The task of transforming the ailing Nigerian health sector has been assigned to the newly appointed Dr Osagie Ehanire and Dr Olorunnimbe Mamora, minister of health and minister of state for health respectively. These two men, recently appointed by President Muhammadu Buhari, certainly have their work cut out of them as the challenges facing the health sector are quite daunting.
Although both Ehanire, a distinguished anesthesiologist and vascular surgeon, who trained at University of Munich, Germany; and Mamora, a respected physician/general practitioner, who later ventured into politics, have impressive academic and professional records, the ministry of health has over the years proven to require more than impressive curriculum vitae to effectively manage.
Therefore, except these new helmsmen of the health ministry do something different from what their predecessors did, they will not only fail to change the narrative of the health sector, but will also end up as their predecesors whose tenures are remembered more for the failures of the nation’s health system than for their great careers as professionals.
Top on the agenda of the new health ministers must be how to innovatively fund the health sector. They must as a matter of urgency devise ways to mobilise the needed funds for healthcare as the age-long problem of low budgetary allocation remains an albatross for the sector.
It is disheartening that the Nigerian government’s allocation to health in 2019 was just about 2 per cent of the total budget which is a far cry from the stipulated 15 percent agreed by African countries in April 2001 when the historic Abuja Declaration was made by African countries under the auspicies of the African Union. Even though this historic agreement was signed in Nigeria, the Nigerian government has been a permanent defaulter. The health budget in Nigeria has never been above 5 per cent since that agreement was signed, while some smaller African countries have been complying and getting great benefits from it.
More worrisome is the fact that more than half of the 2019 budget (62 billion) is for recurrent expenditure, while a meagre 50.15 billion is for capital expenditure. Even though the sector will also get extra 1 percent of the consolidated revenue (51.22 billion), as stipulated by law, and already earmarked for the Basic Health Care Fund, the fact is that this money is still grossly inadequate to provide the healthcare needs of about 200 million Nigerians.
An important aspect of healthcare financing the new health ministry helmsmen must also focus on is how to reform the National Health Insurance Scheme (NHIS) to make it effective and efficient. Perhaps, it is necessary to retool the law establishing it to give it a clear direction, as the NHIS presently plays the dual role of a regulator and provider. It will be better if the NHIS can just be a regulator, helping to ensure quality in the scheme as it is only when this is done that more Nigerians can embrace it and the hope of universal health coverage can be achieved. This will also help reduce the unacceptably high level of out-of-pocket payment for service delivery by patients.
Another germane area the new health ministers must address is the poor state of primary healthcare in the country. Considering the fact that majority of Nigerians needing healthcare are at the grassroots, it is inimical that this sub-sector is in such a sorry state. The hope that the National Primary Health Care Development Agency will help transform primary healthcare across the country has sadly not materialised. This is the time to properly fund the agency to enable it deliver on its manadate.
Beyond all these, however, the new health ministers must work to build relationships among healthcare practitioners and encourage interprofessional collaboration. The ministers must at all cost avoid the controversies of recent years that made other health workers perpetually suspect the motives of health ministers and acusing them of only protecting the interest of their medical doctor colleagues. The Nigerian health system can only thrive and deliver quality healthcare when all the stakeholders work in harmony and for the interest of the patient.