HERALDING A CONCEPTUAL FRAMEWORK FOR HEALTH SERVICE DELIVERY .
I am again plagued with the reality of the Nigerian healthcare sector and the huge potentials inherent if the opportunities can be maximised .
With a population of over 175 million a fragmented governance structure and an apathy in the political will to effective a change one is confronted with appalling figures of maternal,infant and under five mortality rates that are one of the worse globally .
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Developed societies understand the greatest resources they have is their human capital hence the high spending with effective monitoring and evaluation of their health systems .
Even more recently developing country are taking a cue from this eg Thailand, Brazil,Mexico and Rwanda are doing relatively well in achieving Universal Health Coverage .
Thailand for example :
Had a nine successive five-year national health plans ensuring continuity over four decades of health system development. Its generations of charismatic leaders, highly influential technocrats and medical leaders inside and outside of the Ministry of Public Health (MOPH), sharing a common vision of improving the health of the poorest, ensured that pro-poor, pro-rural health policies remained the priority of health system development." (http://ghlc.lshtm.ac.uk/files/2011/10/GHLC-book.pdf)
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So what really is the problem in effective health care service delivery and funding of the Nigerian health sector ?
Honestly I believe we have lacked the political will and health unfortunately hasn't been able to make it up the agenda setting of government .Thailand in achieving Universal Health Coverage and when it was propitious to do so from an economic point of view made huge investment in health even as it was a nation never to have been colonised . In 2001 the Nigeria governmemt made a commitment at the Abuja declaration to commit 15% of our annual spending to health along with some African nations , but rather abysmally we are only appropriate 3.7% of GDP on health and the remainder out of pocket payments leaving the large majority of Nigerians in financial hardship .Whilst some may argue for good health at lost cost the imperative of structural reforms can never be over- emphasised .
Secondly is the failure to address how we effectively want to fund healthcare efficiently .
The National Health Insurance Scheme established in 1999 and enacted into law in 2003 which provided an array of hope largely for all intent and purpose as failed to deliver especially to the informal sector . It's coverage only amounting to 3% (5 million ) yet with it's internal bureaucratic bottlenecks and lacunas in its legal framework which allows an in and out opt from states is a huge set back .
Going forward we have to build on existing successes and adopt a locally adaptable health framework .
Government must subsidise the very poor (muttelles rwanda) and through robust political negotiations expand the remit of the National Health Insurance Scheme whilst also bridging the lacunas in the legal framework .
Such wouldn't be easy and I don't expect it not to. The passage of the recent Obamacare in an over bloated and fragmented United States Health system where health super pacs with large financial war chest in congress constituent huge challenges . But yet President Obama was able to pull this through his healthcare reform act in both houses through a sagacious bipartisan approach.
President Muhammadu Buhari is in a similar situation especially given the support he has and can galvanise both locally and internationally . His party the APC has majority in parliament as well as controlling 22 of the 36 states of the federation .
Would health resonate in his incorruptible conscience or would it be business as usual ?
Only time would tell , but in the wait for an act of divinity to to cause a tsunami of health thoughts and a desperation for true change in the health sector its pertinent to underscore the fact many children born today( close to 50%) wouldn't see their fifth birthday alive mainly due to deaths from preventable childhood diseases .
In concluding we all must make demands on government to take responsibility and do the needful within the confines of the law for not doing so and keeping mute would mean mortgaging the future of the yet unborn to the dictates of a health care system that's not only weak but a big disgrace to a country that prides itself as the giant of Africa .
In the words of Senator Ben Murray Bruce :Ijustwanttomakecommonsense
Dr Babatunde Tikare writes from London .
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