Once every year, the Ministers of Health, leaders of all the health parastatals, and the commissioners of health and their teams gather to agree and harmonise health policy for the Federal Republic. It is the highest policy making body in the health sector for the country. So between the 7th and 11th of March 2016, public health sector leaders congregated in Sokoto, (the State of the Caliphate as it is called), to deliberate on the progress in the Nigerian health sector and to chart a way forward.
It was the first National Council of Health meeting for the Minister of Health, Professor Isaac Adewole, his Minister of State Dr. Osagie Ehanire, the Permanent Secretary Dr. Amina Shamaki and most of the Commissioners of Health (this is not counting the emergency meeting called in the wake of the Lassa Fever outbreak late in 2015).
The theme of this year’s meeting was “Universal Health Coverage – An Agenda for Change”. Universal Health Coverage (UHC) has stayed on the agenda in Nigeria as an aspiration of the new government. It is an aspiration to which you will not find any contradictory voices. However, the challenge for all the previous governments, as it is for this one, is how to translate this aspiration to reality in the Nigerian context. The Minister of Health has virtually staked his legacy on achieving UHC, with some far reaching promises of delivering universal (primary) health care to 100 million Nigerians by making 10,000 PHCs “functional” by the end of 2017, at the rate of 5,000 per year. Those are topics for a future Thought Leadership piece.
At the opening of the Council meeting, the Sultan of Sokoto, His Eminence Alhaji Muhammadu Sa’ad Abubakar expressed his frustration on the state of healthcare in Nigeria, an opinion shared by all those who made opening statements. The Sultan lamented the situation where airports are being built in the context of extreme poverty, and wondered why governments should see their role in the service of the small elite that uses these airports. Sokoto, however, has been fairly progressive with health, absorbing the midwives that were previously employed under the “Midwives Service Scheme” and setting up its Primary Health Care Development Board. The Governor of Sokoto, His Excellency Aminu Tambuwal however, could not hold back from grand ideas and announced the establishment of a new medical school, a new infectious diseases hospital and a new “state-of-the-art” renal and cardiac centre!
During the technical sessions that preceded the council meeting, guest lecturers were invited to speak on specific issues, which were ably summarised by Professor Eyitayo Lambo, a former Minister of Health and one of the most credible voices in the Nigerian health sector today. He aptly summarised Dr. Ali Gombe’s talk stressing the link between health, economic development and national security. At this point, Dr. Jide Idris, Commissioner of Health in Lagos State shared his experience in having difficulties in convincing his colleagues in Lagos to invest in health until the Ebola outbreak happened, which put health security at the centre of discussion in Lagos. Dr. Idris hoped his colleagues would fare better in their states, and not need a crisis before the link is demonstrated. Jide Idris is one of the most experienced commissioners of health in the country, being in his second term. Professor Asuzu also shared his thoughts on the need for more intra and intersectoral collaboration in the health sector.
The other major issue on the agenda was the implementation of the National Health Act. It was pointed out that the National Health Act was first approved in 2004, but it still took 10 years for it to be signed into law in October 2014, and gazetted in December 2015. Many changes happened to the law between the earlier versions and the one that was eventually signed into law. Attendees were all encouraged to read the act again (see link here), to fully understand the opportunities and challenges that the act offers the country. Discussion on the act seemed to focus primarily on the provisions of the 1% allocation from the consolidated account in the Basic Health Care Provision fund.
Listening to the questions, comments and responses during the meeting illustrated the complexity of the Nigerian health sector. Comments from some states on their frustration with the National Health Insurance Scheme led to the call for a side meeting with the agency to sort out issues. Controversy in some states on the models for implementation of State Primary Health Care Boards/Agencies (as prescribed by the new health act), the position of its leadership vis-a-vis commissioners of health as well as the change of lines of reporting from the local government to states, led to another side meeting with the National Health Care Development Agency (NPHCDA). It is obvious that the on-going tension between State Ministries of Health, their Primary Health Care Development Boards and the Local Government Areas was an area that will need proactive engagement by the leadership of NPHCDA during the year.
It was hard not to observe the minimal authority of the council in ensuring that decisions taken were actually acted upon. Many of the decisions of the previous National Council of Health meeting were yet to be implemented by some states. Dr. Mike Egbo, leader of the PATHS II project and a long serving leader in the health sector asked a critical question – how do we ensure accountability for the decisions taken during the council at Federal, State and Local Government levels? He suggested a peer review mechanism, with the states peer – reviewing each other at agreed intervals. This idea gained a lot of traction during the meeting. A zonal coordinator of the NHIS made what was one of the most important comments of the day; that the government should give itself firm targets in health terms, and hold itself accountable to the delivery of these targets.
During the meeting, the Minster of Health made a few bold statements. The one that we will hold on to the most was the assertion that he will put up all funding information for his primary health care plans up on the Federal Ministry of Health’s website. He promised to be completely and publicly accountable with all the funding streams associated with his plans and the new health act. This may be the most profound change that will come to the sector. At the moment, it is impossible to find almost any document on the Ministry’s website, much less information on funding flows.
There were 78 memos considered at the meeting. Some landmark issues discussed and agreed include the adoption of a new task shifting policy, increasing the range of maternal and child health services that Community Health Extension Workers (CHEWS) are allowed to carry out, a new quality assurance policy for medicines and other health products, and a policy integrating a regional centre for disease control into the national centre for disease control. There were also memos considering a new policy transferring existing blood transfusion centres outside Abuja to the states in which they are located, a new fine of $50.00 for passengers arriving without a yellow card from countries from which this is required, and the adoption of a new emergency medical services policy, amongst others.
Altogether, it was a fairly tepid meeting, with very little disagreement on the core issues, which must be a good thing. The key issue will be how to deliver on the promises of the meeting and start “turning the titanic” that is the Nigerian health sector. We wish ourselves success, as we definitely cannot continue with business as usual. One thing is for sure, your Nigeria Health Watch team will be at the next Council meeting to bring you progress on the promises made at this first annual National Council of Health meeting of the new government.
Dr. Azodo and her team in the Directorate for Research and Planning did an excellent job in organising and the Hon. Commissioner for Health, Sokoto State, Dr. Shehu Kakale Shuni, did a great job at hosting, especially the decision to use local manufacturers for the conference bags. He gets it.
A final word on Sokoto: it’s a great city with a deep heritage and a Sultan that is obviously committed to the welfare of his people.