Dear President Buhari; Without Health, We have Nothing

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Dear President Buhari, congratulations on your election to a second term as president of the Federal Republic of Nigeria. You are the second president to achieve this feat since our foray into democracy as a nation in 1999. Today, you were sworn in to serve Nigeria for the next four years. As the nation celebrates your inauguration as Nigeria’s fifth democratically elected president, we at Nigeria Health Watch reflected on some of your achievements in the health sector and share recommendations for your second term.

Mr. President, “without health, we have nothing”. You clearly understand this, for when you were ill you went to great extent to get excellent healthcare. We are thankful that you got the quality of healthcare you needed from the United Kingdom and are now stronger to steer the ship of governance.

Every day we are inundated by posts on social media of Nigerians raising funds to treat various illnesses at home and abroad. Examples of crowdfunding for medical treatments abound – Mr. Okoye, a lawyer, needs $35,000 for a kidney transplant; Jude Tyowase, a 2-year old son of a peasant farmer from Benue State needs $14,169 for treatment of cancer of the eyes; Ify Okeke needs $146,610 for a lung transplant in South Africa or India. Your Excellency Sir, no one should be denied healthcare because of their inability to pay. The 200 million Nigerians that are looking up to you for better access to quality healthcare must be assured of affordable, accessible and equitable healthcare.

Health Sector First Term Achievements

The BHCPF
Political will is the most important determinant for any country to achieve universal health coverage. President Buhari, you, through the work of Minister of Health Professor Isaac Adewole, Senator Lanre Tejuoso and the
Senate Committee on Health, demonstrated political will by budgeting for the Basic Health Care Provision Fund (BHPCF) twice – in 2018, where you budgeted NGN55 billion, and now in 2019. We applaud this action. The BHCPF, popularly known as “Huwe”, means “life” in Ibira, one of Nigeria’s indigenous languages. On May 17, 2019, the first tranche of the BHCPF was credited to the Treasury Single Account (TSA) of the NHIS, the Nigeria Centre for Disease Control (NCDC), and the National Primary Health Care Development Agency (NPHCDA), domiciled at the Central Bank of Nigeria (CBN).

L-R: Delta State Governor, Ifeanyi Okowa, Founder of Wellbeing Foundation and Wife of the Senate President, Mrs. Toyin Saraki, Director General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus, Honourable Minister for Health, Prof. Isaac Adewole and Chairman Senate Committee on Health, Senator Lanre Tejuoso at the launch of the logo and beneficiary identification card for the BHCPF. Photo credit: Nigeria Health Watch 

Fresh Leadership
Mr. President, in 2016, you did something unprecedented in the history of Nigeria’s health sector. In one fell swoop, you appointed new heads to 5 public health agencies, all under the supervision of Minister of Health Prof. Adewole – The National Health Insurance Scheme (NHIS), Nigeria Centre for Disease Control (NCDC), National Agency for the Control of AIDS (NACA), Nigeria Institute of Medical Research (NIMR), and the National Primary Health Care Development Agency (NPHCDA).

Your administration was convinced that fresh leadership of these institutions was important to help you achieve some of your plans for the health of Nigerians. Given the critical roles that these agencies play in the Nigerian health sector, we chose to reflect some of your achievements through their work.

In 2016, President Muhammadu Buhari appointed new heads to 5 public health agencies. Photo credit: Nigeria Health Watch 

At the 2017 Nigeria Health Watch Forum, focused on the theme, “Does Leadership Matter?”, three of the 5 new heads shared their vision for their agencies. Three years running, have these 5 agencies delivered on their mandates to improve Nigeria’s health sector?

NHIS
His Excellency Chief Olusegun Obasanjo signed the NHIS Act in 1999 when he was President. Act 35 of the 1999 constitution established the National Health Insurance Scheme (NHIS) to improve the health of ALL Nigerians at an affordable cost, through various prepayment systems. It’s been almost 13 years since the establishment of the NHIS and less than 1% of Nigerians have any form of health insurance coverage.

At the 2017 Health Watch Forum, an enthusiastic Professor Usman Yusuf of NHIS promised to hold everybody accountable – from the NHIS, to hospitals, Health Maintenance Organisations (HMOs) and electoral representatives; to increase coverage of Nigerians covered by NHIS including the vulnerable. The Agency has almost from the onset been embroiled in multiple controversies to the point that Prof. Yusuf was suspended from office. Right now, the NHIS is in limbo and has struggled to provide transparency and accountability to Nigerians.

NACA
Dr. Sani Aliyu of NACA wanted to define the extent of Nigeria’s HIV problem and determine the true prevalence of HIV in Nigeria; upscale prevention of mother-to-child transmission of HIV; and develop a sustainable plan for HIV response in Nigeria, so we depend less on donors. Within nine months, he successfully led the conduct of the National AIDS Impact Indicator Survey (NAIIS). Prior to NAIIS, Nigeria erroneously had a HIV prevalence of 3.2%. A key output of NAIIS is a new HIV prevalence rate for Nigeria of 1.5% (1.9% for females and 1.1% for males). This new HIV prevalence rate has implications for HIV/AIDS programming – it will save lives and money.

NPHCDA
Through the leadership of NPHCDA Executive Director Dr. Faisal Shuaib, Nigeria is currently on course to be declared polio-free by August 2019. Key achievements that have sustained this momentum include incidence reporting, reaching inaccessible children and improving the quality of polio surveillance. There is still work ahead but we have made progress. Other achievements include engagement of at least 100,000 community health volunteers under the Community Health Influencers, Promoters and Services (CHIPS) programme.

NCDC
Dr. Chikwe Ihekweazu, now Director General of NCDC, at the 2017 Forum said he planned to focus on 5 priority areas – Lassa Fever, Meningitis, Cholera, Measles and Anti-Microbial Resistance; to restore the confidence of partners and introduce a sense of accountability in the Agency. The achievements of the NCDC were recently aptly articulated in an opinion piece written by Professor Adewole. Some of these achievements include; signing of the NCDC Bill into law; the Joint External Evaluation (JEE) of International Health Regulations (IHR) for Nigeria which identified achievements and gaps and proffered solutions; getting the National Reference Laboratory in Abuja working; and launch of the National Action Plan for Health Security (NAPHS).

NIMR
Professor Babatunde Salako of NIMR and his team have recorded successes such as a collaborative research between NIMR and the Co-creation Hub called NIMCURE. This collaboration seeks to develop and pilot a digital tool to support Tuberculosis patients in Nigeria and enhance their adherence to treatment through the development of an interactive mobile application with key features that encourage patients to take charge of their treatment. If NIMCURE succeeds, it will improve TB programming in Nigeria because TB kills about 115,000 HIV-negative people annually in Nigeria.

No doubt there are other achievements we are not able to mention; incredible work done by the Ministry of Health and its departments and agencies, and of course development partners, to help Nigeria’s health sector progress over the past four years.

Health Sector Second Term Recommendations

Your Excellency, despite the achievements listed above, there is still a lot to be done to provide accessible, affordable and equitable healthcare to all Nigerians. Below are just a few recommendations.

Universal Health Coverage
Universal Health Coverage is non-negotiable, and we expect that in your second term as president, you will be intentional about UHC in Nigeria. Most important in achieving UHC has to be the leadership of NHIS. It’s been 4 years wasted on quarrels. The agency is critical now that funds from BHCPF are being disbursed. Your Excellency, you should appoint a substantive head of NHIS to lead your UHC efforts.

Photo credit: Nigeria Health Watch 

Human Resource for Health
Your Excellency, we cannot speak of UHC without addressing the challenge of human resource for health in Nigeria. In 2017, Nigeria Health Watch and NOIPolls conducted a survey to measure the scope of emigration of the Nigerian healthcare workforce, particularly doctors. Findings revealed that 88% of the respondents in Nigeria said they are considering work opportunities abroad.  Leading factors that make doctors emigrate from Nigeria include high taxes and deductions from salary, low work satisfaction, and poor salaries and emoluments. Improved renumeration, upgrade of hospital facilities, provision of equipment, increase in healthcare funding, and improved working conditions of health workers were the top suggestions respondents gave to mitigate the challenges doctors are facing.

We cannot speak of UHC without addressing the challenge of human resource for health in Nigeria. Photo credit: Nigeria Health Watch

Health Security
Dr Adhanom Tedros, Director-General of the World Health Organisation (WHO), points out that UHC and global health security are two sides of the same coin. Within 36 hours, an infectious disease from a remote corner of the world can get to any major capital. You must budget adequately so the NCDC can lead the effort to protect Nigerians from infectious diseases. The National Action Plan for Health Security (NAPHS) shows that Nigeria needs to budget N145 ($0.40) per capita to adequately predict, respond to and manage infectious disease outbreaks in Nigeria. This amounts to N29 billion ($80 million) annually. To adequately protect Nigerians from the threats of infectious diseases during your second term (2019 – 2023), you should ensure that at least N116 billion is budgeted, appropriated and released.

Sustainable Finance
Mr. President, Nigeria has the largest GDP in Africa. It is time for the country to show leadership and stop the overdependence on donor support to fund health programs such as immunisation and Antiretroviral Drugs (ARVs) for People Living with HIV (PLHIV). At our 2019 Health Watch Forum titled, “Prevent Epidemics: Immunise”, Dr. Chizoba Wonodi, Country Director of IVAC, noted that Nigeria requires N702 billion ($1.95 billion) to procure vaccines for routine and supplemental immunisations from 2018 to 2028. GAVI is currently providing 38% of this budget. However, in 2029 Nigeria will transition from GAVI support and would then require N106.3 billion ($295 million) each year to purchase vaccines. Your Excellency, during your second term, you must begin to plan for 2029 so that Nigeria can become truly independent of GAVI.

Private Sector Engagement
The private sector can play an important role in strengthening health systems in Nigeria. Several initiatives have been tested to bolster the health sector and Public-Private Partnerships (PPPs) in healthcare have emerged as a possible vehicle to enable advancement towards UHC. Recently, you commissioned the NSIA – LUTH advanced cancer treatment centre at the Lagos University Teaching Hospital. The project is a US$11 million investment that will provide advanced radiotherapy and chemotherapy treatment services. Mr. President, we urge you to take to scale such public-private partnerships that could improve the quality of tertiary healthcare in Nigeria.

Oversight of Primary Health Care Funds
Your Excellency, provision of primary health care is within the purview of Local Government Councils. In 2018, you signed a bill into law for the independence of the Nigerian Financial Intelligence Unit (NFIU). Recently, the NFIU issued guidelines on disbursement of LGA funds, which limits abuse by governors. Mr. President, you should ensure strict adherence to the NFIU guidelines and funds used by LGAs to provide primary health care services to the people. Without a functional primary health care system, it is impossible to achieve UHC for all Nigerians.

Mr. President, we wish you a second term that will bring health, prosperity and security to all Nigerians. As you begin this journey, please remember that without health, we have nothing. Thank you. God bless the Federal Republic of Nigeria.

Your Nigeria Health Watch Team.

Do you have other achievements of the past administration or recommendations for the incoming administration that you would like to share? Drop us a line in the comment section below or on our social media handles, using the hashtag #DearPresidentBuhari.

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