Matters Arising in the Public Health Sector

By Kola Orilowo
The ‘health’ of the health sector ordinarily should be a gauge of the wellness and wealth of a nation. This assumption takes its root from the saying that a healthy man is a wealthy man. Little wonder, therefore, that Nigeria is under severe need to improve health facilities and healthcare delivery systems for her citizenry.
Lately, the increasing spate of suicides among other ills, have been rightly or wrongly attributed to the paucity of facilities and feasible long term plans to get the health sector out of the woods. The previous government’s 2014 National Health Act (NHAct) was a step in the right direction. It made a case for 1% of the Consolidated Revenue of Government towards the setting up and maintenance of basic health care facilities and the provision of basic healthcare services to all Nigerians.
The laudable nature of this programme and its intention for the general good notwithstanding, sadly, government bureaucracies and less charitable personal egos and aggrandizements are clogs in the wheel of its implementation.
Meanwhile, in view of the importance of the sector, the World Health Organisation (WHO) had insisted that nations must dedicate 15% of a country’s annual budget to the health sector. It is disheartening that Nigeria has never, for once, met this onerous responsibility it owes her citizens. Therefore and, regrettably, the health sector continues to be in shambles.
In the light of the huge deficit in health facilities and feasible development initiatives, the coming of Prof. Isaac Adewole as the Honourable Minister of Health in November, 2015 was received with applause. The very impressive profile of the erudite Professor as former Provost of the College of Medicine, University College Hospital (UCH), Ibadan, and as a former Vice Chancellor of the University of Ibadan rekindled hopes among stakeholders and the nation in general.
According to Felix Obi, Physiotherapist and Health Policy Management Consultant, Health budgets are one of the victims of government’s fiscal tightening in times of economic crisis. In his contribution to A-H Nigeria, he noted that from a high of 6% budget allocation in 2012, the health budget as a percentage of total government budget had fallen to 5.8% in 2015 and plunged further to 4.23% in 2016. “In stark terms, the budget is N659billion short of the 15% commitment made by African Heads of State in Abuja in 2001”.
This reality manifests in the deterioration of public health facilities. Other issues of concern in the country’s health sector include reproductive health challenges. According to Dr. Ejike Oji, Chairman, Association for the Advancement of Family Planning (AAFP), the nation’s maternal mortality ratio has hit 576 deaths out of every 100,000 live births. This gives Nigeria the infamous record of being the country with the second highest maternal mortality rate, after India. This is an upswing from the December 2013 figures which puts the numbers at 224 deaths per 100,000 live births. The United Nations Children’s Emergency Fund, UNICEF, captured it accurately in its 2015 report: “every single day, Nigeria loses about 2,300 children under five and 145 women of childbearing age”. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world.”
To show that the Minister met an already bad situation, a WHO 2014 report on Healthcare delivery which surveyed 200 countries has Nigeria placed in the 197th position. The country only ranked ahead of Congo (Democratic Republic), Central African Republic (CAR) and Myanmar. This indicates that all other countries in Africa are ahead of Nigeria in healthcare delivery, except these three. The report justifiably further indicts: “Nigeria lacks a serious approach to health care”. The healthcare condition is worse at the level of primary health care which, due to lack of political will and willful neglect, has deteriorated very rapidly over the years.
There is no gainsaying in the fact that the country needs to poll resources (funds) to finance healthcare sustainable development goals, especially umbrella projects undertaken by the likes of UHC which translates to “universal financial risk protection of the population from catastrophic spending on health services, which further impoverishes already poor and vulnerable households”.
Dapo Fafowora in his Health Matters column in The Nation newspaper reined in the issue, when he asserted that “Health care matters….Health is wealth. A healthy nation is a prosperous nation. Its workers are more productive”. Fafowora also agreed with Obi when he pointed out that some of the social divisions and conflicts in our country are made worse by the existing poor health care. Though there can be no justification for it, the poor are tempted to take to crimes such as kidnapping and armed robbery, when they are unable to meet their health challenges and medical bills. A good and affordable public health system will reduce some of the violence in our country.
Therefore, the ways and means towards mobilizing necessary funds for Nigeria’s health sector should be of concern to all. Tax must be fair, equitable and also just. The process should be devoid of vindictiveness to any industry or sector.
The Western region had a head start in good healthcare system when, in 1953, Chief Obafemi Awolowo introduced free health programme. The government committed 50 per cent of government’s budget to the health and education sectors, without strangulating any industry or operator. Similarly, late Professor Olikoye Ransome Kuti, former Minister of Health, as one of the earlier advocates of functional Primary Healthcare System, made his imprint in a bid to develop and stabilize the PHC system in the country.
As an outstanding technocrat, in less than two years in office as Health Minister, Prof. Adewole has facilitated development of the 2016 National Health Policy (2016) which is based on the theme ‘Promoting the Health of Nigerians to Accelerate Socio-economic Development’, which captures the intent of the UHC. The policy replaces the 2004 National Health Policy.
The Prof should also be commended for his ambitious ‘100-Day Better Health for All Nigerians’ launched on July 18, 2016, as part of government’s Rapid Results Initiative (RRI). According to the Minister, the objective was to fast-track his vision of One PHC centre per Ward, through the revitalization of 10,000 PHC centres across the country within the next two years, all in a bid to providing access to quality healthcare to about 100 million Nigerians. Sadly, the novel project was truncated when the Minister of Finance, Kemi Adeosun, disclosed the sad truth that the States and Local Government Areas (LGAs) might not be able to meet up with their expected contributions to the project. The good side however, is that the MoH has commenced the first phase of the promise of renovating, equipping and posting of essential medical staff to the newly renovated 110 PHCs (1 model PHC per senatorial district). “The European Union will also be supporting revitalization of 774 PHCs across the country”, declared the Minster, adding that “functional PHCs will effectively handle 70% of all medical consultations” needed by Nigerians.
In the midst of these myriad health issues (especially at the policy level), begging for the minister’s attention and intervention, a recent tweet from the Minister’s twitter handle (@IsaacAdewole) seems to make a mockery of the job being done by the Minister to salvage the health sector.
The tweet which proudly announced, “We are exploring raising taxes on Tobacco for financing UHC while achieving major public health outcomes (NCDs) like the case in Thailand”. As a fan of the Prof, reading between the lines, one could see some signs of an over-zealous determination, which may, on the hand, Meet healthcare demands for a while before unintended consequences appear.
Without holding brief for the manufacturers, there is the fear of an unplanned outcome that illicit importers/traders are waiting to take over the industry, as soon as the legitimate operators are forced out of the system through over taxation. Then, the same tobacco products hitherto manufactured to standards, but now covertly imported under illicit trade, may be of inferior standards are unleashed on the market and consumers, while government will lose revenue in the form of taxes –excise duties and import licenses.
In fact, the said tweet from the Minister’s handle could spell doom for legitimate operators. While nature itself abhors a vacuum, a gap such as described will indirectly prepare the ground for illicit traders to the detriment of the consumers and the government.
The tweet referred to the Thailand Tobacco industry’s experience in justifying its quest for more taxes from tobacco but there is a huge difference. Thailand Tobacco Monopoly (TTC) as the company is known, operates on a different plane, entirely. TTM is state-owned and enjoys government’s protection with about 75% of the market share as against Philip Morris’ 22.5% share. Imported substandard brands that evade taxes do not have much of a space or chance of competing in the Thai market, because of the legislations in place.
Therefore, the company, a state enterprise under the supervision of the Ministry of Finance and established in 1939 according to the Cabinet’s resolution, as a responsibility contributes substantially to the running of the nation by taxing other players heavily while generating revenue from consumers purchasing state owned tobacco products.
What this goes to say is that Nigerian consumers need to be reasonably assured of the quality standard of the products they choose to consume, while companies are reasonably taxed and levied for development projects. It will be rather counterproductive, if legitimate entities are forced out of business, while the targeted product still finds its way into the market, illegally, only to cause greater harm to consumers. Once again, that will eventually put some strain on Nigeria’s health care facilities and do more harm than the planned good.
Kola Orilowo is a Public Affairs Analyst based in Lagos