With the singing of the National Health Bill at the twilight of 2014, stakeholders in the Nigeria health sector naturally appear to be gearing up to actively participate in what they anticipate would be the beginning of a ‘new dawn’ for health care delivery in the country.
Theoretically, the National Health Bill now an Act of the National Assembly (Parliament) creates a huge opportunity that would help the country chart a path towards achieving Universal Health Coverage (UHC) in the very near future. Specifically, as this law makes provision for financing Primary Health Care (PHC) from the Federation Account, outside the regular monthly allocations to the 36 States (that is not mandated for any goods or services); it is expected that the in-built mechanism of using this as a ‘challenge fund’ would leverage additional resources from the States for PHC. And there is therefore the assumption that the potential increased funding for PHC would by and large provide vital health services at the community level, as well as secure financial risk protection for ordinary Nigerians when they use such services.
But this futuristic glance of the coming year – 2015, advise the exercise of caution in balancing optimism with a tinge realism.
Here is why ‘fundamental health system change’ that leads to: (i) better health outcomes – for all demographic and socio-economic groups; (ii) improved individual satisfaction and experience – with health activities and interventions; and (iii) enhanced financial sustainability – for both individuals and the economy as a whole – may not happen (or begin to happen) in 2015.
First – 2015 is election year in Nigeria. Though the elections will definitely come and go, and there will be winners and losers for sure. But as most things in Nigeria depend on government, the period of electioneering and the outcome of this significant national event will influence what happens generally in the country for the whole year. The May 29th ‘transition date’ somewhat divides the year into two halves. The first part of the year, overshadowed by ‘election fever’ will create uncertainly as stakeholders within the health sector may not fully engage with government as they are not sure of who they may be dealing with after the elections. The second half, the transition period will be equally unsettling as political officer holders – who are either new to office or consolidating their mandates – would either be finding their bearing or trying new approaches to doing things based on their previous experience.
Second – as technical capacity at all levels of government (Local, State and Federal) within the health sector remains weak; 2015 is not the year when suddenly technocrats in Nigeria are able to translate policies into plans and get them implemented. Moreover, as they are known to be territorial and clandestine in their dealings; this may not be the year when they become more transparent and agree to openly work collaboratively with all stakeholders in the health sector.
Third – Nigeria is an emerging economy (despite income inequalities) with all the trappings of affluence, and a growing middle class. But the International Donor Community (aka Development Partners) remain pretentious about delivering International Aid in the health sector based on conventional ideas of helping a poor country. In 2015, Development Aid to Nigeria in the health sector will continue to be ineffective as the interventions of Donor organisations will continue to be seen as projects of the respective agencies (including those with global mandates); and not national health programmes since they will fail to make the connection of engaging with a country in transition.
However, all hope is not lost for the Nigeria health sector in 2015. Based on the ‘drivers of change’ analysis – we are aware that while actors make outcomes possible their capacity to act is ultimately set by the structural context which they find themselves. Notwithstanding, in 2015, change may still come through collective action by actors who are able to overcome such structural obstacles by re-making of institutions – modifying the way actors relate with each other and with the structures. As previously demonstrated by the ‘Nollywood Paradigm’, the group that got the National Health Bill passed and signed through sustained advocacy – the Health Sector Coalition of Nigeria – will continue to ensure that the National Health Act begin to provide benefits for all Nigerians as intended and not hijacked by vested interests. But fundamentally, as the market-based Nigerian economy powers on (irrespective of low oil prices, which will only affect government revenue), the health sector will most likely follow the approach of the multi-national companies serving Nigerians (even the very poor) with good and services – by converting them into effective consumers rather than being patronising in their dealings.
On this note, stakeholders in the Nigeria health sector should look forward to a 2015 that will not only engage their energies, but also their mental faculties as they ‘navigate’ the ‘treacherous waters’ of re-vitalising the health system, especially primary health care delivery.