Press
Conference by the
Nigeria Universal
Health Coverage Actions Network (NUHCAN)
On
behalf of the Civil Society in Nigeria
In
commemoration of the 2019 Universal Health Coverage (UHC) Day in Nigeria
PROTOCOLS
BACKGROUND
AND INTRODUCTION
The Nigeria Universal Health Coverage Actions Network
(NUHCAN) was established during the 3rd quarter of 2019, as a non-governmental,
non-profit making, non-political, non-religious, autonomous organization; to
serve as the coordination body for recognized Civil Society Organizations,
Private Voluntary Organizations, Non-Governmental Organizations, Institutions
and Individuals involved in Universal Health Coverage activities and programs
in Nigeria.
As the lifestyle of people become more sophisticated, the UHC
2030 goals are essential but will only become achievable with radical
thinking executed through insightful organizations acting in networks carefully managed to produce
tangible results. It requires the involvement of experienced professional and
business leaders to make this happen. It is as a result of this
realization that the Nigeria Universal Health Coverage Action Network (NUHCAN)
was founded as Nigeria Universal Health Coverage Advocacy Group (NUHCAG) on the
7th of June, 2019 with NUHCAN’s Executive Secretary Dr.
Uzodinma Adirieje as then NUHCAG’s Interim National Coordinator. The
Network now consists of about 50 registered members. Our goal is to translate
the UHC concepts into action in Nigeria through the achievement of the
following objectives:
o Synergize
with
relevant
stakeholders/partners
for the
commemoration of
the United
Nations’ historic and
unanimous endorsement of universal health
coverage
in 2012.
o Facilitate grassroots
awareness, engagement
and demand for
UHC
o Accelerate private, public
and political participation
and accountability for
UHC.
o Galvanize an inclusive,
cohesive and
multi-sectoral
advocacy community
thus
maximizing
reach,
coordination
and impact
of the
movement towards health
for all.
UNIVERSAL HEALTH COVERAGE
(UHC)
Universal Health Coverage
(UHC) means
that all people are receiving the
health services
they
need,
including
health
initiatives
designed to
promote better
health (such
as anti-tobacco policies) prevent
illness
(such as vaccination) and
to provide treatment,
rehabilitation,
and palliative
care (SUCH AS END-OF-LIFE CARE) of sufficient quality
to be effective while at the
same time ensuring
that
the use of these services does
not expose the user to
financial hardship.
UHC is firmly based on the WHO constitution of 1948 declaring
health a fundamental human right and on the Health for All agenda set by the
Alma Ata declaration in 1978. UHC cuts across all of the health-related
Sustainable Development Goals (SDGs) and brings hope of better health and
protection for the world’s poorest.
UHC is a Global Health Policy which was relaunched as part of the Sustainable
Development Goals by all the countries of the United Nations at the 74th UN
General Assembly in New York, USA, in August 2019. Its aim is to ensure an
inclusive framework for the delivery of health care “Leaving No One Behind”
This definition of UHC
embodies three related objectives:
1.
Equity
in access to health services - everyone who needs services should get them, not
only those who can pay for them;
2.
The
quality of health services should be good enough to improve the health of those
receiving services; and
3.
People
should be protected against financial-risk, ensuring that the cost of using
services does not put people at risk of financial harm.
A suitable Health Care Financing Framework
outlines the need to create resources through Revenue generation, Pooling and
Purchasing for Service Delivery. The benefits of raising resources should
include Equity in Resource Distribution, Efficiency, Transparency and Accountability.
This should lead to the final Coverage Goals of Utilization Relative to Need
and Financial Protection
The healthcare problems in
Nigeria result from a combination of factors.
Many of the
underlying causes of disease, injury and death lie beyond the preview of the
core healthcare system. They cover a range of environmental and situational
factors such as inadequate sanitation, water, drainage, waste disposal, housing
and household energy, road transportation as well as behavioural factors such
as personal hygiene, sexual behaviour, violence, driving habits, alcoholism and
tobacco smoking. The medical profession has a great challenge in tackling these
health and health-related problems. This is why there is a need for
intersectoral groups that will address the various underlying factors.
Universal
Health Coverage should be based on strong, people-centred primary health care.
Good health systems are rooted in the communities they serve. They focus not
only on preventing and treating disease and illness, but also on helping to
improve well-being and quality of life.
The UHC IN NIGERIA WILL BE DISCUSSED UNDER SIX HEADINGS AS FOLLOWS:
1.
Economic Contribution of the health sector
a.
What is the
contribution of healthy populace as compared to an unhealthy population? We
need a healthy populace to work productively and drive the economy.
b.
Health sector
is also an economy generating hub for all sectors in the sense that there are all
cadres of artisans in the health sector,
2.
Health Governance Structure
a.
Holding each sector of the government
accountable for their constitutionally defined obligations to the health of the
citizens --- especially the Local governments
b.
The National
Health Act has a lot of well thought out collaborative processes that should be
encouraged
c.
Health
governance should be politicized to encourage improvement of structures e.g.
optimizing for PHC should be scored against political party in power.
3.
Financing the Health Sector
a.
The
recommended allocation for national health sector budget (Abuja declaration) is
still 40-60% short. Yet the deterioration of the health sector is obvious to
all. This is fundamental to addressing many of the urgently necessary
improvements.
b.
Over 70% of
healthcare funding is from out-of-pocket of the users thus exposing individuals
and families to extreme financial hardship
c.
The
establishment of NHIS and BHCPF funding systems are projects in progress and
they should assist in alleviating the huge out-of-pocket expenditures of
patients at the points of need of healthcare services.
d.
Accountability
framework exists but processes to monitor this are necessary.
e.
Fund
mobilization should look inward and depend less on foreign sponsorship and
donation.
a.
Skills
acquisition must also include financial management education.
4.
The Management and Functionality of Regular
Health Sector Facilities
a.
This is a
source of monumental stress on the health sector facilities varying from PHC
clinics to Tertiary Hospitals -- an urgently needed focus includes:
i. Sustainable infrastructural development
ii. Functional lay out of facilities to decrease
manpower waste of time, and delays in the delivery of services
iii. In-Service continuing training and
orientation of the health workforce
iv. Shaping the attitudes of health workers as
well as the administrative and other
staff members perform important ancillary services such as cleaning etc.
v. Development of a sound referral system
b.
Public private
collaboration should be encouraged.
5.
Health Sector Human Resource Capacity
a.
There is a
huge health human resource in the country ranging from the health workforce in
primary health clinics to highly skilled professionals in tertiary centers. The
massive brain drain of this later cadre is evidence of the quality of the human
capital of our health sector. There is therefore a need for the development of
some world-class tertiary and even super-specialty facilities which will meet
the needs of Nigerians who go abroad for more sophisticated services. In this
way, there is a chance for the brain drain to be stemmed or even be reversed.
b.
However, there
still exists a huge gap in skills acquisition in some areas of medical practice.
The health workforce can be complimented by experienced Nigerian practitioners
in the Diaspora who could be enticed to
well-equipped and functioning hospitals to assist in bridging the skills
gaps.
c.
In view of the
huge investment required for this to happen, innovative funding mechanisms will
be required. It will involve new business approaches which may require a more
facilitatory legislative framework.
d.
In order to
ensure a sustained level of standard setting and quality of service, the
government must exercise its regulatory role equitably.
6.
Leveraging on Internet Technology and
Innovations
The delivery of equitable, accessible and
affordable health services can be facilitated in practically all areas of the
Health System by leveraging on IT INNOVATIONS. The basic tool is the Smart
phone which almost every adult in Nigeria has and uses
·
Information Base
Health bracelets bearing personal health
information such as the ID, Blood Group, history of life-threatening problems
such as severe allergies, asthma, sickle-cell. disorder, bleeding disorders, previous
hospitalisations, previous surgeries and obstetric history for women. During
emergencies, the information stored on this bracelet can be extracted to save
the life of the wearer especially if unconscious
.
· Mobile Health Clinics for the Rural and
Peri-urban Areas
Containers (40Ft) can be fashioned into
Health Clinics in order expand the reach of health services at the PHC level.
They can also be equipped with space-saving beds and furniture.
·
Making Health Facilities Friendly and
Efficient
Tracking Health Facility’s effectiveness and
efficiency through the use of
IT paraphernalia currently in use in Banks
including the terminal management system.
·
Equipment Maintenance
Fabrication of spare parts by “mechanics”
should be encouraged because it will eventually lead to local manufacture just
as the local manufacture of spare parts for some brands of cars such as the Peugeot
is now almost perfected.
·
Emergency Transportation and Roadblocks’
Clearance
Use Early Warning System to synergise source
of take-off of emergency transportation with traffic control officers and road
mapping by IT intelligence device such as Google. Linkage with Flying doctor
may be possible in some cases. Ambulances to be equipped with life-saving
equipment and trained ‘para-medics’
· Funding
Tracking of Contributions to Public and
Private Health Insurance systems to ensure appropriate distribution to priority
areas such as the strengthening of the infrastructures, transportation,
referral system, essential drugs, vaccines and materials. The National Health Act has articulated the
formula by which the PHC will be funded at the Local Government Level using 1%
of the Consolidated Federation Revenue through the National Primary Health Care
Development Agency (NPHCDA) in collaboration with the National Health Insurance
Scheme (NHIS) and with contributions at State and LGA levels of not less than 10% and 5%
respectively of the total cost of Projects undertaken.
The Monitoring
Framework for this exemplary Funding Process is of great importance to the
delivery of UHC at the PHC level.
· Health Information to the Community and the
Public at Large
Health information to the community should be
localized to the priority health problems based on a broad analysis of simple
surveys conducted with apps which are developed for the purpose by health
professionals. An example is an APP for sharing information on breast and
cervical cancer recently developed by an indigenous CSO.
Social media posts can also be utilized with
verification interventions.
· Training and Skills Acquisition
Through the development of Telemedicine
Methodologies.
Innovations which can be justifiably
developed and/or adopted must meet the criteria of having the potential to save
lives, save costs and be sustainable.
PRAYERS:
Gentlemen of the Press, in furtherance of NUHCAN’s commitments and those
of the other non-state actors involved in UHC, we urge the Federal Government,
Multilateral Agencies, Foundations and all stakeholders in Health in Nigeria
to:
1. Ensure Political Leadership Beyond Health; by committing to achieve
UHC for healthy lives and wellbeing for all at all stages, as a social
contract, since Health is the foundation for people, communities and economies
to reach their full potential;
2. Leave No One Behind; by pursuing equity in access to quality health
services with financial protection; since Health is enshrined as one of the
fundamental rights of every human being;
3. Regulate and Legislate; by creating a strong, enabling regulatory and
legal environment responsive to people’s needs; because UHC requires a sound
legal and regulatory framework and institutional capacity to ensure the rights
of people and meet their needs;
4. Uphold Quality of Care; by building high-quality health systems that
people and communities trust; with quality primary health care (PHC) as the
backbone of UHC and create trust in public institutions;
5. Invest More, Invest Better; by sustaining public financing and
harmonising health investments; since current funding levels are insufficient
to achieve UHC by 2030; and governments need to increase domestic investments
and allocate more public financing for health through equitable and mandatory
resources; and
6. Move Together; by establishing multi-stakeholder mechanisms for
engaging everyone within Nigeria for a healthier world; while encouraging other
countries to take active steps to meaningfully engage non-governmental actors -
particularly from unserved, underserved or poorly-served populations - in
shaping the UHC agenda.
CONCLUSION:
Whereas in the past, we had been preoccupied mainly with the monitoring
of the extent of healthcare coverage with basic health packages, the monitoring
of UHC must include the magnitude of coverage with financial protection without
which any expected improvement in coverage with healthcare is likely to remain
an illusion.
We are being bombarded on daily basis with
Social Media Posts which give news of preventable deaths as a result of
problems arising from within as well as outside the Health Sector. Our
responses usually vary from expressions of bewilderment, shock and
lamentations. Our resolve on the NUHCAN Platform is to make a critical analysis
of such situations, propose and follow up actions which would assist in
providing the desired solutions. No longer can we afford the luxury of doing
absolutely nothing because of our state of powerlessness in most instances. We
are duty bound to share whatever information is given to us with the relevant
agencies whose actions can save the lives of those in jeopardy. Our source of
motivation is that through information sharing, we are at least restoring to
the implementing agencies that basic human element of EMPATHY which is being
stolen from all of us as a result of our feeling of powerlessness. We on this
platform can and will try to restore those basic human values that will ensure
that “No one is left behind” in our effort to promote Universal Health Coverage
nationwide.
We thank the Federal Ministry of Health (FMOH) and our colleague
organizations for the confidence reposed in NUHCAN to address this press
conference on behalf of the civil society in Nigeria, as part of the national
activities planned by the Federal Government to mark the 2019 UHC Day on 12
December 2019. We assure Nigerians of our commitment to ensure that Nigeria
realizes her UHC targets by the year 2030.
Thank you for listening!
Professor
Adenike Grange
Chairman,
Board of Trustees (BOT), NUHCAN
Dated
in Abuja, Nigeria; this 9th Day of December 2019
