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How to improve medicare delivery in Nigeria


Muhammad Ali Pate

Former Minister of State for Health and Executive Director of National Primary Health Care Development Agency (NPHCDA), Prof. Muhammad Ali Pate, has identified gaps in the country’s healthcare delivery system even as he proffered solutions on how to improve services.

Pate a Professor in Duke University’s Global Health Institute, United States (US), at the Third Distinguished Lecture of the Ondo State University of Medical Sciences (UNIMED) titled “The Future of Health and Promise of Primary Health Care in Nigeria” appreciated the efforts of past and present administrations in fixing healthcare in Nigeria but, however, said there are still important gaps remaining.

Pate said lack of coherent, effective national health financing policy is manifest in at least two ways: the inefficient resource mobilization for health, whereby 95 per cent of the 63 percent private portion of total health expenditure is household out of pocket expenses, contributing to the significant equity issues that we experience in the health sector; and allocation inefficiency, whereby allocation of health sector budgetary resources tends to favour higher level, infrastructure dominant and curative services.


Pate said primary health care services, core public health functions, multi-sector approaches, such as for dealing with malnutrition, still play at second place to more expensive curative care. “In other words, the mindset of panacea still tends to trump that of Hygeia,” he said.

Pate added: “We only hope that the new National Health Policy will build on these preceding efforts to bring further coherence in health sector governance in Nigeria and improve focus to deliver preventive services using platform of primary health care.”

Pate insisted that appropriate financing levels and mechanisms and clearly universal primary health coverage is in Nigeria’s future.

He said Nigeria should domestically finance its efforts to end Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), Tuberculosis (TB) and Malaria epidemics before the upcoming epidemic of non-communicable disease for which there may not be external finance. To seize the path to universal Primary Health Care (PHC) coverage in Nigeria, Pate said, substantial improvements are needed in levels of allocation, efficiency of mobilization and quality of spending on health.

Pate in the Third Distinguished Lecture of UNIMED said the Nigerian Government should be courageous enough to guarantee off-the-top the cost of basic vaccination for all children born in this country regardless of where they are located. “We have, for decades, subsidized universal consumption of hydrocarbon fuel, but remain unable to guarantee vaccines for our children. The Federal Government and States should allocate resources enough to show seriousness in the move to universal health care,” he said.

Pate said people-centred health system is primary health care. He explained: “The idea of people centeredness in health system is not new, as it had been part of the original conception of primary health care at Alma Ata. It involves understanding the dynamic interrelationships of ‘people, processes, systems, power relations and values in the foundation and the pillars of any effort to improve health and wellbeing’.”

To unlock the potential of the private health sector, Pate encouraged the Federal and State Governments to collaborate with the Private Sector Health Alliance of Nigeria in addressing policy, regulatory and access to capital constraints that had shackled private sector health delivery in Nigeria.

Doing so, he said, will develop the sector, including manufacturing and services, create jobs at home and reduce foreign exchange losses from reverse import of health services.

Pate said the government must prioritize investment in training within the country’s health institutions of higher learning; and beyond clinical experts with technical depth, Nigeria should develop curricula and train for expertise in broader health management, clinical governance, quality of care and exercise of leadership, as is currently being done by the Healthcare Leadership Academy in collaboration with Lagos Business School and external partners.

Pate concluded: “… The future of Nigeria and its population’s health is bright. But, that future cannot be taken for granted. Bold, visionary leadership is required to realize that future through the path of universal access to quality, effective, efficient primary health care services, as foundation for a people-centered health care system. Ensuring public health is also at the core to our national survival.”

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