Welcome to the 2022 edition of the annual National Health Dialogue, a high-level platform organised by the Centre for Journalism Innovation and Development (CJID) in collaboration with PREMIUM TIMES to advance conversations around key health issues in Nigeria and Africa by extension.
The 2022 edition which is themed: “Primary Health Care Financing; Role of State and Non-state Actors” is taking place today (Tuesday) in Abuja, Nigeria’s capital city.
The event is expected to bring together policy makers and experts to discuss and share experiences on key issues in the primary healthcare subsector, such as financing, and human resources for health and insurance.
Vice President Yemi Osinbajo, Minister of Health, Osagie Ehanire, Executive Secretary of the National Primary Health Care Development Agency (NPHCDA), Faisal Shuaib, are among other key figures expected to attend the event.
Others attending include but not limited to health practitioners and advocates, political, religious, and traditional leaders.
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The media will also play key role at the event which aims to address challenges facing healthcare services in the country.
Ahead of the event, PREMIUM TIMES, the co-organiser presented five things participants should expect from the dialogue.
Stay on this page as this newspaper provides live updates of the event scheduled to commence by 9:00 a.m.
09:55 a.m: It is beautiful morning here at the BON ELVIS hotel, Abuja. We are live at the 2022 edition of the National Health Dialogue. Although the event was scheduled to commence by 9:00 a.m., it will be starting late as registration is still on going.
10:05 a.m: All is set for the commencement of the event. The facilitator of today’s high level event is Moji Makanjuola, a renowned broadcaster who will be assisted by Tope Mustapha, a journalist with Federal Radio Corporation of Nigeria (FRCN).
10:06 a.m: Ms Mustapha takes the podium and the event commences with the national anthem. She welcomes every one to today’s important event which focuses on primary health care financing in Nigeria.
10:07 a.m: The moderator invites the Executive Director of CJID, Tobi Oluwatola, to deliver his welcome address.
10:08 a.m: Mr Oluwatola said today’s event is coming at a time the country’s health system is facing a mirage of challenges.
10:09 a.m: He said Nigeria, Africa’s most populous nation, still accounts for high maternal mortality rates, high number of deaths from malaria, cholera and other disease that can be easily prevented.
10:10 a.m: He said the Nigerian government has continued to give insufficient attention to the health sector. He said the budget allocated to the health sector is never enough to address health needs of Nigerians.
10:12 a.m: Mr Oluwatola said until the government starts prioritising health sector, the system will continue to be in bad shape. He said there is a need to examine the value that drives us in getting quality health care.
10:14 a.m: He said the dialogue is a great opportunity to make great decisions that will change the face of health care in Nigeria. “Decisions made here today will go a long face in shaping the future of Nigeria’s health system,” he said.
10:16 a.m: Speaking on the National Health Insurance Authority (NHIA), he said majority of Nigerians still pays out of pockets for health care. He noted that until the gaps in health insurance is addressed, the country still has a long way to go.
10:17 a.m: He explained that the gaps in primary health care prompted the CJID to organise this dialogue and lead the conversation. “We need more dialogues like this to have an ingenious solution to health care challenges in the country,” he said.
10:19 a.m: The co-facilitator, Ms Mustapha, takes the podium to invite the representative of the World Health Organisation (WHO), Claudia Torrealba, to deliver her goodwill message.
10:21 a.m: Ms Torrealba said Universal Health Coverage (UHC) ensures that all citizens (individuals and communities) receive the health care they need without suffering financial hardship.
10:22 a.m: She said governments of every country is expected to prioritise, promote, and protect people’s health and well-being, at both population and individual levels, through strong health systems.
“Primary health care (PHC) and health services that are high quality, safe, comprehensive, integrated, accessible, available, and affordable for everyone and everywhere, provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated, and committed, and partners and stakeholders are aligned in providing effective support to national health policies, strategies, and plans,” she said.
10:24 a.m: She said although Nigeria has prioritised primary healthcare revitalisation as the core strategy towards achieving UHC, more effort should required.
10:26 a.m: She said global evidence has shown that the choice of health financing policies determines the achievement or otherwise of the UHC aspirations of countries.
10:27 a.m: Quoting the Lancet Global Health Commission for Financing Primary Healthcare, she said improving financing arrangements can drive improvements in how PHC is delivered and equip the system to respond effectively to evolving population health needs.
“Prioritising PHC financing, therefore, would be a useful enabler in ensuring the attainment of UHC through PHC in Nigeria,” she said.
10:28 a.m: Ms Torrealba said the National Health Account estimates that 16.6 per cent of the current health expenditure is from government, 11.8 per cent from development partners while 3.6 per cent is from Insurance.
“This leaves the remaining 70.5 per cent of health care spending in Nigeria including primary healthcare to households who pay out-of-pocket with catastrophic potentials.
“In addition, it is important to note that 61.4 per cent of health spending in Nigeria is on communicable diseases,” She said.
10:30 a.m: The WHO representative said health is a fundamental human right by WHO’s standard. She appeals to the government to prioritise quality health care for all.
10:32 a.m: She congratulates the organisers of this dialogue on their thoughtfulness and prioritisationof the health of Nigerians. She said the media have a vital role to play in galvanising policy makers towards achieving the desired change in the health financing space.
10:33 a.m: Ms Torrealba ends her speech and leaves the podium.
10:35 a.m: The Co facilitator, Ms Mustapha takes the podium to welcome the Minister of Health, Osagie Ehanire, for his remark. Mr Ehanire is represented by Ngozi Azodoa, director of Health planning, research and statistics of the Federal Ministry of Health.
10:36 a.m: Mr Ehanire said the focus on primary healthcare is timely and well-placed, considering that PHC has been identified as the path to UHC, a goal Nigeria continues to pursue.
PHOTOS:
10:37 a.m: He said UHC is key to the health and well-being of all Nigerians as it guarantees needed quality healthcare services for all persons without financial hardship.
10:39 a.m: The minister noted that Nigeria’s journey to UHC has been slow, but remarkable milestones have been achieved.
“With heightened efforts to revitalise and strengthen the PHC system, I am confident that Nigeria will inch closer to attaining UHC,” he said.
10:41 a.m: Mr Ehanire said several challenges have bedeviled the country’s health care system. He said some of these challenges include
shortage and maldistribution of healthcare workers, dilapidated infrastructure, and weak referral systems.
“However, limited financing for the PHC system stands out as a factor that has significantly limited the advancement of our healthcare system,” he said.
10:43 a.m: Mr Ehanire said National Health Account reports published over the past decade indicate that expenditure on primary healthcare has been sub-optimal, with significant spending on curative healthcare.
10:44 a.m: He said the inadequacy in funding the PHC system has negatively impacted the delivery of services such as immunisation and maternal and child health services.
10:45 a.m: Mr Ehanire noted that robust financing would require collaborative efforts of both state and non-state actors.
PHOTOS:
10:47 a.m: He said while state actors in government continue to play their roles to ensure that more public resources are available for the PHC systems, a significant proportion of the progress with financing for PHC is dependent on the role of non-state actors.
“The private sector, civil society organisations , the media, faith-based organisations, trade unions, professional organisations, academia, community groups, and private citizens alike can all contribute to financing PHC in Nigeria,” he said.
10:48 a.m: The minister said Nigeria has continued to make efforts to improve the proportion of resources allocated to the PHC system. He said the Basic Health Care Provision Fund has been a game changer and resulted in increased financing for the PHC system through the different gateways.
10:49 a.m: Mr Ehanire commends the event organisers, noting that he is optimistic that all state and non-state actors will not rest on their oars until we have a well-financed PHC system that can meet the aspirations of our national health system. The minister ends his remark.
10:51 a.m: The representative of the National Primary Health Care Development Agency (NPHCDA), Ngozi Nwosu, takes the podium to give her presentation on “PHC financing: the role of government in achieving optimum PHC performance.” Ms Nwosu is the director, PHC system development of the agency.
10:53 a.m: She said it has been recognised that health is a fundamental universal right for all, and an essential condition for the integral and sustainable development of the people and a necessity for economic growth with equity.
10:55 a.m: She noted that the failure of many countries to achieve health for all led to a global commitment that aims to strengthen PHC systems as an essential step towards achieving UHC.
10:56 a.m: Ms Nwosu said the PHC approach is the most effective way to sustainably solve health system challenges. She said the government role in PHC is well documented in-country and is supported through partnerships with the private sector, NGOs and charitable institutions.
10:58 a.m: She said the signing of the National health act into law proves the Nigeria government’s commitment to achieve UHC by 2030. “Beyond policy declarations, the health sector significantly underperforms on key health outcomes such as life expectancy, maternal mortality and child health indices,” she said.
11:00 a.m: Ms Nwosu noted the increased challenges caused by the COVID-19 pandemic and subsequent economic constraints. This she said has brought new challenges for achieving accessible health care for all Nigerians.
11:02 a.m: She said at this point, the provision of health services is a shared responsibility for all three tiers of government. “While the federal government is responsible for overall policy making, coordination and regulation, provision of tertiary care and support to PHC through NPHCDA, state government hold thecore service delivery mandate on health,” she said.
11:07 a.m: She said local governments also need to take charge of health care delivery within their community.
11:09 a.m: Ms Nwosu said although remarkable progress has been made in PHC development, the system has remained weak and health outcomes suboptimal due to fragmentation of services and other multiple challenges in various aspects of the health system framework.
11:12 a.m: She said at this point, the importance of adequate financing for PHC cannot be over emphasised. She said this is important to build resilient health systems. “This is very important because health financing is the enabler to major parts of the health system operation.
11:16 a.m: Ms Nwosu said there are so many challenges facing Africa’s largest economy. She noted that Nigeria’s increased wealth has not translated to better health outcomes due to large inequities.
11:18 a.m: “This means Nigeria has fallen behind most other African countries and much below international standards in terms of health financing and health outcomes,” she said.
11:22 a.m: She highlighted the inadequacy in the majority of PHCs across the country. “Some PHCs facilities across the country are poorly equipped, with only a quarter of facilities having more than 25 per cent of the minimum equipment package,” she said.
11:25 a.m: She said the limited coverage of important PHC interventions is further aggravated by poor quality care, with poor performance of health workers also contributing to this.
11:27 a.m: Ms Nwosu said there is an urgent need to improve data quality and information platforms which will further ensure evidence based decision making and policies.
11:30 a.m: She concluded that strong political will, with a robust and sustained focus on PHC is vital to ensuring a transformational change in Nigeria’s health sector. Ms Nwosu ends her presentation and leaves the podium.
11:33 a.m: Ms Mustapha, the Co facilitator takes the podium to announce the end to the first session of this dialogue. She calls on the participants for a group photograph.
10:37 a.m; It’s time for Tea break, we will be right back.
12:25 p.m: The tea break is over. The Co facilitator, Ms Mustapha takes the podium to announce the commencement of the second session. The session begins with the first panel discussion on “The role of community in improving the standard of PHCs in Nigeria.
The panellist focus will be on “Primary Health Care: For the people and by the people; the role of citizens in quality service delivery at the PHC level.” The moderator of this panel is Mojeed Alabi, head development desk, Premium Times.
12:27 p.m: The first speaker is Anthony Agughasi, the ward development council chairman, Gwarimpa. He said the community has been directly involved with the government in the implementation of PHCs policy.
12:28 p.m: The next speaker is the representative of connected development, Pearl Utuk. Ms Utuk said persons in rural communities have a right to well equipped health facilities but this is not the case in Nigeria. She said the majority of communities lack an efficient PHCs system which has left them struggling for health services.
12:30 p.m: The next speaker is Chika Offor, the executive director of Vaccine Network for Disease Control. Ms Offor said the NPHCDA has never admitted to having everything figured out. She said the essence of PHC is to address health needs of persons especially in rural communities.
12:32 p.m: Ms Offor said the PHC system in Nigeria is not working. She said the majority of persons have lost their lives due to poor service delivery in PHCs. She also mentioned that despite the existence of the BHCPF, many PHCs including those in FCT are lacking adequate equipment to deliver effective services.
12:33 p.m: The director general, West African Institute of Public Health, Francis Ohanyido, takes the mic. Mr Ohanyido said the institute tries to be actively involved in the communities and scale up inter-sectoral collaboration.
12:35 p.m: He said about 70 per cent of diseases in Nigeria could be managed at the primary health care level if they are well functional. He said unfortunately, people especially those in rural communities are dying due to lack of effective health services.
12:37 p.m: Mr Ohanyido said the failure of the PHC system cannot be disconnected from its low funding. He said adequate funding will go a long way in improving service delivery. He said Nigeria has to innovatively find ways to ensure the PHC system works effectively.
12: 40 p.m: The moderator, Mr Alabi, raises questions on the effect of brain drain in the country and how it is affecting other health workers.
Responding to this, the chairman Nigerian Medical Association, FCT chapter, Charles Ugwuanyi, said the issue with the PHC system is not policy formulation but policy implementation. Mr Ugwuanyi said the effort of every responsible government should be to strengthen the PHC system.
12:44 p.m: On brain drain in the health sector, He said the Nigerian government has not done enough to keep doctors from travelling abroad. “The push factors are enormous,” he said.
12:46 p.m: He said the government must increase remunerations of health workers amongst other issues to keep them in the country. He noted that Nigeria has lost many doctors to developed countries within the last 11 months.
12:48 p.m: He said the government cannot keep developing tertiary health centres when PHC are in poor condition.
12:51 p.m: He said all stakeholders must be on board to improve health care delivery in the country. “It doesn’t matter where the funding is coming from, what matters is how well it is utilised,” he said.
12:53 p.m: The panelists are highlighting their points. Mr Ohanyido said the country needs to do better in terms of policy implementation.
12:54 p.m: Ms Offor said assessment of various PHCs across the country indicates a huge gap in health service delivery.
12:55 p.m: She said the government, stakeholders and all partners must come up with an innovation that is more sustainable in the future. She said citizens must level up and take control of the system. “We need a citizens’ accountability mechanism,” she said.
12:57 p.m: Mr Agughasi, the Gwarimpa ward development council chairman, said for policies to work, there must be continuous advocacy.
12:59 p.m: Ms Utuk, the representative of Connected Development said building the capacity of citizens to demand accountability and optimal service delivery is important. “If citizens know what they want, they will ask questions,” she said.
01:00 p.m; A participant, Gloria Orji said the mentality of PHCs being meant for the poor is wrong. Ms Orji said PHCs are meant for health service delivery for all. That brings us to the end of the first panel discussion.
01:04 p.m: The second panel discussion is on “The New Health Insurance Act and the future of health financing in Nigeria.” The moderator is Gafar Alawode. Mr Alawode said insurance is mandatory for the country to achieve UHC and also making health provisions for the vulnerable groups. He said the panelists will discuss the health insurance Act and its benefit to the people.
01:08 p.m: The first speaker is Gaza Gwamna, the executive secretary, State Social Health Insurance Scheme, Nasarawa state.
Mr Gwamna said when health insurance is voluntary, people have different attitudes towards it. He said that is why health insurance must be mandatory for the country to achieve UHC.
01:11 p.m: He said there are many good laws in Nigeria but the problem is domesticating such laws. He noted that the new health insurance act will fill the existing vacuum in service delivery but only if it’s well implemented.
01:13 p.m: The next speaker is the managing director of health partners HMO and general secretary, health and managed care association of Nigeria, Olumuyiwa Olusanya.
Mr Olusanya said HMOs play a very vital role in stabilising health insurance. He said it has created opportunities for financing using other channels.
01:16: He said no country can achieve UHC through private health insurance, it has to be through social insurance.
01:18 p.m: Mr Olusanya said states need to adopt a uniform social health scheme. “If state’s scheme is at variance with federal government model, then the aim of NHIA will be defeated,” he said.
01:22 p.m: The next panelist is Oritoke Okeowo, Neuroscience Unit, school of basic and medical sciences, Federal University of Technology, Akure, Ondo state. Ms Okeowo said health development can only be achieved through strong collaborations. She said this is evident in many developed countries.
01:24 p.m: She explained that in developed countries clinical researchers work together with the authorities, but this is the opposite in Nigeria. She said the Nigeria government has continued to sideline researchers when needed.
01:27 p.m: She appeals for researchers to be given the opportunity to work and be trusted. “So when there is a problem, they can be approached to provide the most effective study to solve problems,” she said.
01:29 p.m: The next panelist is Kemi Agbaoye, Director of programmes, Nigeria Health Watch. Ms Agbaoye said there is a need to interrogate and clarify some aspects of the new health insurance Act.
01:31 p.m: She said the Act is not clear enough as to its difference from the previous NHIS. “There is need for intentional community participation and education about the new Act.
01:34 p.m: Ms Agbaoye said communities need to get involved to institute accountability mechanisms. The moderator takes the mic and calls for reaction from the participants.
01:36 p.m: Responding to questions and reactions from the participants around innovation, Mr Gwamna said, “We are using social networks and new technology innovation to achieve health insurance schemes,” he said.
01:38 p.m: He also said there are multiple indicators used to identify vulnerable persons as regarding the NHIA.
01:41 p.m: Mr Olusanya is speaking now. He said HMOs are technology driven in Nigeria and there are platforms to collaborate with tele communications networks.
01:43 p.m: He said “technology is available and what we are going to explore is the partnership with telecom and bring NHIA on board.”
01:46 p.m: Ms Okeowo said there are issues around climate change hence the need to start investing for climate health emergencies. She said the NHIA cannot work alone, there is a need to collaborate with other sectors to make health accessible for all.
01:48 p.m: She said the aim is for all Nigerians to be aware of the Act and its benefits. “There should also be education at community level in various gatherings.”
01:52 p.m: Ms Agbaoye, the director of programmes, Nigeria health watch, said it’s time for the government to be intentional about the health of its people. The moderator, Mr Alawode, takes the mic to announce the end of the second panel session.
01:57 p.m: Ms Mustapha, the Co facilitator takes the podium to announce commencement of the third panel session. The moderator is Moji Makanjuola, the event’s facilitator. The panelist will be discussing “2023 Elections: What are the health priorities to focus on?”
01:59 p.m: The first panelist is Akomolade Jimoh, a representative of the Sydani group. Mr Jimoh said the Nigerian government and stakeholders fail to understand what the problems are hence, the difficulty to provide solutions to challenges.
02:03 p.m: He said to get the government to prioritise health, “we have to get them to understand the criticality of the issue.”
02:05 p.m: The next panelist is Busola Ajibola, deputy director of journalism programme. Ms Ajibola said the recent multidimensionally poverty index released by the National Bureau of Statistics should serve as a wake up call to understand the extent of the gap in accessing PHC.
02:08 p.m: The third panelist is Afolabi Adekaiyaoja, a research analyst from Centre for Democracy and Development (CDD). Mr Adekaiyaoja said one of the biggest problems is that “we look at these issues sideways but they are interconnected.
02:10 p.m: He said health care is not an issue that concerns only the ministry of health, it requires a broader approach.
02:11 p.m: He said there is a need to create an enabling environment for multi-sectoral partnership to work.
02:14 p.m: The fourth panelist is Francis Ayomoh, a representative of the federal ministry of health. Mr Ayomoh said there is a financial angle to implementing policies. He said the citizens have done nothing to make politicians understand how pertinent the issues are.
02:17 p.m; He said the people have to wake up and call on the government to know the importance of providing quality healthcare.
02:20 p.m: Mr Ayomoh said no matter the funding invested in health, it can never be enough. “We have to map out at our level to fund healthcare,” he said.
02:21 p.m: He said citizens have a lot to do when it comes to investing in the health system.
02:24 p.m: Mr Adekaiyaoja takes the mic. He said the focus of funding in healthcare is important. He explained that without funding, the country cannot achieve health for all
02:27 p.m: Ms Ajibola, the deputy director, Journalism Programme said it is pertinent for citizens to demand for good governance. She said political leaders can be held accountable for their actions.
02:30 p.m: She said various social media platforms can also be used to demand change and accountability from the government. “Get yourself familiar with the data and afterwards demand for answers in your own little ways,” she said.
02:33 p.m: Mr Jimoh, the representative of Sydani group, said there is a need to take advocacy to the grassroots. He said advocacy should go beyond social media to effect change.
02:33 p.m: Mr Jimoh, the representative of Sydani group, said there is a need to take advocacy to the grassroots. He said advocacy should go beyond social media to effect change.
02:37 p.m: The moderator, Ms Mankanjuola takes the mic to wrap up the panel session. She said the room for more investment in the health sector cannot be over emphasised.
02:40 p.m: She said everyone must get involved at this stage to evoke change. She said the media, private sectors, individuals and other stakeholders can come together to improve healthcare services.
02:42 p.m: She said new hospitals are emerging in Nigeria with the ability to provide effective services as experienced in foreign countries.
02:46 p.m: Ms Makanjuola said at a recent event, Aliko Dangote, Tony Elemelu amongst others made a commitment to construct one health facility in each LGA across the country.
02:48 p.m: Ms Makanjuola announces the end of this panel session and the panelist poses for a group photograph.
02:50 p.m: The co-facilitator, Ms Mustapha, takes the podium. She calls for the presentation of the draft communique from the National Health Dialogue.
02:52 p.m: Tosin Omoniyi, a Premium Times Editor takes the podium to deliver the communique.
02:53 p.m: Mr Omoniyi said it has been recognised that health is the fundamental universal right of all and an essential condition for integral and sustainable development.
02:55 p.m: He said complex and fragmented institutional arrangements between the local, state and federal government constrain the delivery of public health services in Nigeria.
“As a result of this, the NPHCDA initiated the Primary Health Care Under One Roof (PHCUOR) in 2011 to unify all structures and programmes at the state and local government levels under one authority to ensure efficient service delivery for proper accountability within a decentralised system,” he said.
“The SPHCB maintains and coordinates all PHC activities in the state such as PHC services, human resources and PHC advisory services.”
03:00 p.m: He said the National Health Insurance system has yet to be developed to the extent that people do not need to pay out-of-pocket and this calls for an efficient primary health care system.
03:01 p.m: He noted that the majority of the country’s health expenditure is funded through out-of-pocket payments with little financial protection and inequitable access to health services.
03:04 p.m: Mr Omoniyi said the full communique will be shared with participants at the close of the event.
03:07 p.m: The deputy director, development CJID, Akintunde Babatunde, takes the podium to make an announcement. Mr Babatunde applauds the audience for an engaging participation.
03:09 p.m: He said more information about CJID’s activities can be found on its official website.
03:15 p.m: The CEO of CJID and publisher of Premium Times, Dapo Olorunyomi, gives the closing remarks. Mr Olorunyomi expressed appreciation to attendees, WHO representative, representative of the minister of health, NMA and the NPHCDA.
03:17 p.m: He said the state of the health sector in the country is an indictment on health journalism. He challenged journalists to do more to further the agenda for better healthcare, especially PHCs for Nigerians.
03:19 p.m: The publisher wishes everyone a safe return to their homes. This brings us to the end of the 2022 edition of the National Health Dialogue.
Thank you for staying with us.
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