Stakeholders want new ministers to prioritise better funding mechanisms

As part of agenda-setting for the new Health Minister, Dr. Osagie Emmanuel Ehanire, and the Minister of State for Health, Dr. Olorunninbe Mamora, stakeholders in the sector have urged them to prioritise the institutionalisation of better funding mechanisms for the sector by reforming the ailing National Health Insurance Scheme (NHIS) and making the Basic Health Care Provision Fund (BHCPF) more operational.

The BHCPF is the minimum of one per cent of the consolidated Federal Government revenue and contributions from donor grants set aside to fund the basic health need of the citizens. 50 percent of the fund is to be used for the provision of a basic minimum package of health services under the NHIS while five per cent is meant to cater for emergency health interventions.

45 per cent of the fund is expected to be used for the provision of primary health care under the National Primary Health Care Development Agency (NPHCDA). Out of this 45 per cent for NPHCDA, 20 per cent is meant for provision of essentials drugs and vaccine, 15 per cent is meant for provision and maintenance of facilities, equipment and transport for eligible primary health care facilities while 10 per cent is meant for the development of human resources for primary healthcare.

The stakeholders include: a consultant cardiologist and Executive Director, Nigerian Heart Foundation (NHF), Dr. Kingsley K. Akinroye; former President, Pharmaceutical Society of Nigeria (PSN), Olumide Akintayo; President, Nigerian Medical Association (NMA), Dr. Francis Faduyile; and President, National Association of Resident Doctors (NARD), Dr. Segun Olaopa.

Akinroye wants operationalisation of the BHCPF to ensure the fund is promptly and effectively disbursed with an institution of a committed Monitoring and Evaluation Team to work directly with the Minister, Dr. Osagie Emmanuel Ehanire; and Minister of State for Health, Dr. Olorunninbe Mamora.

The cardiologist also called for the mandatory and significant integration of Non-Communicable Diseases (NCDs) as a core issue of the BHCPF. Akinroye explained: “NCD is the highest killer disease in the most productive ages of the Nigerian population especially cardiovascular diseases (CVDs) between ages 22 -55 years; and also the highest cause of morbidity between 35 – 70 years in the adult population. There is a claim that NCDs have been included in the Basic Minimum Package of Health Services (BMPHS) but all that is provided for is blood pressure check and urine screening for diabetes for all adult Nigerian at no cost in BHCPF designated health facilities. This needs to be revisited to include more reliable basic- screening tests.”

He said there must be provision for NCDs prevention and treatment in the benefit packages for both BHCPF and State Social Health Insurance Schemes

Akinroye said it is highly commendable to the last administration that 23 States have commenced the State Social Health Insurance Agency but each of the States are at different stages of implementation of the schemes. He said it is mandatory to ensure that all the states are encouraged to be at the same operational level and move together while the other remaining states are brought on board within a short time.

“We have waited too long for an effective “alternate” Nigerian Fund for Health and therefore, all attention that is deserved must be given to getting it right and drive on a path-way of sustainability,” he said.

Akintayo said the current challenges of the health sector are numerous and include lack of harmony in the ranks of the critical workforce due to poor management skills of the leadership of Federal Ministry of Health (FMoH), which excels in preferential treatment to a favoured profession.

The pharmacist also identified extremely wretched management of Federal Government’s Social Health Insurance programme through the NHIS. This, he said, continues to stall the drift towards Universal Health Coverage (UHC) in Nigeria.

Akintayo said there are perennial negative health indices, which continues to compel very poor ratings of the health system as well as poor output and of the regulatory agencies, which should regulate and control the various health professions.

What can Ehanire do to address the situation? Akintayo said the Federal Government has set out to fail in the health sector through the appointment of the two ministers, which is skewed 100 per cent in favour of medicine.

He said any good observer of the output of Ehanire, as Minister of State for Health- between 2015 to 2019- should be worried. “He is on record as the dramatis personae who endorsed the evil perpetrated by the notorious former Chief Executive of Federal Medical Centre, Owerri. Despite glaring evidence of thievery and fraud, Ehanire was interested in maintaining the unfortunate status quo in that facility. Ehanire will, therefore, need a major regenerative process mentally and emotionally to get it right on this new beat,” Akintayo said.

What are the most pressing needs of the health sector that Dr. Ehanire needs to address within his first 100 days? Akintayo called for the approval of adjustment of Consolidated Health Workers Salary Scale (CONHESS) as was done for Consolidated Medical Salary Scale (CONMESS) scale since 2014 and payment of withheld salaries of health workers who went on strike in April and May 2018 in a most discriminatory way.

Akintayo urged the new ministers to ensure all fall-outs of the consent judgement of National Industrial Court of Nigeria (NICN) are implemented without further delays as well as facilitate appropriate and lawful appointments in Regulatory Agencies in the health sector.

To achieve universal health coverage, Faduyile and Olaopa said health insurance should be made compulsory but with a choice for Nigerians to freely decide whether to buy public or private sector health plans. They said no one should be forced by any guise to subscribe to the Federal Government or state government plans and that it must be by the free choice of operator and provider if it must be compulsory.

The stakeholders said the NHIS must be reformed to solely be a regulator instead of being both a regulator and an operator. They said the government must ensure that at least 60 per cent of Nigerians are enrolled on the NHIS to increase financial access to health. The stakeholders said the NHIS should regulate the operations by both public and private operators at all levels and provide guidelines for all categories of players/operators and providers.

Olaopa said the next health minister must ensure that this current administration works on the clearly defined job description and responsibilities for all staff in the health sector and that the era where unions define the roles of staff employed and paid by the government must be stemmed. He said the government should also ensure regular engagement of all professional groups, and unions to foster harmony and eliminate suspicions in the administration of government processes.

Faduyile said hospitals at all levels must be revamped within the first two years with major focus on emergency care and life-threatening ailments. The NMA President said the challenges in the health sector could not be totally solved in four years. He said the Ministers for Health must be able to work with industry stakeholders to sincerely prioritize the issues in the sector and begin with those issues that available resources can effectively resolve.

Faduyile said increasing human resources for health might be amongst the top priority and fashioning a robust uniform performance monitoring template for all Chief Executives of all the Federal Tertiary Health Institutions to check and determine and reward performance while naming and shaming unproductivity

Faduyile said other parastatals under the Ministry of Health like the National Primary Healthcare Development Agency (NPHCDA); Nigeria Institute of Medical Research (NIMR); Nigeria Institute of Pharmaceutical Research and Development (NIPRD); the National Agency for Food and Drug Administration and Control (NAFDAC) should be made to have a productivity output reporting timelines

He said the ministers should aim to achieve some components of the Sustainable Development Goals (SDGs) that are possible within the four-year tenure. Faduyile said the ministers should attempt to reverse the brain drain in the sector; must be fathers to all health sector stakeholders and must be seen to do so, and meritocracy must be allowed to reign in all aspects of the administration of the sector.

Osagie Emmanuel Ehanire (born November 4, 1946, in Oredo Local Government Area of Edo State) is a Nigerian medical doctor and politician. He was appointed as the Minister of State for Health in the President Muhammadu Buhari administration in November 2015.

Ehanire is a surgeon and holds a medical degree from the College of Medicine, Ludwig Maximilians University of Munich, Germany. He also holds post-graduate diplomas from the teaching hospital of the University of Düsseldorf and Essen, Germany in the areas of anaesthesiology, general surgery, and orthopaedic trauma surgery. He has served on various boards both within and outside Nigeria, including Chair of the Board of Trustees of the TY Danjuma Foundation.

Before going into administration, he had an illustrious clinical career – he was Senior Registrar Clinical Instructor, University of Benin Teaching Hospital; Member of the old Bendel and Edo States Hospital Management Board; Consultant Surgeon, Shell Petroleum Development Company of Nigeria; Clinical Course instructor, Fracture Internal Fixation course at the BG Accident Hospital, Duisburg, Germany. He co-authored the orthopaedic book “The severely injured limb” edited By John Ackroyd.

The new Minister of State for Health, Dr Adeleke Olorunnimbe Mamora, is a medical doctor and a politician representing Lagos State.

Mamora was born on February 16, 1953. He obtained a B.Sc Health Sciences, Bachelor of Medicine, and Bachelor of Surgery (MBBS) from the University of Ife, Ile Ife. He is a general practitioner.

He was elected to the Lagos State House of Assembly in 1999 and was elected Speaker.

Mamora was chairman of the Conference of Speakers (2000-2001). He was elected to the Senate in April 2003 and reelected in 2007. He was also a member of the Economic Community of West African States (ECOWAS) Parliament (2003-2006).

In 2003, he was appointed the chairman of the Senate Committee on Ethics, Privileges and public petition.