• It will improve health sector, says NARDs president
• ‘Agenda yet to become evident in medical lab services’

One year after, stakeholders are divided in opinion on the effect of President Bola Tinubu’s Renewed Hope Agenda on the health sector, citing that healthcare investment in Nigeria has been low by global standards, with high individual out-of-pocket costs restricting access to healthcare.

Tinubu had in July 2023, two months after his inauguration, promised to raise the health budget from five/six per cent to 10 per cent and put the sector on the front burner of Nigeria’s national development priorities while unveiling of Nigeria’s Health Sector Renewal Investment Initiative, and signing of the Health Renewal Compact by Federal, state governments, and development partners in Abuja.

According to him, the administration will be prioritising and improving Nigeria’s health sector through massive investments, and improved allocation of funds in the proposed 2024 budget. However, the N1.228 trillion allocated to the health sector under the 2024 Appropriation Act fell short of the 10 per cent promised as it represents five per cent of the total proposed budget expenditure.

Besides, over the past 12 months, the nation’s health sector has been inundated with various challenges ranging from the mass exodus of skilled health workforce, and the exodus of pharmaceutical companies to skyrocketing prices of essential medicines and the high cost of health care.

However, the Coordinating Minister of Health and Social Welfare, Prof Muhammad Ali Pate, said the last 12 months have seen significant accomplishments with the vigorous implementation of the four-point agenda – governance of the health sector, improving population health outcomes, unlocking the healthcare value chain and health security, which is yielding tangible and intangible results.

While some stakeholders have agreed with him and lauded the government’s policy direction for the health sector in the last one-year, others are yet to see its visible impact on the lives of Nigerians.

Assessing the government’s performance, President, Nigerian Association of Resident Doctors (NARDs) Dr Dele Abdullahi, said that the current plan by the Tinubu-led administration shows a more focused direction in improving the health sector.

Abdullahi noted that though the Coordinating Minister of Health and Social Welfare put in place plans to rejuvenate the health sector, the association is hoping that there will be proper implementation.

“It is difficult to have a holistic and critical judgment of the health sector in the first one year of the president. For an average Nigerian, for an average health care worker, your judgment will be based on what you have on ground, what you can see. So, for the health sector, we have both negatives and positives. The current plan shows a more focused direction in improving the health sector.

“We are hoping that the promises of better remuneration for health workers will be achieved. He should look into the issue of manpower gap in the health sector. No matter the equipment and facilities you have, without the necessary manpower, it is of no use. The government needs to find ways to keep within the country, the manpower we have and produce more to meet WHO standard for Universal Health Coverage (UHC).”

For the Executive Director, Civil Society Legislative and Advocacy Centre (CISLAC) Auwal Rafsanjani, Nigeria’s biting economy presents significant challenges to health accessibility for its citizens, adding that the basic medical services and medications are increasingly becoming expensive, pushing them out of reach for many Nigerians.

Rafsanjani who called for government intervention to regulate the price of medications and make them more accessible, advocated targeted subsidies for low-income earners and those with chronic illnesses could ease the financial burden.

He lamented that due to financial constraints, people now delay seeking medical attention or forgo treatment altogether, leading to worsening health outcomes and because of the high cost of prescribed drugs, many Nigerians resort to self-medication with potentially harmful consequences.

He said: “High medical bills can push families into debt, creating a vicious cycle of financial hardship. The current economic situation in Nigeria makes healthcare affordability a major challenge for many citizens. Basic medical services and medications are expensive, putting a strain on household budgets. This is further exacerbated by the stagnant wages, especially for low-income earners; which makes it difficult for people to keep up with rising healthcare costs.”

Rafsanjani noted that the Federal Government allocated ₦1.228 trillion to the health sector in the 2024 Appropriation Act, which translates to roughly 4.47 per cent of the total proposed budget expenditure falls short of the Abuja Declaration commitment of 15 per cent of the national budget for health. This translates to approximately ₦6,831 per person in Nigeria, which may not be sufficient considering the population of over 220 million.

He said: “Despite this poor allocation to the health sector in general, further analysis shows that there’s a recognised imbalance in how health sector funds are distributed in Nigeria, with a bias towards secondary and tertiary healthcare over primary healthcare. This creates challenges in the system.”

He urged the administration to ensure that more funding is allocated to the sector in the coming years, especially primary healthcare. “Health insurance coverage remains low, leaving people to pay out-of-pocket for medical bills and this further exacerbates the already crushing financial hardship, especially for those with chronic illnesses or emergencies. There is a need to expand Health Insurance to achieve Universal health coverage and provide broader financial protection for Nigerians.

“Targeted subsidies for low-income earners and those with chronic illnesses could ease the financial burden. Partnering with private healthcare providers can address funding limitations and expand service reach. This can improve efficiency and offer more options to Nigerians. Nigeria needs more healthcare workers, along with better training and incentives. This includes doctors, nurses, pharmacists, and community health workers. Shifting focus from just funding inputs to measuring health outcomes can ensure resources are used effectively,” he added.

The National President, Association of Medical Laboratory Scientists of Nigeria (MLSCN) Dr Casmir Ifeanyi told The Guardian that the government has been able to set an agenda for the health sector clearly, but they are yet to become evident in the medical laboratory services.

Ifeanyi observed that President Tinubu has been able to translate a few of his ideas into policy documents. For instance, he has been able to speak to the issue of UHC through the launch of the UHC policy which was launched some months ago.

He, however, argued that the UHC policy document was deficient in medical laboratory services. “The president has improved funding for health, you will recall that the Coordinating Minister of Health came up with a four-point agenda for the health sector but of all the coordinating efforts of the minister, we are yet to see his coordination of the medical laboratory services in Nigeria.

“According to the Maputo Protocol of 2008, any nation suppressing the laboratory is not keeping to that protocol, which Nigeria has committed to, that protocol clearly states that the way to enhance the nation’s health system is to strengthen and develop and expand the laboratory services. I have not seen the coordination speaking to this, the four points are clear and laudable, but they are not speaking to medical laboratory services, so the minister needs to up his game and coordinate the medical laboratory services by putting in place the requisite structure.”

The MLSCN president, who recalled that the government released funds in paper for equipment and health infrastructure upgrades in tertiary health Institutions in the six geopolitical zones, noted that the association is happy that there is a provision for clinical pathology. “We want to believe that that policy document will speak to issues of developing and expanding medical laboratory services,” he added.