working with all the States, development partners, non-state actors, etc… This process is currently being managed via the Health Systems Forum in which most of you have been participating.
9. The NSHDP is aimed at ONE single country health plan; ONE single results framework; ONE single policy matrix; ONE costed plan that will be the basis for funding; ONE single mutual monitoring and reporting process; ONE single country-based appraisal and validation process for country health plan; ONE single fiduciary framework; Benchmarks for Government performance, Benchmarks for development partner performance; agreement on aid modalities; and process for resolution of non-performance and disputes. These are the cross-cutting principles of the IHP+ built on the Paris Declaration on Aids Effectiveness.
10. A series of processes to develop the NSHDP will culminate in a framework that will guide the states and LGAs in developing their own plans, with assistance from partners working at the State level. We will make a presentation at this meeting on the process steps towards producing the NSHD framework and related plans at Federal and State levels.
11. The NSHDP is indeed for us, a call to action, and in working together to meet the goals of our national health systems. We recognize that mobilizing additional resources in these times is a major challenge…but that is precisely the reason why the development of the NSHDP becomes even more urgent. We are therefore calling on you to identify with this process and make commitments accordingly to take the process to its logical conclusion. When finalised, the document will serve as the country level compact that commits development partners and government to support one results-based National Health Plan, in a harmonized and aligned way, and improve resource mobilization and outcome through ensuring a predictable long-term financing. At the end we will have a product that we have jointly developed and jointly owned.

International Health Partnership +Related Initiatives:

12. As you are all aware, the IHP+ is a Country-led and Country-driven initiative that calls for all signatories to accelerate action in order to scale-up coverage and use of health services and to deliver improved outcomes against the Health-MDGs as well as honour commitments to improve universal access to health. The process calls for pooling of expertise and resources to drive the initiative, especially for aids effectiveness.
13. As you are also aware, countries that signed up to IHP+ are committed to developing “Country Compacts” with International development partners. These compacts are expected to result in: increased focus of national resources for health and AIDS strategies and plans on health-related MDGs; improved harmonization and alignment of aid; and in long term predictable financing.
14. Nigeria signed unto membership of the IHP+ in May 2008 during the 61st Session of the World Health Assembly in Geneva. In the process, Nigeria committed to addressing Health Systems bottlenecks in the country. Under the leadership of the Federal Ministry of Health, we have worked with our partners to re-conceptualize the National Strategic Health Development Plan, which will serve as the reference context for IHP+ compacts.
15. However, and more importantly is the challenge that we now face in the midst of financial crisis – how do we rise up to the challenges of making and delivery on financial commitments. It is a common knowledge that our national budget is facing unprecedented challenges as we struggle through a combined global financial crisis and more particularly the instability in oil revenues.
16. We recognize that domestic funding should make a significant contribution in meeting the challenges for Health-MDGs. Thus, the Government has steadily improved on its funding support for Health-MDGs in recent years: =N=15 Billion in 2007; =N=17 Billion in 2008; and =N=22.5 Billion proposed for 2009. We are internally challenged by issues of efficiency and in spending wisely…and we are thus looking for technical assistance in this regards, especially in building capacity for proper costing for Health-MDGs, and in innovative mechanisms that offer tremendous potential to save lives through new and creative solutions. Domestic funding alone is unlikely to meet all the challenges of funding Health-MDGs. We also remain concerned on whether or not we are making real progress in terms of the indicators.
17. Arguably, the greatest burden of disease in Nigeria is attributable to the index diseases of HIV/AIDS, Malaria, and Tuberculosis (ATM), and the diseases are at the heart the Health-MDGs Global compact. As mentioned above, the level of resources, both from within and external, to fight these diseases has increased steadily. However, the national response remains complex and confusing with multiple overlaps and poor coordination. Progress has been very slow. We certainly can do far more, and we intend to do so. For this reason, a Task Force on ATM has been established, under my direct supervision, as part of a renewed spirited effort to ensure visible progress on Health-MDGs.
18. Membership of the Task Force are drawn from the Federal Ministry Health, other Federal Ministries (National Planning, Ministry of Finance/Budget Office), and representative of States MOHs, members from Cooperating Partners active in ATM, representatives from Civil Society, and representatives from private sector bodies. The Committee has focal point persons from the Federal Ministry of Health to assist in both technical and administrative work of the Committee. The Hon. Minister of Health shall be the Chairman, with the Hon. Minister of State for Health serving as Alternate Chairman and Member of the Committee.
1. The Terms of Reference (TORs) includes: to take responsibility for the development and overall performance in the implementation of a coordinated ATM plan of action in meeting established Key Performance Indicators (KPIs) for ATM;
2. Develop and use a common validation/appraisal framework for planning and implementing ATM activities, with a strong M&E component.
3. Discuss and approve allocation of resources and related expenditures
4. Identify the bottlenecks that prevent the fulfilment of commitments of the and identify
national level action that is required to address these bottlenecks
5. Make recommendations for focus of activities in ATM
6. Review existing programmes and activities to determine which ones should be continued, modified and, where necessary, suggest new programmes and activities
7. Ensure that development assistance for ATM implementation is in full compliance with the principles of Paris Declaration on Aids Effectiveness and the Accra Agenda for Action and the IHP+ principles…
8. Identify institutional, legal and administrative frameworks for effective and efficient implementation of ATM programmes and activities.
9. Where necessary, establish specialised technical sub-committees to work on specific areas of concern.
10. Establish a secretariat to be responsible for the preparation of working papers for endorsement by the Task Force, at least 7 days before the date of the Task Force meeting. The secretariat shall include ATM Program Managers a representative of cooperating partners.
11. The Task Force shall meet at least once a month, in the first instance, and thereafter quarterly. Ad hoc and/or Emergency Meetings may be called by the Chairman as deemed necessary. However, technical working groups which may be established will meet on a more frequent basis. Further, the Task Force shall participate in an annual Health Sector National Conference.
19. The Task Force will have its first inaugural meeting next week, and further details will be shared in due course.

20. With regards to mitigating the likely impacts of the twin forces of global financial crisis and dwindling oil revenues on the health sector, we are looking for ways and means of handling this, and we are counting on you for innovative approaches. In this particular regards I want to solicit your understanding in permitting fiscal space for flexible response within your respective framework of engagements, to take cognizance of these unexpected worsening global financial crisis. I believe we may need to re-prioritize areas of technical and financial assistance to the health sector within existing support programs.
21. We have a secretariat within the Ministry to anchor the IHP+ activities. In addition as will be shown in the NSHDP presentation, I will soon re-inaugurate a single Technical Working Group that would serve as the Country Health Sector (strategy development) Team. The Ministry, through my predecessor had earlier committed to review some of the existing structures such as the HPCC and the HSF and Health Recipients Forum and align these with the IHP+ implementation processes. We shall soon prepare and share a draft concept paper on a Coordinating Mechanism for the health sector.

22. For us in the Federal Ministry of Health, will push to sign a compact with our partners, starting with the development of the NSHDP to which I urge you to support and fund the process agenda that will provide the mechanism and road map and context for follow-on compacts for delivering on results.

23. Like many other countries, we are opened to work with our partners to deepen our understanding and domestication of the IHP+ process to avoid setting up confusing institutions and structures. We believe that the IHP+ is not a project but ways of working together to deliver results together. We believe that there is a large scope for us to improve on aids effectiveness in Nigeria. In addition we need to begin to work now to anticipate how we shall respond to the country compact process once the NSHDP is finalized and ready for implementation. I will welcome concept papers on this issue. I will also want to urge you to begin to anticipate and think how to harmonize your assistance with the NSHDP, in terms of what needs to change and how, and also including your expectations from us on improving country systems.

24. Finally, because the NSHDP holds the key for implementing the change-management process for aids effectiveness that the IHP+ stands for, it may appear too early for us to assess IHP+ impact in the Nigeria health sector. But I want to say that our joint articulation of the NSHD process agenda so far is itself an achievement. And I am confident as the actual plans documents at Federal and State levels are completed, momentum will be poised for greater success.

25. We intend to attend the International Health Partners (IHP+) meeting coming up in Geneva from 4-5 February 2009. We shall use that opportunity to explore further how to rise to the challenges of country compact mechanisms in the face of the global financial crisis.
26. In conclusion, ladies and gentlemen, I wish to note that this forum is of great value and it should continue to hold quarterly, more so since we are going to be using it to monitor and review the implementation of the NSHDP and our joint monitoring exercises. Honourable Minister of state, permanent secretary, your Excellencies, distinguished Ladies and gentlemen, I thank you all for your attention.

Professor Babatunde Osotimehin, OON

Hon. Minister of Health

January 30, 2009

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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