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Just recently, health experts and stakeholders gathered at a webinar organised by the Universal Health Coverage Forum in Nigeria to discuss the implications of the US funding cut and potential solutions for Nigeria’s healthcare sector. HELEN OJI reports
A wake-up call
The US funding cut has been described as a wake-up call for Nigeria to re-evaluate its dependence on foreign aids. With the global health landscape undergoing significant changes, Nigeria must now explore innovative ways to fund its healthcare needs. Also prompting experts to urge the country to look inward for sustainable health financing.
Repositioning health
According to the Health Financing Specialist and Co-Convener of the UHC Forum Nigeria, Dr. Gafar Alawode, Programme Director of Development Governance International, (DGI), said leveraging on the largely unutilized private sector funding, strengthening and expanding, utilization of health-related taxes, especially alcohol, tobacco, sugar and sweetened beverages etc. for the health sector, institutionalization of effective accountability framework and peer review and leveraging on the abundant economic resources in Nigeria to fund health. More importantly, the panelists sought the demonstration of political will on the part of leadership at the various levels of government to reposition health financing in Nigeria in the face of emerging realities.
Also, the co-convener and chair of the Universal Health Coverage Forum in Nigeria, Mrs. Moji Makanjuola, noted that the Executive Order of President Donald Trump last month cutting off livelihoods and expectations of many has been a shocker to the donor funded world. She expressed regret that African nations, including the potentially wealthy Nigeria have to depend on aids, which discerning observers have noted may come to a halt sooner or later.
She stated that despite the abysmally low budget provision and releases in a country like Nigeria, corruption and misappropriation, low value delivery etc. have further compounded the problems in healthcare delivery. She charged the discussants to stimulate further discussions and actions, think out of the box for a shift from dependence on donors no matter how well meant. She however noted the efforts of the present national health administration in various ways and requested for institutionalization of accountability, integrity in the system and innovative and equitable resource administration.
Chair Steering Committee for UHC2030, Dr. Magda Robalo, emphasised the need for stakeholders not to allow the present crisis in global health financing go to waste. “We need to turn this crisis into a great opportunity. There is need to engage political leadership to ensure more money for health and more health for the funds allocated”. She noted that major cuts in aids budgets by donors have been on for some times, affecting abilities to deliver on programmes. She commended Nigeria for leading through the National Health Sector Renewal Investment initiative announced last year. She however called for decisive actions for sustenance of the initiative and commitment from stakeholders including governments and civil society, so that Africa and middle-income countries take its health sovereignty in their hands.
A Universal Health Coverage enthusiast and London School of Economics, Prof. Rob Yates, noted that the changes being engineered by the United States Government will have profound impacts on world health financing although the aids cuts have been witnessed in the last four years.
He observed that the party seems to be over for aids recipients. This according to him is however coming when needs of countries including Nigeria are growing massively.
Domestic funding
Prof Yates noted that from the current realities, Universal Health Coverage cannot be achieved though aids and donor funding in a country like Nigeria. “To a large extent Nigeria should eliminate this from its calculation. Looking at the numbers, the funding that may come isn’t going to make much difference. That is the world we a living in at the moment.”
He however agreed that the current situation provides an opportunity to be grabbed. He noted further that Nigeria will have to own its future and rely majorly on domestic public funding to finance UHC as exampled by some other countries. What it takes, according to him is political commitment especially by the President and State Governors, realizing how important health is to their electorate. He suggested that effectively utilizing vast natural and human resources in the country to fund health is a way to be considered.
Country Director, Pathfinder International, Dr. Amina Aminu Dorayi, a system strengthening specialist, donor funding could serve useful purpose if not strategically designed to catalyze public spending and aligned with felt needs and identified priorities of donor recipient countries.
Dr. Aminu stated further that donor funding are complimentary and should normally facilitate attainment of countries’ objectives. She emphasized the need for effective mobilization of critical stakeholders including governments, health professionals, media, the academia etc. to move for policy changes towards domestic financing in this critical juncture of donor freeze. She recommended practical, context specific smart advocacy, “which is a collaborative and transformational process that brings together advocates and allies from different backgrounds to create change and sustain progress. The smart advocacy will focus on decision makers, focuses people that have the power to act on requests from well prepared champions”.
She explained further that transitioning from donor funding should be carefully planned to involve all critical stakeholders, emphasize the use of data for evidence-based decisions and ensure significant domestic resource mobilization. She noted that domestic funding could be significantly improved by strengthening tax collection, improved allocation to health, strengthening health insurance scheme and many other areas.
Harnessing local resources
Nigeria Governors Forum Secretariat representative, Dr. Chinekwu Oreh, a Health Specialist disclosed that as the administrative and technical arms of the association of the 36 state governors in Nigeria, the secretariat has been helping to keep governors accountable and tracking commitments in line with the set priorities and agenda.
She states further that the secretariat has been involved in evidence-based advocacy regarding health financing and Universal Health Coverage.
“The NGF secretariat has been making efforts to extract finance data to track spending on health as well as encouraging positive peer pressure to ensure good programmes and policies in one state is adopted in other states as well as help states adopt sustainable financing framework.
She disclosed that the tracking of government to partners spending already adopted for nutrition will be scaled to other areas. She agreed on the need to mobilize more resources into the health space despite the constrained fiscal space, maximizing available resources and ensure improved allocation efficiency.
Director of Policy at Private Sector Health Alliance of Nigeria Dr. Anne Ogoh, stated that the private sector has contributed significantly to improving health outcomes although there is still need for synergy for the private sector basket to be more impactful and demonstrate higher returns.
She disclosed that different mechanisms for mobilizing resources from the private sector including Adopting Healthcare Facility Project which has ensured private corporate organizations like MTN are adopting about 52 health care centres. The organization, according to her is also working through high-net-worth individuals in the philanthropic health financing approach. She also mentioned the Public-Private Partnership either through build-operate and transfer or through the leasing of government infrastructure for improvement. She gave example of the considerable funding realized during the COVID 19 pandemic as an example of what is achievable. She also dwelled on the need for improvements in other social determinants of health for a comprehensive approach to tackling the difficulties that may arise.
The Chairman Health Sector Reform Coalition, Dr Muhammed Mustapha Lecky spoke on the efforts of the civil society in ensuring the establishment of Basic Healthcare Provision Fund (BHCPF)and the success story in this regard will assist in the efforts towards innovative financing of health. He regretted that much suggestions have been made but these suggestions and documentations on innovative financing have not been implemented.
Dr Lecky called attention to a landmark study by USAID on the potential to raise additional money to meet healthcare needs in Nigeria. He said the study; Local Health System Sustainability Project holds a lot of promise for sustainable health financing. The study, according to him shows clearly the quantum of money readily available, not even requiring new taxes.
He mentioned the possibility of doubling the BHCPF from 1% to 2% although this may require amending the existing law. He mentioned also the alcohol and tobacco taxes which is already being collected but not utilized for health. There is also sugar sweetening tax, according to him. These taxes alone, he said will amount to about N200 billion.
He explained that the adoption of innovative health financing is mainly about political will and pressure that can come from the civil society members. He mentioned that the Health Sector Reform Coalition is in the process of drafting required bill for the national assembly for the utilization of the taxes for health.
An advocate of improving efficiency in the health sector Prof Obinna Ojekwe, a Health Economist also spoke on the sector wide approach to improve efficiency of government financing. The webinar has provided a basis for discussions and possible actions so that Nigeria will look inward to fund its health needs utilizing domestic resources. Experts believe that this is the time to reconsider the dependence on aids, harness the obviously abundant local resources to provide health for the Nigerian people and uphold health sovereignty of the country.
English (US) ·