The recently published Lancet Nigeria Commission (LNC) generates landmark evidence on the country’s health system gaps and context-appropriate policy options to transform Nigeria’s health sector landscape. The findings and recommendations presented in the document are particularly important at this point considering Nigeria’s forthcoming general elections that come with a potential policy-reset window for the health system.
Based on this, the International Society of Media in Public Health (ISMPH) in collaboration with DGI Consult deployed their policy advocacy capital toward translating the LNC knowledge into action. ISMPH and DGI Consult organized a Webinar tagged “Lancet Nigeria Commission: Translating Knowledge into Action” on the 12th of April 2022. The webinar was geared toward expounding the findings and recommendations of the Lancet Nigeria Commission and engaging policymakers, the media, development partners, and civil society on how to translate the body of knowledge into action.
The webinar, hosted by Chief Mrs. Moji Makanjuola (CEO/Founder, ISMPH) had seven speakers who are key health sector stakeholders and included some of the LNC authors. These are:
- Dr Amina Baloni (Honourable Commissioner for Health, Kaduna State)
- Nasir Sambo (Executive Secretary, National Health Insurance Scheme)
- Ibrahim Abubakar (Dean, Faculty of Population Health, University College London)
- Obinna Onwujekwe (Professor of Health Economics, University of Nigeria)
- Adebayo Fayoyin (Media and Communication Expert)
- Dr Ebere Anyachukwu (Health Advisor, FCDO)
- Dr Gafar Alawode (Managing Partner, DGI Consult)
The webinar was heralded by a brief presentation of the LNC Findings and Recommendations from the Lead Speaker (Prof. Ibrahim Abubakar) followed by a panel discussion session with the other speakers, and a question-and-answer session with the webinar participants.
In his presentation, Prof. Ibrahim Abubakar emphasized that although Nigeria is Africa’s largest economy, “wealth does not equal health”. This is because Nigeria’s population is growing more rapidly than its economy, and health indices are despicable – the life expectancy at birth is just over 54 years, the fifth lowest in the world; the country has the highest under-5 mortality in the world and the 4th highest maternal mortality ratio. Meanwhile, the burden of disease and mortality in Nigeria are of a preventable origin, necessitating a “Health in All Policies” approach towards improving the social determinants of health such as nutrition, infrastructure and sanitation. Prof. Abubakar also stressed that the impact of previous health policy reforms has been limited by governance and accountability obstacles in their implementation, therefore, it is time to rethink and reposition the country’s health policy. The vision of the LNC report is to provide recommendations for ensuring the health and wealth of future generations of Nigerians, for Nigeria to fulfill its potential.
Speaking on the potential policy levers for curbing the worrisome health sector inefficiencies spotlighted by the LNC, Prof. Obinna Onwujekwe detailed key practical steps to be undertaken by governments at all levels in Nigeria. According to him, the present federal and state government budgeting is very inefficient and not aligned to achieve anything. Therefore, there’s a need to reintroduce the broad-based participatory Medium-Term Sector Strategy (MTSS) development which usually precedes the annual budget preparation. The health sector also needs to improve the delivery of its health financing functions, particularly in the pooling of funds, including external funding and in the strategic purchasing of health services. Prof. Onwujekwe stressed the need for the health sector to acknowledge the high level of corruption in the system, including in financial management and human resources for health. Thus, the need to deploy vertical and horizontal mechanisms for reducing these corruptions. He also stressed the need for transparency through a digital database system and the deployment of effective broad-based accountability mechanisms for public and donor health funding towards improving the health system efficiency in Nigeria. Emphasizing an earlier point by the Lead Speaker, Prof. Onwujekwe stated the need to mainstream health in all sectors towards preventing duplication of efforts and achieving the full range of possibilities and efficiency that can improve the health sector.
Prof. Nasir Sambo spotlighted relevant actions for expanding health insurance coverage to Nigeria’s teeming population. He underscored the retrogressive out-of-pocket health spending in Nigeria which accounts for 70 to 80% of the total health expenditure; meanwhile, health insurance is the most progressive health financing option in Nigeria which provides vertical and horizontal equity, and it is a veritable vehicle for attaining Universal Health Coverage (UHC) in Nigeria. He stressed the need for all policymakers and Nigerians to view health as a key development issue and ensure that UHC is highly placed in the nation’s development agenda, as well as the critical need for quantifying the UHC investments needs and covering the UHC funding gap. Prof. Sambo highlighted that the National Health Insurance Scheme (NHIS) would facilitate the strategic purchasing of health services from the pooled social health insurance fund, and this informed the 3-point rebranded agenda of the Agency and the Health Insurance Under One Roof (HIOUR) policy. The NHIS serves as the effective coordinator of the State Social Health Insurance Schemes (SSHIS). The agency has developed an extensive ICT structure for the digitalization of the healthcare system and the NHIS Drug System is being deployed towards increasing the availability of quality and affordable medicines in Nigeria.
Dr Amina Baloni expounded on how the LNC recommendations can be implemented at the State level in Nigeria using Kaduna State as an example. The state contextualizes and domesticates national-level policies (e.g. the health supply chain policy) to ensure they align with established benchmarks. Among the LNC recommendations, Dr. Baloni alluded to the need to contextualize trainings and establish baselines and gaps at the state level as well as the need for improved health insurance pooling and health data management. There is also a need to domesticate the task shifting and sharing policy at the state level to curb the human resources for health (HRH) challenges in states. Dr. Baloni also emphasized the need for state-level multisectoral collaboration, public-private partnerships, and the regulation of healthcare facilities to ensure quality health services are provided.
Dr Ebere Anyachukwu acknowledged the LNC finding that the current arrangement of development assistance for health is inefficient, and he attributed this to the lack of an effective system for transforming foreign aid into actual outcomes. Many donor organizations are aware of this and have been deploying efforts to create a system that will transform aid to deliver outcomes. For instance, the FCDO has been supporting the national health system to transform its funding into outcomes, rather than creating a parallel system. These include support for the BHCPF and PHCUOR policies, the establishment of state-level Drug Management Agencies. These strategies help to reinforce the nationally led health system and promote sustainability in the absence of donor funding. In line with addressing the HRH training inefficiencies highlighted by the LNC, the FCDO plans to address in-service training in the future to consolidate health workers training and establish a coherent system of training and continuous improvement of health workers. The plan is to establish a health workers’ training centre supported by all donors, where health workers can regularly access relevant capacity improvement trainings.
Prof. Adebayo Fayoyin discussed the role of the media in creating awareness for behavioural change towards health in Nigeria. He highlighted the failure to engage with the community effectively to raise awareness as a key limitation to health system reform in Nigeria, as reported by the LNC. Towards implementing the Lancet recommendations, he emphasized the need to delineate the multiple actors required for multiple actions; these include mass and social media, policy entrepreneurs, private sector organizations, technical activists, religious leaders, and beneficiary groups. He stressed the need for strategic engagement of political actors with the LNC recommendations to ensure the needed actions in political conversations and dialogues.
Dr Gafar Alawode reiterated the timeliness and alignment of the LNC with the current efforts of non-state actors in Nigeria, including the UHC 2023 Forum which is working to put health on the political front burner ahead of the 2023 general elections. The LNC has helped the UHC 2023 Forum to further generate evidence for articulating a citizen-led health manifesto and it has reinforced the credibility of the policy shifts and strategies outlined in the health manifesto. The strategic policy shifts include policy and resource optimization, sustainable financing, raising the accountability bar for health for the healthcare system, health in all policies, and strengthening health institutions. In alignment with Prof. Fayoyin’s delivery, the UHC 2023 Forum also plans to engage the media, citizens and political class with the health manifesto to ensure its adoption and demand for accountability during and beyond the elections.
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