Debating approaches for tracking healthcare funds
The constitutional basis for the campaign for quality and affordable healthcare would be seen in the details of the fundamental objectives and directive principles of state policy as enshrined in Chapter Two of the Constitution.
Specifically, Section 17 (2b) provides that “the sanctity of the human person shall be recognised and human dignity shall be maintained and enhanced.” Section 17(3c and d) similarly mandates the State to build a social order where the “health, safety and welfare of all persons in employment are safeguarded and not endangered or abused.”
Added to these constitutional directives on health is the provision, which puts the responsibility on the Nigerian State to ensure there are adequate medical and health facilities for all persons.
With these express provisions in the constitution, as well as international human rights instruments, which Nigeria is signatory to, the implication is that citizens have no business suffering as a result of lack of access to quality healthcare.
In the area of maternal health for instance, Nigeria continues to account for dire maternal mortality figures, compared to its peers across the world. A joint report (Trends in Maternal Mortality: 1990 to 2015 by World Health Organization, WHO, World Bank and United Nations Population Fund, UNICEF) estimates that Nigeria has approximately 58,000 maternal deaths, accounting for 19% globally.
According to the figures, at least 800 women die in every 100,000 live births. These issues were once again brought to the spotlight recently, when community activists, healthcare workers, traditional authorities and healthcare agencies compared notes on the critical question of accountability in the health sector in Kano State.
The discussion, which took place at the Grand Central Hotel, Kano, focused on how to ensure funds being poured into the health sector, are used to achieve the objectives for which they were budgeted.
The Focus Group Discussions (FGDs) are integral components of a research by the Resource Centre for Human Rights & Civic Education (CHRICED) to understand the state of accountability in the maternal health sector in Kano State.
After generating research knowledge about accountability, the project is expected to provide a community framework for tracking and monitoring funds devoted to health interventions by focusing on health facilities, especially Primary Healthcare Centres.
CHRICED helmsman, Comrade Dr. Ibrahim M. Zikirullahi stressed that it was important to provide opportunities for the participants to freely share their views, based on the reality of quality of healthcare and extent of access in their respective communities. He stated that CHRICED has over the years worked to build the capacity of grassroots activists and communities to enable them engage relevant institutions with the goal of ensuring accountability in the maternal health delivery chain.
According to him, the current phase of the project on Promotion of Democratic Participation with Focus on Maternal Health focuses on how citizens can influence the duty bearers and institutions to respond to key issues affecting their social conditions.
His words: “In this context, we are focusing on resource budgets and funds earmarked to tackle the problem of maternal health. The draft report before you today is a collation of data, view points and realities on how the deployment of financial and human resources have been done towards tackling the scourge of maternal mortality.
While CHRICED has in recent times commended the Kano State government for achieving key milestones in terms of the rise in the budgetary allocation for the health sector, the other essential step is to go beyond the big budget figures to understand where the resources are going, and to see if the impact recorded on the ground is commensurate to the resources, which have been deployed over time.”
The FGD therefore provided space for citizens to reflect on how best to deepen accountability in maternal health delivery in Kano State.
In terms of the scope of what has to be done, participants at the discussion agreed that the task before citizens involving the tracking of resources earmarked for health interventions was a herculean one.
Part of the difficulty stems from the absence of a reality check about how Kano, Nigeria’s most populous state has fared in the critical area of tackling maternal mortality.
In recent times, there have been celebrations over the increasing budgetary allocation to the health sector in the state. In terms of budgeting, things have been so good that Kano has received thumbs up for getting very close to the realization of the Abuja Declaration on healthcare financing, which mandates government actors to prioritize the health sector by committing at least 15 percent of their budgets.
Activists however insist that beyond the big budget figures, there is a need to follow the money to the point of the end user to see if what has been budgeted is trickling down to the facilities at the grassroots, and whether the monies expended have translated into the desirable outcomes in the lives of citizens.
Therefore, those checking for “the devil,” which is in the detail, are keeping their eyes on the flipside of implementation. Part of the conclusion from the interaction at the FGD is that a lot of monitoring is required to ensure there is value for money.
The other major observation was that while Nigeria’s most populous state has taken important steps in the area of budgeting to provide for more funds, there remain significant gaps in the area of monitoring to determine whether the monies so voted have been properly expended.
In his presentation, Professor A.B. Ahmed of Faculty of Law, Bayero University Kano who led the research echoed the need for proper accountability in the health sector, which he noted would have to fall into the categories of financial, performance, and political accountability.
According to the research preliminary findings, the accountability gaps in the health sector in Kano State are numerous, meaning that stakeholders must work to ensure resources committed to achieve health outcomes do not go down the drain.
The researcher noted that in many health facilities visited by the research team, medical consumables were not readily available in sufficient quantity.
According to the Lead Researcher, in facilities where such consumables were readily available, they were materials supplied through the direct intervention and partnership of projects like the Maternal and Newborn Child Health (MNCH2) programme of the UK-Department for International Development (DFID). He said the research team specifically observed that in many facilities, the space available for patients accessing the facility and those who need to be put on observation was too small and not well ventilated. His words: “The same observations were made in relation to laboratory. It was again discovered by the team that there is inadequate staffing, particularly considering the number of patients accessing the services at the facility. He said due to the inadequacy of human resources, the staff at the facility were constrained to engage the services of voluntary staffs that have no formal engagement with either the State or the Local Government.”
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