Health sector reform: the task before the new administration

This year’s May 29 ushered in a new government in Nigeria headed by President Bola Ahmed Tinubu. It was a heartwarming and smooth change of baton between the former president, Major General Muhammadu Buhari and the new one, Asiwaju Bola Ahmed Tinubu, a former Governor of Lagos State. This peaceful transition of power, without a doubt, further deepens and strengthens our democracy- the largest on the Continent.

The eight years of former President Muhammadu Buhari obviously produced mixed results on all fronts of our national life and development and the jury is still out on how well the administration performed. What is however not in doubt is that despite all the efforts of the Buhari administration, more still needs to be done particularly in the country’s health sector.

When President Buhari took over power, one of the declared goals of his administration was healthcare. While in his inaugural speech on May 29, 2015, he considered insecurity, pervasive corruption, and economy as his “immediate concerns”, he however assured Nigerians that his administration would prioritize healthcare.” “We have to look at the whole field of medicare. We have to upgrade our dilapidated physical infrastructure” he declared in his now famous “I belong to everyone, I belong to no one” speech.

The Journey So Far…

One of the notable achievements of his administration was the establishment of the Nigeria Centre for Disease Control (NCDC) in 2011, which played a crucial role in responding to disease outbreaks such as Ebola and Lassa fever. Under his administration, the NCDC received increased funding and support, leading to improved disease surveillance and response capabilities.

In 2017, President Buhari launched the Primary Health Care Revitalization Programme with a target to revitalize of over 10,000 primary health care facilities across the country. It focused on improving infrastructure, manpower, and the availability of essential drugs at the grassroots level so as to provide affordable and accessible healthcare services to all Nigerians, particularly in rural areas. However, the implementation of this program faced significant challenges as it failed in its target number of revitalized PHCs. With this, many primary healthcare centers continue to suffer from inadequate infrastructure, staffing shortages, and a lack of essential medical supplies.

Another positive aspect of the administration of former President Buhari was the launch of the Basic Health Care Provision Fund (BHCPF) in 2018. The Fund, which is financed by not less than 1% of the Consolidated Revenue Fund (CRF) of the Federal Government and donor agencies, aims at ensuring that every Nigerian has access to basic healthcare services through the provision of a mandatory health insurance scheme. It is worthy of note that by the creation of this Fund, sub-national governments were also encouraged to establish their respective primary health care agencies and state health insurance schemes in order to be able to access it through counterpart funding model. While the establishment of the BHCPF was commendable, its implementation has been slow, and there are concerns about the effective utilization of the fund to achieve its intended goals.

One major area of concern during President Buhari’s tenure was the inadequate funding of the health sector. Nigeria’s healthcare budget remained significantly below the benchmark of 15% of the national budget as recommended at the Abuja Declaration of 2001 by African Heads of Government. Allocation for healthcare was inconsistent and hovered between 4-6%. Insufficient funding no doubt hampered efforts to improve healthcare infrastructure, recruit and retain skilled healthcare professionals, and provide essential medical supplies and equipment. This has contributed to the persisting challenges in the healthcare system, including inadequate healthcare access, poor quality of care and health outcomes.

Additionally, during President Buhari’s tenure, Nigeria experienced several outbreaks of diseases, including meningitis, measles, and most notably, the COVID-19 pandemic. The initial response to the COVID-19 pandemic was criticized for being slow and lacking in coordination. However, the government later took steps to ramp up testing, establish isolation centers, and procure vaccines to control the spread of the virus.

Most notably, and in the twilight of his administration in May 2022, President Buhari signed into law the new National Health Insurance Authority (NHIA) Act which repealed the old NHIS Act and makes health insurance mandatory for every resident in the country. This new law, with its new provisions, is no doubt capable of expanding health insurance coverage from the current approximate figure of 5% thereby reducing the incidence of out-of-pocket spending among the populace, ensuring affordable healthcare and generally improving access to quality healthcare. However, there is need to ensure effective and broad-based implementation through a guideline document which should address the challenges of low awareness, limited coverage, and stakeholders’ misalignment.

Another major challenge which the Buhari administration had to grapple with was that of brain drain and Health Workers Welfare. Nigeria faced and continues to face mass exodus of qualified professionals especially those of health professions. This is the now-famous “Japa” syndrome where many qualified healthcare professionals migrate to other countries in search of better opportunities. The government has made efforts to address this issue and improve health worker welfare. However, more needs to be done to retain skilled healthcare personnel, ensure their job satisfaction and remuneration and create a generally-conducive environment for them to practice.

In summary, while President Muhammadu Buhari’s administration made some efforts to address health challenges in Nigeria, there are still significant areas of concern. The overall performance in the health sector under President Buhari’s leadership has been met with mixed reviews, and there is a need for sustained efforts to strengthen Nigeria’s healthcare system.

Renewed Hope of Better Health?

For the citizens, May 29, 2023 brought to a close a chequered chapter and journey in nation-building and offered them a much-desired chance to begin again with enthusiasm and hope for a better Nigeria. And Nigerians are right to hope. This is because President Tinubu and his All Progressive Congress (APC) party had anchored their campaigns on the theme of “Renewed Hope.”

The new president has his job cut out for him. And he seems to be aware of this when he said to Nigerians not to pity him for he willingly applied for the job!

With a growing population, poor funding leading to increasing disease burden, and inadequate infrastructure, the need for comprehensive health sector reform has never been more urgent. Crucially, the new government needs to prioritize healthcare as a fundamental pillar of national development.

To underscore the task before the Tinubu Administration in the health sector, we shall highlight key areas that require attention.

One of the most pressing issues that the new government must tackle is the inadequate healthcare infrastructure. Many health facilities across the country lack essential equipment, suffer from poor maintenance, and are understaffed. This leads to a substandard quality of care and contributes to the high mortality rates observed in Nigeria. To address this, the government should invest in the construction and renovation of healthcare facilities, ensuring they are adequately equipped and staffed by qualified healthcare professionals.

Another critical aspect of health sector reform is the need to address the issue of healthcare financing. Nigeria’s current healthcare financing system is predominantly out-of-pocket, which places a heavy burden on individuals and families, particularly the poor. To achieve universal health coverage and ensure equitable access to healthcare, the new government, as it has promised during the electioneering campaigns, should explore options for implementing a more robust health insurance scheme. The new NHIA Act provides an effective framework through which government at both federal and state levels, working the private sector, can deliver affordable, accessible and equitable healthcare. We must move faster towards achieving universal health coverage for our country.

Additionally, the new government should prioritize human resource development in the healthcare sector. Nigeria faces a shortage of skilled healthcare professionals, particularly in rural areas. By investing in the training and deployment of healthcare workers, especially in underserved regions, the government can improve access to quality healthcare services across the country. This could involve increasing the number of medical schools, expanding nursing and midwifery training programs, and scaling up current incentives to encourage healthcare professionals to work in rural areas.

Healthcare governance and accountability are also areas that demand attention. The new government must strengthen regulatory bodies and ensure transparency and accountability in the health sector. This includes effective monitoring and evaluation mechanisms, strict enforcement of professional standards, and appropriate sanctions for those who engage in malpractice or corruption. By fostering a culture of accountability, the government can restore public trust in the healthcare system and improve overall healthcare delivery.

Furthermore, the government should prioritize preventive healthcare measures and health promotion programs. Many diseases in Nigeria, such as malaria, HIV/AIDS, and non-communicable diseases, are preventable with proper education, vaccination campaigns, and early detection initiatives. By investing in public health programs and awareness campaigns, the government can significantly reduce the burden of disease and alleviate the strain on healthcare facilities.

Achieving industrial harmony is also critical to stability in the sector. It is worth noting that strike actions in Nigeria’s health sector have been a recurring issue in recent years. Healthcare workers, including doctors, nurses, and other professionals, have embarked on strikes to protest various issues, such as inadequate working conditions, low salaries, lack of equipment and facilities, and other grievances. The new government needs to be creative and proactive in engaging the various stakeholder groups within the sector and to forge a collaborative and collective bargaining approach in addressing their issues.

The private sector is a critical driver of value. Private sector participation both at financing and delivery ends should therefore be encouraged and actively supported by government by creating an enabling legal environment and prioritizing policies that encourage investment (and safety of such investment) in the country’s healthcare value chain in the country. By deepening engagement and partnership with the private sector, government can facilitate the unleashing of the value potential in the country’s health sector.  

Leveraging technology and innovation can play a pivotal role in transforming the healthcare sector in Nigeria and especially help to reverse medical tourism and brain drain to become “brain gain”. The government should embrace digital health solutions, such as telemedicine and electronic health records, to enhance access to healthcare services, especially in remote areas. Technology can aid in trans-location health knowledge-sharing and information management, disease surveillance, and improving the efficiency and effectiveness of healthcare delivery.

In conclusion, Nigeria’s new government faces a significant task in reforming the health sector. By addressing issues such as healthcare infrastructure, financing, human resource development, governance, preventive healthcare, and technological innovation, the government can pave the way for a healthier nation. These reforms require strong political will, sustained investment, and collaboration with relevant stakeholders, including healthcare professionals, civil society organizations, and international partners. With a renewed commitment to healthcare, Nigeria can make substantial progress in improving the well-being and quality of life for its citizens.

• This Report is a health sector agenda for the new administration of President Bola Ahmed Tinubu by Health Insurance Today Magazine
• Compiled by Akindayo Ajiteru and Richard Adeyinka Emmanuel

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