The ERGP and healthcare
The ERGP is a medium term plan of the federal government (FG) for the period of 2017-2020 for the purpose of economic resurgence and growth. Health is a key sector that requires major intervention by both the public and private sector. This is owing to the fact that Nigeria’s health indicators are not looking so […]
The ERGP is a medium term plan of the federal government (FG) for the period of 2017-2020 for the purpose of economic resurgence and growth. Health is a key sector that requires major intervention by both the public and private sector. This is owing to the fact that Nigeria’s health indicators are not looking so good: highest maternal mortality rate in the world with 814 per 100,000 live births; universal health care service coverage index of 39; incidence of malaria 349.6; 55.2 years life expectancy at birth, and 43.6% prevalence of stunting in children under five years of age (WHO, World Health Statistics, 2018). This write-up will look at the ERGP with a focus on what it has for improving healthcare.
The thrust of the ERGP for the health sector falls within the its broad objective of investing in our people which looks at economic growth as being helpful to the society when it creates opportunities and provides support to the vulnerable. The policy objectives under health include: “improve the availability, accessibility, affordability and quality of health services; expand healthcare coverage to all local governments; provide sustainable financing for the health care sector; and reduce infant and maternal mortality rates”.
To achieve the above objectives, five (5) key strategies were proposed. First is the revitalization of the primary healthcare system which looks at ensuring that there is at least one functional Primary Health Care (PHC) in each ward; fully implement primary healthcare financing programme to mobilize domestic resources and to tackle infant and maternal mortality rates. Second is the expansion of the National Health Insurance coverage; its enforcement at tertiary institutions; the pilot of Social Health Insurance Programme for the pupils of public primary schools etc. Third is the strengthening of delivery beyond the primary health care system to tackle diseases like HIV/AIDS, polio, measles etc. It will also focus on investing in tertiary health care institutions to set up diagnostic centres in all states of the federation. Fourth is to partner with the private sector to develop at least one mega-health centre in all states to be funded by the NHIS and Public Private Partnerships (PPPs) to ensure high quality healthcare – both preventive and curative. Fifth is to build capacity of healthcare personnel to provide a rural service allowance and basic amenities to health workers in rural areas to retain qualified personnel. It is to also look at improving the health worker-to-population ratio by recruiting and training more health workers and attracting talent from abroad.
Taking a closer look at these strategies, the overall goal of improving healthcare for Nigerians would be better achieved if the following are considered. Strategy one which is about establishing one PHC in each ward is a noble idea but would be better achieved if the FG could sign an MOU with the states and local governments (LGs) where these PHCs would be located with a view to building sustainability. Such MOU would contain the states and LGs commitments to fund the recurrent component of the expenditure after the FG had expended the capital component. Next strategy which is achieving universal health coverage would be achieved quicker if health insurance is made compulsory for everyone. An amendment of the National Health Insurance Act to this effect is recommended. Getting hospitals to drive health insurance coverage by increasing the acceptance of medical services payments through insurance would also reduce out-of-pocket expenditure.
Thirdly, increasing the health allocation closer to the 15% Abuja Declaration of 2001 (from the current 4.5% of the overall 2018 FG budget); enactment of the Nigerian Immunisation Trust Fund Bill for sustainable funding of immunisation in Nigeria and swift approval of the National Policy on Health (which is still a draft) would ensure the strengthening of service delivery beyond primary health care system. Fourthly, on partnering with private sector to erect at least one mega-health centre in each state to be funded by the NHIS and PPPs, the establishment of ‘Health Bank of Nigeria’ to provide capital for sustainable funding of health investments would be helpful. Lastly, the NOI polls 2017 revealed that eight (8) out of ten (10) medical doctors are seeking work opportunities outside of Nigeria. Factors responsible include high taxes and deductions from salary; low job satisfaction; poor salaries and emoluments; and the huge knowledge gap that exists in the medical practice abroad etc. Building the capacity of healthcare personnel to improve service delivery could be complemented by addressing these issues so as to make staying back and working in Nigeria attractive. This would ensure that the country’s Physician density which currently stands at 0.4 per 1000 of population is improved.
Onyejegbu wrote this piece from Abuja