It is time to strengthen accountability for health

The decision to establish the forum came out of a meeting between the former minister and Nigerian participants at a breakfast meeting during the Women Deliver Conference in Kuala Lumpur, Malaysia, that took place last week of May 2013.A day before the breakfast meeting, I met Dr Pate by chance before he presented a paper […]

The decision to establish the forum came out of a meeting between the former minister and Nigerian participants at a breakfast meeting during the Women Deliver Conference in Kuala Lumpur, Malaysia, that took place last week of May 2013.
A day before the breakfast meeting, I met Dr Pate by chance before he presented a paper in one of the sessions. He jokingly told me “If you ask me a hard question I will throw the question back at you to respond.”  His paper titled  ‘Expanding Access: Reaching the Hard to Reach; Insights from the Saving One Million Lives Initiative’  had provided insight about SURE P MCH programme and midwives service scheme and how both were contributing to reduction of maternal and child death.
The breakfast meeting then, with the minister, civil society organisations as well as the media took place amidst the initial apprehension and tension that the aim was to embarrass the minister in an international forum.  It turned out to be a positive and useful interactive dialogue for the sake of Nigerian women and children.
According to the brief call to action that was read in the meeting, ‘the Nigerian delegates at the Women Deliver Conference had recognized that laudable commitments have been made by the Federal Government on reproductive, maternal, newborn and child health (RMNCH) but they need to be monitored more adequately to track progress and resource flows. Consequently, there is inadequate translation of these commitments into implementable actions at the state and local government levels. The overall result is that efforts continued to be fragmented; quality of care for women still inadequate, piloted best practices are not adequately institutionalized and scaled-up at the state and local levels.
They observed that “while we recognize that much progress has been made, it is our firm conviction that every woman in Nigeria should survive pregnancy and childbirth and any maternal death is unacceptable.” Recommendations from the meeting were as follows;
1. To generate data and information on RMNCH through transparent and replicable methods, and facilitate evidence-based response from the government on those issues.
2. To engage non-health sector stakeholders like the ministry of water resources on maternal, newborn and child health issues.
3. Liase with the coordinating mechanism of the steering group of the saving one million lives initiative to promote accountability in RMNCH.
4. Make maternal deaths notifiable occurrences through mobile reporting.
5. Civil society delegates made a commitment to generate and disseminate adequate data on RMNCH.
A consensus was reached to maintain the momentum generated at the Women Deliver Conference, on return to Nigeria, through having a national civil society organisation’s (CSOs) coalition/Nigeria Independent Accountability Mechanism for MNCH in collaboration with the Federal Ministry of Health to be convene a quarterly interactive forum with Government, CSOs and Media to  share useful information, updates on various commitments, projects and activities in line with saving one million lives initiative and Nigeria’s  road map on accountability and other related commitments.
I volunteered to write the 1st draft of the term of reference for the establishment of the agreed Quarterly Health Interactive Forum at the national level as a means to strengthen accountability in the health sector and to circulate for review and inputs.
It was on the day I was writing the 1st draft that the announcement came in that Pate resigned. I felt so bad and depressed as everything happened just so fast. He was enthusiastic about the Quarterly Health Interactive Forum and all the issues agreed in that meeting.
We weren’t friends actually as we had disagreed on many public health issues and strategies and I made such disagreement known in many of my published articles but on the issue of accountability, we had found a common ground.
I was frustrated because I was very much aware that initiatives of such nature would require an internal champion within the government cycle committed to make it happen. It is not just about having the structures on ground, a lot of initiatives in public health require internal and external champions to work together. His resignation actually collapsed the move as we couldn’t get another senior government official or policy maker willing to take  leadership and champion roles about establishing the quarterly forum.
It was on record that in May 2013, in Geneva, at the 66th World Health Assembly, Nigeria was reportedly applauded by the World Health Organisation (WHO) and delegates to the 66th World Health Assembly (WHA) for leading global efforts aimed at reducing mother and child deaths and Dr Muhammad Ali Pate was singled out for special commendation at a high level side event for ministers and senior participants and called ‘Super hero’ for what Nigeria achieved. This also served among some of the reasons why we were happy to work with him.
Last week, precisely on Friday 7th November 2014, another opportunity came and I had a deep and thought provoking meeting with the Executive Director of National Primary Health Care Development Agency and the Minister of State for Health and, in principle, we all agreed that we need to push for the emergence of that quarterly accountability forum for health. Keep a date with this column for more insights on this next week.
Dr Aminu Magashi is the publisher of Health Reporters ([email protected])