Eze Onyekpere
The outbreak of the coronavirus pandemic offered an opportunity for a critical evaluation and rethinking of our investments and management of the health sector. At the initial stage, public officers and private sector executives made the right noise about prioritising health care, enhancing investments and guaranteeing value for money in the sector. Pledges of funds were made by both the public and private sectors and regional and international donors and development banks. National committees involving multiple agencies were created to meet the national health emergency and for the first time, a practical understanding of health as a phenomenon beyond hospitals, health centres and the Ministries of Health emerged. It came clearly as an all-of-society approach to sustain life through the health system.
National and state level budgets were reviewed purportedly, inter alia, to prioritise health investments and to cut waste in the system considering the diminished revenues of governments. The impression was created that the momentum of fundamental reforms and change was about to sweep the health sector. This was reinforced by the international lockdown which ensured that Nigerians, from the President to the poorest person, could not access medical care outside our shores. We had to live or die on the quality of available local health facilities as no one had access to international medical tourism. There was also the national lockdown which ensured that people would only be treated in hospitals and health centres in their locality and the opportunity to travel from city to city in search medical care was ruled out. Within the international lockdown, Nigeria lost some notable personalities who would have otherwise been flown out of the country. This reinforced the hope that the sector would be taken very seriously in the scheme of things.
Apparently, the national lockdown has been eased and the international lockdown is in the process of being finally lifted. What has this led to? The return of medical tourism as notable personalities around the presidency have started travelling round the world for medical care. Yes, everyone wants to live and no one who can afford to get better treatment abroad would like to restrict themselves to the local hospitals. The major issues arising from the pandemic and the public noise around them are straightforward. How many hospitals and health centres have been refurbished from the proceeds of the new funds from the public and private sectors dedicated to health? How many new facilities have been built? Have we changed even superficially, our approach and management of the health sector? Which agencies and companies have benefitted from the Central Bank of Nigeria dedicated funds for the sector?
It would be a waste of precious opportunity if we only take the pains of the pandemic without learning the requisite lessons which will put us in a good position to tackle any future challenges. The fact that the pandemic is getting to a plateau and may be slightly receding and that a few Nigerians have died from it should not make us to miss the opportunity. It is within the context of the foregoing that the following recommendations are made.
The first is that government must ensure that all the new funds and promises of money made on the pandemic are properly invested in a value-for-money approach. It is also a time to think through the value chain of the health industry, the economic opportunities including jobs, enhanced income, taxation and general value added to the economy that will arise from improved investments and service delivery in the sector. The first is that we must work towards universal health coverage where no one is left behind. We must properly cost the needed investments to ensure a drastic reduction in out of pocket expenditure for the health care of citizens. The payments for the new investments need not come from the public sector alone but the public sector must lead the way in terms of prioritising the sector through increased budgetary allocations which are not just appropriations on paper, but sums of money duly released and processes set up to ensure that the released funds are utilised in a corruption-free environment. This will entail designing procurement processes that deliver to the best specifications.
The federal and state governments must ensure by law that health insurance becomes compulsory and universal and government will be under obligation to pay the premium for citizens, who are unable, for no fault of theirs to afford the premiums. The compulsory nature of health insurance will generate a large pool of funds that will be used to maintain quality care in the sector. Also, the private sector should be given tax incentives up to a reasonable limit for investments and donations to the health sector. For instance, the Lagos State Revenue Service stated it allowed up to 20% of the value of donations to the pandemic cause to be set out of the 2012 tax assessments of the donor companies. Such companies could also be recognised by special awards from government and the industry under the leadership of the Ministry of Health. Special taxes could be created to increase resources available to health. These taxes could be specifically levied on alcohol, tobacco and ostentatious goods and services.
Investments in local production and servicing of health machinery, pharmaceuticals, goods and commodities should be prioritised through a special fund that works with the Bank of Industry model to provide long term, low interest funding to the sector targeted at key manufacturing and local value added. It will build up a cluster of producing firms and human competencies in key areas that will provide the backbone for a strong medical sector that caters to the need of Nigerians. Investments could also be expanded to specialist hospitals that attend to a specialised area of medicine equipped with human and material resources to be real centres of excellence that can attract medical tourists from Africa and beyond. Such hospitals must have access to 24 hours of uninterrupted power supply and retain our best hands.
Instead of perpetually being a training ground for medical personnel who will move over to Europe, America and Asia because of poor remuneration and working conditions, we must design a human resources for health scheme that keeps our best doctors, nurses and pharmacists, etc. in the country. With greater access to funds from public and private sources as well as the compulsory health insurance scheme, it will be easier to keep our best hands at home through competitive remuneration.
These are just a few things that can be kick-started today and not a full list of what needs to be done to get the sector back on track. But the leadership of the federal and state ministries of health is fundamental to this health revolution. The National Council on Health must take on the challenge of drawing up a workable scheme and convincing the highest levels of leadership in the presidency and the respective governors to buy into such a scheme. It is doable but we need men and women, ministers and commissioners who can say – yes, we can.
