Healthcare Delivery in 2019: Getting It Right from the Beginning

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Every new year presents the opportunity of a fresh start, driven by a sincere review of the previous year and a strategic blueprint for subsequent advancement.   For the Nigerian health sector, maximising such opportunity and hope of a positive transformation must begin with getting some parameters right from the start of the year. Indeed, from all indications, key stakeholders in the sector would have to do a lot more to make this year better than the outgone year. What is uncertain, however, is whether the nation has the political will to actualise the desired improvements the sector needs to deliver the quality care that Nigerians deserve.

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The reason for this shaky optimism can be easily inferred: the early signs are not encouraging enough. To start with, although there is a marginal increase in the health budget for 2019, compared to 2018, the amount allocated to the sector is still a far cry from what it needs. The present health budget estimates total N365.77 billion, out of the N8.83 trillion total budget, which is 4.1 per cent of the budget. For 2018, the budget was N340.456 billion out of a total budget of N8.612 trillion, which was 3.95 per cent. As usual, the budget contravenes the recommendation of the 2001 African heads of state summit, which coincidentally held in Abuja. Tagged “the Abuja Declaration”, the document stipulates that, at least, 15 per cent of the annual budget should be for the health sector.

Consequently, with the year beginning with a paltry allocation, improving the health sector already overwhelmed by myriads of challenges which require huge financial injection, will need a lot of ingenuity by managers of the sector. We urge stakeholders to prevail on government to consider a supplementary health budget, specifically to accommodate more capital projects for the sector and bridge the huge gap of infrastructure deficit.  In addition, more concerted efforts must be made to ensure that the government does not renege on its commitment to using one per cent of the Consolidated Revenue Fund (CRF) which it stipulated in the budget will be for the Basic Health Care Provision Fund (BHCPF).

Beyond funding, however, the quest to improve healthcare in 2019 will also require a lot of attitudinal changes and sacrifices by players in the health sector. As a matter of priority, stakeholders in healthcare must find ways to stop the gale of health workers’ strike, which over the years, and specifically in the outgone year 2018, has impeded progress in the health sector. Incidentally, as with the issue of finance, the prospect of achieving this change in the new year has begun on a worrisome note, as the Joint Health Sector Unions (JOHESU) recently threatened to embark on another nationwide strike by 31 January, if the federal government fails to meet its lingering demands.  Both health workers and the government must devise constructive ways of resolving issues without repeatedly jeopardizing the health of the citizenry.

Crucial to ending the incessant strikes is the need to decisively deal with the challenge of interprofessional rivalry. Cheeringly, the leaderships of the Pharmaceutical Society of Nigeria (PSN) and the Nigerian Medical Association (NMA), as well as other health workers groups, are having fruitful engagements that we hope will lead to a firm understanding that will engender industrial harmony. This is crucial if the health sector is to make progress in 2019 and the years to come.

Also of concern is the National Health Insurance Scheme (NHIS), which has been generally rated as underachieving.  The previous year was particularly bleak for the scheme, as it was bogged down by its own internecine war of attrition against its executive secretary, who was suspended, recalled and then suspended again indefinitely over allegations of corruption and impropriety. For the NHIS to deliver on its mandate, this imbroglio must stop because a functioning NHIS would be a great catalyst for the delivery of affordable quality healthcare services to Nigerians. More importantly, all the states of the federation must be encouraged to start their own health insurance scheme in tandem with the NHIS Act.

We must also note that improving access to quality affordable medicine is crucial to improved healthcare delivery in 2019. It needs not be repeated that without medicine, there would be no healthcare. Therefore, to improve the pharmaceutical sub-sector of the Nigerian health sector, the government should be enjoined to sign the Pharmacy Council Bill already passed by the National Assembly into law. It should also expedite action on the implementation of the new National Drug Distribution Guidelines (NDDG) and give NAFDAC all the support it requires to deliver on its mandate of ensuring drugs in the country are genuine and fully approved for consumption.

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