Once a year, the Minister of Health and his team meet with all the Commissioners of Health for the National Council on Health (NCH). This year, the Council deliberated, reviewing key health issues of national importance, between the 6th and 9th of November 2017. As provided for in the National Health Act (2014), this is the highest policy-making body on matters relating to health in Nigeria. This year, over 700 delegates gathered for the 60th National Council on Health in Abeokuta, Ogun state. The Honourable Minister of Health, Honourable Minister of State for Health, Commissioners of Health from the 36 States and the FCT, as well as other key stakeholders in the health sector were present.
In 2016, Nigeria’s economy slipped into recession for the first time in more than two decades. The Federal Government in response, developed a Nigeria Economic Recovery and Growth Plan (2017-2020). For this reason, the theme for the 60th NCH was “Economic Recovery and Growth Plan (ERGP) and the Health Sector: Matters Arising”. This theme aptly reflects the effect of health on economic growth and the effect of the economy on the development of the health sector.
The technical committee at the 60th NCH considered 65 memoranda (38 from the Honourable Minister of Health and 27, from the State Commissioners for Health and FCT Secretary of Health). Following extensive deliberation on each of the memoranda, Council approved 17, noted 40 and stepped down 7. Here are some of our takeaways from this year’s NCH:
Achieving universal health coverage in Nigeria, one state at a time
Nigeria has struggled to join the rest of the world in intensive efforts to make meaningful progress towards universal health coverage, but there has been some progress. Attahiru Ibrahim, the Acting Executive Secretary, National Health Insurance Scheme (NHIS), mentioned that 14 states had passed their state health insurance laws. The 14 states are Lagos, Oyo, Ekiti, Delta, Bayelsa, Cross River, Akwa Ibom, Kwara, Abia, Adamawa, Kano, Anambra, Sokoto and Bauchi. Different states have adopted different strategies in rolling out their health insurance programmes. At the formal opening of the 60th NCH meeting, the Governor of Ogun state, Senator Ibikunle Amosun, spoke about ‘Araya’, a flagship community health insurance scheme in Ogun state where 16,000 are enrolled. ‘Araya’ consists of two categories: one is free for pregnant women, the elderly and children under five, while other categories of people in the second group, pay a premium with an additional subsidy from the Ogun state government to fully cover the cost of access health care services. Another example mentioned was from Delta state, where public-sector workers in the formal sector will have 1.75% of their consolidated salary deducted, while the government contributes an equivalent 1.75% on their behalf.
Human resource for health
Being a health worker in Nigeria is not very easy. It is little surprise that there are more and more anecdotal reports of doctors choosing to leave Nigeria to work elsewhere. Many of these have left due to inadequate resources. It is rare to hear that a hospital in Nigeria is overstaffed. However, according to the Sokoto State Commissioner for Health, the Usman Danfodio University Teaching Hospital, Sokoto apparently has 100 consultants, 400 resident doctors, 1000 nurses and other health professionals; almost double the number available in primary and secondary health facilities owned by the state government. In order to fully utilise the expertise of the workers, the Sokoto State government has proposed a working arrangement with the Federal Government where doctors and other health care workers would be deployed from the Teaching Hospital to state hospitals and primary healthcare centres. We hope that more states adopt strategies like this to fast track more equitable delivery of quality healthcare services to the grass roots.
Posting of Medical doctors during NYSC
Kogi state created an NYSC/Medical Team project to prioritise and provide the services of more doctors, nurses, laboratory scientists and pharmacists at primary healthcare centres in the state. The Kogi state commissioner recommended this project to other states and suggested that a policy be adopted whereby during the youth service year, medical doctors are only posted to primary healthcare facilities. This suggestion resulted in an extensive debate amongst commissioners. While some argued that secondary/tertiary hospitals are short staffed and need the services of doctors, others argued that NYSC doctors need to develop their skills in primary healthcare facilities before advancing to secondary/tertiary facilities.
The resolution from this deliberation, was for the Federal Ministry of Health to review previous laws in place with regards to the posting of medical doctors during their NYSC year. Finally, it was agreed that NYSC doctors should definitely not work in tertiary care centres, while the question of their service at secondary care level will be left for states to decide. The Honourable Minister of Health promised to follow up on this as he lauded the initiative to utilise this cohort of medical doctors in strengthening primary healthcare facilities.
Outbreak response activities
During his opening address, the Honourable Minister of Health highlighted the importance of states taking ownership in disease preparedness and response activities. He anchored his statement on the increasing reports of ‘strange illnesses’ in different states in the country and the late reporting of these to the appropriate authorities. According to him, ‘The ultimate aim is for each Nigerian to become a Surveillance Officer, and to notify designated authorities of disease occurrences whether usual or unusual’. The Chief Executive Officer of the Nigeria Centre for Disease Control, Dr Chikwe Ihekweazu emphasised this while addressing the Commissioners for Health. According to him ‘Strengthening your State Epidemiology Team may not be your biggest achievement but a weak team is your biggest source of risk.
Reporting on the just concluded National Health Accounts, Dr. Francis Ukwuije, Head of Health Financing, Federal Ministry of Health, said that out-of-pocket expenditure as a proportion of total health expenditure was as high as 73.8% in 2016. The implication is that many Nigerians especially the poor and vulnerable are dying as a result of their inability to afford healthcare. On Tuesday, November 7, 2017 President Muhammadu Buhari presented the 2018 budget proposal to the National Assembly, allocating N340.45 billion to the health sector (N269.34 billion for recurrent expenditure; payment of salaries and overheads and N71.11 billion as capital expenditure). This represents only 3.9% of the total budget, a far cry from the 2001 Abuja Declaration, which stipulated that a minimum of 15% of the annual budget should be allocated to health. Nigeria has not met this target 16 years later and it does not seem likely that this target will be met in 2018. The 60th Council however resolved that subsequent meetings would be held between May and June each year, in order to make key decisions for the health sector that will influence the budget cycle. Hopefully, this will make a difference.
A competitive mechanism is to be put in place for identification and rewarding the two best reporting states as well as identifying the worst three states. We look forward to seeing how this plays out at the next meeting in Kano, May 2018.
In attending this year’s NCH, we noted that many of the decisions of the previous National Council of Health meetings are yet to be implemented. Like many Nigerians, we hope to see the NCH move from agreements to implementation. As Senator Amosun said, “Nigeria is striving to diversify the economy from crude oil, it should realise that only a healthy population can drive this policy”. A healthy population is truly the best insurance we can have for our economy to thrive.