NAPHS – Plugging funding gaps, building capabilities of Nigeria to respond to infectious disease outbreaks

There are different dimensions to national security – food security, economic security, cyber security, human security, health security and others. None is more important than the other. However, nothing is more fundamental to a state’s security than the health of its people. If people are unhealthy, they can’t work, and this means that they can’t contribute to the economy. If they can’t contribute to the economy, the government can’t provide services and infrastructure and this leaves the state or country vulnerable to security threats, natural and economic.

According to the World Health Organisation (WHO), health security encompasses the “activities required minimising the danger and impact of acute public health events that endanger the collective health of populations living across geographical regions and international boundaries”. It is the responsibility of governments globally to protect the health of their populations.

In November 2018, the Federal Government of Nigeria developed a five-year costed National Action Plan for Health Security (NAPHS) as an approach to close identified gaps in health security with the goal of preventing, detecting, and responding to public health threats. The NAPHS (2018 – 2022) provides a roadmap to improve health security in Nigeria; to be achieved through a multi-sectoral approach hinged on the principles of ‘One Health’ with significant participation from stakeholders from relevant government ministries, departments and agencies and partners. These include the Office of the National Security Adviser and the Federal Ministries of Health, Agriculture and Rural Development, Environment, Mines and Steel Development, Finance, Budget and National Planning, Defence, Transport, Science and Technology, Justice, and Information.

The NAPHS is a well thought out plan and successful implementation will increase Nigeria’s capacity to protect its citizens from public health threats. The One Health approach it adopts decentralises health security, therefore making it everybody’s business, not just the responsibility of the Ministry of Health. The partnership with other government ministries and agencies and partners who bring cross-disciplinary expertise is critical to the successful implementation of the plan.

However, there have been a few challenges in implementing the plan. In a workshop with NAPHS focal persons, titled, “A Critical Review of NAPHS as an Effective Budgeting Tool for Epidemic Preparedness in Nigeria”, convened by Nigeria Health Watch in July 2020, some of the challenges affecting implementation were discussed. They included: no immediate availability of domestic funding for outbreak response at all levels, low budgetary allocation to health security, weak commitment of the Ministries, Departments and Agencies (MDAs) directly involved with implementing the NAPHS and so on. One key recommendation aimed at improving implementation of the NAPHS was the need to engage with Heads of MDAs, the International Health Regulations (IHR) focal persons of each MDA, and other key decision makers in budgetary allocations at MDAs.

The COVID-19 pandemic has brought to the fore, the need for stable and sustained funding for epidemic preparedness and response. A major challenge in the implementation of the NAPHS is limited availability of funding and to address this challenge, on Tuesday April 27th, 2021, the Nigeria Centre for Disease Control (NCDC), the agency coordinating the implementation of the NAPHS, in partnership with the Federal Ministry of Finance, Budget and National Planning invited NAPHS technical leads and the budget officers from relevant MDAs to a workshop with the theme: An Intersection of Health Security and Health Financing. The objectives of the workshop were to improve the knowledge of NAPHS thematic leads on the national budgeting process, equip budget officers in the need to mainstream budget for health securities in their annual budget and the necessary synergy between budget officers and the NAPHS technical leads in each MDA.

In his presentation, Mr. Ben Akabueze, Director General, Budget Office of the Federal Republic of Nigeria mentioned discussed “Government Spending on Financing Health Security in Nigeria”. He showed the trends in health sector allocations from 2008 to 2021, revealing that the Federal Government’s budget for health had more than doubled in the past five years and encouraging sub-national governments to step up funding of health. He concluded by emphasising the need to focus on health security, including adequate funding for preparedness and response to emergencies.

To support the MDAs in exploring funding opportunities in the budget, Mubo Adedokun, Director, Expenditure, Budget Office of the Federal Republic of Nigeria encouraged the workshop participants to study the Federal Government’s budget cycle in order to get a better understanding of how the government conducts its budgetary activities. He also urged the MDAs to domesticate the Federal Government’s budget cycle template to improve the quality of their budget preparation.

When the NAPHS was created, it was recommended that specific linkages at policy and operational levels should be formed to connect the NAPHS with sectoral plans. Documents like the National Health Sector Strategic Development Plan and the Mid Term Expenditure Framework (MTEF) should be identified and strengthened to align the NAPHS with the national budgeting, planning and implementation cycle. These activities are critical to ensuring that domestic financing is made available for health security, which will translates to proper implementation of outlined activities.

Although the NAPHS was developed to address the gaps in Nigeria’s health security architecture, it only focuses on addressing gaps at the national level leaving the sub national level vulnerable. The NCDC in 2019 developed the ‘Strengthening States for Health Security’ strategy. This defines NCDC’s strategic support to improve the capacity of states in Nigeria to prevent, detect and respond to infectious disease outbreaks. The aim is to carry out voluntary sub-national JEEs to identify health security gaps at state level and develop plans to close the gaps and bring them up to par with the national plans.

In 2017, Nigeria carried out a Joint External Evaluation (JEE) of its IHR (2005) capacities. The JEE presented a score of 39 per cent for Nigeria, translated to mean Nigeria had challenges in finding and preventing epidemics. In response to this, the National Action Plan for Health Security (NAPHS) was developed to address some of the identified gaps in Nigeria’s health security. In 2019, a mid-term JEE review was carried out and Nigeria’s preparedness score increased to 46 per cent. Nigeria is due for another JEE in 2022. As the NCDC works to boost health security at sub national level, the upcoming JEE will serve as a litmus test that will show how implementation of the NAPHS better prepares the country to be able to safeguard Nigeria’s national health security.

*Beti Baiye is a Programme Manager at Nigeria Health Watch