Towards the late days of December 2016, I bumped into a New York Times opinion piece titled “Trump Is Going After Health Care. Will Democrats Push Back?” written by one Theda Skocpoldec. It was clearly a well-written article, but what had run through my mind after reading through it was not the politics of Obamacare. Rather, it pulled at my mind, a painful reminder of issues closer home. It occurred to me that the title of a Nigerian- focused article after the 2017 budget presentation by Nigeria’s President, could have read like this: “Buhari Is Going to Prioritise Primary Health Care. Will the National Assembly support him?” Had there been such articles with such tilt, they would have been the climax of 2016 for me and many others who had been working tirelessly to have the national health act implemented. I do imagine from the current body language of parliamentarians leading health –related committees like Lanre Tejuoso, Mao Ohuabunwa, Chike Okafor and David Ombugadu and so forth, that a primary health care -focused health budget would have gotten a resounding “Yes” from the legislative chambers.
However, the budget proposal for 2017 by the executive had not shown that overt will to finally rein in that big gorilla of our health system – a failing and underperforming primary health system. This could have been done by taking that first major step of revitalizing it, by activating the National Health Act (NHA). The budget presented by Mr. President was a missed opportunity to show the world we were serious about mending the broken cornerstone of our health system, through ensuring that the National Health Act is activated. Could it be that Mr. President did not know that it provides an accountability system that strengthens transparency and stifles corruption through reengineering the framework for our health system? Could it be that he did not know that such a ‘pro-poor’ document took a tortuous decade in coming? Alas, since its passage two years ago, it had been waiting for a shot of life.
It missed 2016. Thus, the 2017 budget is a ‘must-not-miss’ opportunity to ensure that the statutory transfer of not less than 1% of the Consolidated Revenue Fund of the Federation (CRF) is included in the budget.
Nigeria like most African countries is yet to honour the Abuja Declaration of 2001 which obliges African Union member states to allocate 15% of their annual budget to the health sector. There is no gainsaying that smart investments along the Nigerian health sector pyramid which primary health care forms the base, combined with policy reforms, with the NHA serving as the pivot for these reforms, would reinvent the health sector, and create the resilience in the long run to brace up to its humongous disease burden and the health needs of our rapidly expanding population. Such a visionary catalytic approach to supporting primary health care through the activation of the Basic Health Care Provision Fund (BHCPF); the holder of not less than 1% CRF mandated by the Act annually, coupled with good regulations and quality standards would greatly improve the health care ecosystem and transform a sector that has a direct bearing on Nigeria’s growth and renewal as it targets to be one of the top twenty economies of the world.
Our parliamentarians would probably have supported him, and would still support him, if he prioritises health care, including the activation of the NHA/BHCPF, this is because the Nigerian citizens whose mandate they have, are burdened by a recession hit economic environment and find themselves in an unfortunate narrative of perennial poor financing of the health system that is characterized by low investment by government, strangulating out –of-pocket payments, dearth of adequate insurance coverage and low donor funding. Therefore, the current health budget stream of 382 billion Naira should be augmented with at least a projected 1% CRF of 49 billion Naira to 431 billion Naira. This would move action to about 6% of the total budget and provide much needed additional resource revitalise primary health care, as this is a major social safety-net in the sector, while the government attempts to reposition the economy.
The health sector burden of diseases of Nigeria cannot be postponed because the time to act is now. A situation wherein 2015 an estimated 550,000 Nigerians, especially vulnerable women, newborns, and children died from diseases like malaria, diarrhoea diseases, neonatal and maternal disorders, which are largely preventable, is totally unfair to the poor and unacceptable!
Nigeria remains one of the worst countries to be pregnant, to be a newborn and to grow up as a child, and ranked 152nd of 187 on the Human Development Index. This must not continue.
This is a corollary to the fact that most of our primary health care facilities are chronically stocked-out of drugs, lack basic infrastructure and are short of skilled medical personnel to manage most of the basic needs of the communities. Furthermore, there is large coverage gap as out of the 774 local government areas, there is at least one primary health facility that is inactive in each of them. It further buttresses the need to activate the National Health Act to unlock the catalytic fund that the BHCPF provides towards repositioning them, as failure to meet the sustainable development goals (SDGs) and attain universal Health Coverage will continue to stare at us in the face if we do not act now.
It is not too late to do something about it. The budget review process at the National Assembly provides an opportunity to break the ceiling of the budget envelope for the health sector.