How council autonomy will guarantee functional primary health care – Part 2

Technology should play a key role in promoting accountability as citizens can now easily ask questions to know how their funds are being used. But more of this needs to happen. The Community Health Watch initiative by Nigeria Health Watch promotes active citizenship by encouraging community members to share their healthcare experiences. BudgIT is also encouraging community members to Ask Questions. Realising that the judgement is only a first step, the Federal Government has capacity-building plans for local governments and traditional rulers.

While it may not be easy, it is not impossible. It requires purposeful leadership and an understanding of the importance of investing in primary healthcare. As Director of the Special Programme on Primary Health Care at the World Health Organisation, Dr Suraya Dalil, aptly puts it, “If we don’t invest in health systems that are founded on the primary healthcare approach, then we have to spend more when the crisis comes.”

Meanwhile, as a pivotal move to enhance primary healthcare delivery at the grassroots, the Association of Local Governments of Nigeria (ALGON) recently held a strategic meeting with the Development Partners Group for Health (DPG-H), Health Sector Reform Coalition group of CSOs, representatives of the Private Sector Organisations and the Guild of Medical Directors, at the ALGON Secretariat in Abuja.

This initiative highlights ALGON’s commitment to redefining healthcare at the local government level, aligning with Sustainable Development Goal (SDG) 3, which focuses on ensuring healthy lives and promoting well-being for all.

Speaking at the event recently, ALGON National President, Aminu Mua’zu Maifata, who is also the Chairman of Lafia Local government council reiterated the association’s dedication to leveraging collaboration and innovation. “We are fully committed to building the capacities of local governments to fulfill their constitutional responsibilities, particularly in primary healthcare and basic education,” Maifata stated.

Indeed, the recent Supreme Court judgment on Local Government autonomy has further fueled ALGON’s resolve to initiate this transformative journey. The multi-stakeholder meeting had in attendance the WHO Country Representative in Nigeria Dr Walter Mulombo along with other DPG-H members , Civil Society Organisations (CSOs) led by the Health Sector Reform Coalition, the Private Sector group leaderships, and the President of the Guild of Medical Doctors.

The meeting was anchored by Dr Ben Nkechika a Public Health Consultant and ALGON Consultant on Health and supported by Dr Okey Udeh ALGON Consultant on Governance and Processes. The aim of the meeting was to develop a roadmap and strategy for making primary healthcare a critical component of development, especially in rural areas.

“Our objective is to ensure effective and efficient health coverage across all communities in Nigeria,” Maifata added, noting that ALGON’s initiative aligns with President Bola Ahmed Tinubu’s ‘Renewed Hope Agenda’ and the Health Sector Investment Programme through SWAP.

He emphasised that the plan would strengthen the implementation of the World Health framework, particularly in areas of research, capacity building, and reducing mortality rates.

As ALGON advances its comprehensive strategy, the Association is set to revitalise and operationalise its Primary Health Care programme. The focus will be on ensuring standardisation, excellence, and sustainability in service delivery through continuous monitoring and evaluation across Local Governments and Area Councils.

Maifata reassured Nigerians that local government administrators will prioritise primary healthcare and basic education.

He made this promise at the opening of the 48th National Executive Council (NEC) meeting of ALGON in Lafia, Nasarawa State.

Maifata emphasised that local government administrators are committed to delivering on their statutory responsibilities, particularly in primary healthcare and basic education.

He said: “As administrators at our various local government councils, we want to assure the people of Nigeria most especially the issue of primary health care, the issue of provision of basic education and other statutory responsibilities on local government councils, we will make sure that we attend religiously to them without any distraction so that this confidence reposed in us by the presidency, by state governors and by the apex court of the land will not go in vain.”

Meanwhile, the Minister of State for Defence, Dr. Bello Muhammed Matawalle MON has applauded the Supreme court judgement on Local Government Autonomy, describing it as a significant milestone in promoting grassroot development, good governance, and democratic decentralisation in Nigeria.

According to Matawalle, the verdict will enable Local Governments to make decisions and take actions without needing approval from State Governments adding that local governments can now manage their finances, collect revenues, and allocate resources without state government interference. “This will boost their independence and direct accountability to the electorates. They can now focus on delivering services and development projects that will lead to better governance and accountability,” he said.

“This will also Improve service delivery. The local governments can now focus on delivering essential services like healthcare, education, Sanitation and infrastructural development to the people without interference from State Government,” the Minister said.

Also, following the recent Supreme Court ruling on the financial autonomy for LGAs, the Federal Ministry of Health and Social Welfare said it was pushing an initiative that would enable both entities at the sub-national levels pull resources to sustain operations of the PHCs.

Speaking at the Inaugural Quarterly Performance Dialogue with State Commissioners of Health in Abuja, recently, Coordinating Minister of Health and Social Welfare, Prof. Mohammed Ali Pate, said the ministry hopes to leverage on an earlier compact agreement signed with the states which en sured that not only federal government but the States are a key part of the National Health System.

He said the National Health Act envisioned a national health system with theFederal Government leading the states and local governments through the Federal Ministry of Health and Social Welfare in the drive to provide better healthcare for Nigerians.

Based on the Act, Pate said all state governors and the Minister of the Federal Capital Territory (FCT) had signed a compact with the federal government on December 12, 2023, to work collaboratively towards improving population health outcomes for all Nigerians.

With the reality of the Supreme Court judgement, Pate said even local governments would be required to join in signing to the collaborative initiative.

The Minister explained: “The initiative aligned with the Health Sector Renewal Investment Initiative and the Sector-Wide Approach that we have adopted.

“It embodies the spirit of cooperative federalism mandated by the National Health Act of 2014, which calls for shared responsibility and collaboration among all health providers across various levels of government, the private sector, and development partners.”

According to Pate, the initiative was not just about cooperation; but also about accountability.

“We have agreed to hold each other accountable, learn together and work together through regular performance dialogues and evaluations.

“This is not an inquiry but a collaborative effort to use data to understand what is working, what is not, and where improvements are needed.

“Even if the initial quality of some data is low, the journey of learning and improvement is what matters,” he said.

Speaking on the agenda of the performance review meeting Pate said: “We discussed with the commissioners the implication of the Supreme Court judgement on local government autonomy. We clarified that this is an evolutionary process, that before 2011, Nigeria had a very fragmented healthcare system.

“And there was a policy approved by the Council on health on the primary health care under one roof, which accelerated the creation of state primary health care agencies, state health insurance agencies on this federal government working with the states.”

The minister said the National Health Act created a mechanism to the Basic Health Care Provision Fund in 2014, adding that in 2023, process, President Bola Tinubu upscaled that into a sector-wide programme to ensure that states are a key part of the National Health System.

He added that local governments by law are also part of National Health System.

“So we are all operating in the context of cooperative federalism where all hands are on the deck and our dividend partners have joined in that we have raised grant resources to provide incentives to the states to contribute their counterparts.

“And with this development, even local governments will be required to step up and will measure each other’s performance and Nigerians should be able to tell which state which local government is doing its part from the Federal Government,” he said.

Concluded.

Muanya is a freelancer, public affairs analyst and mediconsultant. He can be reached via:[email protected]