WHEREAS at this time of national economic crisis, it is easier to become despondent, cynical, desperate-survivalist, hyper-critical or enjoy the heaven-will-not-fall cocoon of privileged positions within the system than to volunteer in the rescue efforts, it is considered necessary to contribute towards adding value to the 2016 budget’s quality and implementation framework.

The focus of this contribution is the management of the health sector which has not fared well for several decades. Clearly the lack of a functional Primary health care delivery has degraded the secondary care level to the primary level while the tertiary level functions overwhelmingly as the secondary level, thereby systemically “outsourcing” the real tertiary healthcare needs to various foreign hospitals in India (why India plans direct flights to Nigeria!), South Africa, Europe and America for those who can afford them.

The Minister of Health, Professor Isaac Adewole, confirmed this anomaly thus: “The tertiary institutions are not meant to treat malaria or skin rashes, but to attend to critical issues. We are determined to take away over 70 per cent of patients from the teaching hospitals, but the heads of tertiary institutions must find a way to relate freely with these cadres for effective healthcare delivery…We won’t abandon those cadres, so that the sequence of referral could be protected.” (Punch, 29/12/15) This was why Nigeria’s healthcare management received its one-off boost during the late Professor Olikoye Ransome-Kuti’s tenure as the Minister for Health through his enduring commitment, passion and drive for emphasis on the efficiency and effectiveness of care at the primary level.

Thus, perhaps the minister’s plans to build “10,000 primary health facilities in the 774 local government areas across the country for effective service delivery and to reduce pressure on tertiary institutions plans” (Punch, 29/12/15), may be understandable partly to reduce the resultantly high maternal mortality rate, noting his specialty in obstetrics and gynaecology. But, it appears that the techcnocrats in his ministry did not brief him adequately like their counterparts in Power, Works, Housing, Solid minerals, Transportation and Aviation among others.

This is because the Chairman of the House of Representatives Committee on Health, Honourable Chike Okafor (Imo-APC), recently disclosed : “Statistics show that we have over 32,000 healthcare facilities in the country, but only 20 per cent are functional…The question is how can we make these 32,000 health care facilities to be fully functional?” In addition, he commended UNICEF for establishing primary health care centres in all the wards in the country. He also stressed the need to reposition healthcare centeres across the country…(and) to ensure that the centeres are better equipped with modern facilities towards ensuring that Nigerians had better access to qualitative healthcare (PM News 09/12/15).

Moreover, he recommended the removal of Primary Health Care from the control of local governments because they lack the required resources to cater for the health of Nigerians in the rural areas: “Majority of Nigerians reside in rural areas. We cannot afford to allow local government councils to manage primary health care centres. The truth of the matter is that local government councils do not have the resources to fund and equip these health centres…The situation must be reversed. The Federal Government must take over the management of primary health centres, equip them with necessary facilities and adequate personnel (doctors, nurses and pharmacists).. Most importantly, health professionals serving in these health centres must be given necessary incentives to live and work in rural areas” (Vanguard, 16/12/15).

Thus, the logical question is why should the minister plan to build 10,000 additional PHCs despite his N296 billion (4.93%) budget? This is because the current solution to the problem is not to build new PHCs but to make all the existing ones effectively functional.

And the Legislature has done the Minister’s spadework for him through its oversight survey which shows that only 20% of the existing 32,000 PHCs (6,400) are functional, leaving a balance of 80%, 25,600, (156% more than his plans) that are non-functional! Hence he can easily exceed his 70% target reduction of patients from the teaching hospitals simply by not creating new PHCs but by implementing these practical recommendations of the House Health Committee: equip them with necessary facilities and adequate personnel (doctors, nurses and pharmacists), incentivise the health professionals serving in these health centres to live and work in rural areas where the PHCs are located and sponsor a bill for the removal of Primary Health Care from the control of Local Governments (as another serious doubt on the constitutional relevance of LGs!) And he can obtain the details of the non-functional PHCs from the House committee immediately!

This is his easiest and fastest way of achieving an effective change towards becoming the next biggest success after Prosessor Olikoye Ransome-Kuti in the healthcare sector. And by achieving more with less through the better utilisation of existing infrastructural facilities, he can contribute significantly towards maximising the national resource productivity by “making every Naira count” especially at this critical time of resource inadequacy.

The prevention of similar lapses across all the MDAs can stop the scandalous waste which has traditionally characterised Nigeria’s public financing from the obvious lack of cumulative value-addition in implementing development plans through the annual budgets. Therefore, the creation of a Budget Effectiveness Unit (“Eff-unit”), using the current resources and infrastructure in the President’s or Vice-President’s office, to complement the “E-unit” in the Finance ministry may be the recipe for correcting this problem from 2016.
• Okunmuyide wrote from Lagos