Malnutrition: Jigawa vows to establish more CMAM activities

By Abubakar Jimoh

There are indications that apart from working to ensure timely release of N150million (out of N300million budgeted) being nutrition counterpart balance to UNICEF for the procurement of Ready to Use Therapeutic Food (RUTF), Jigawa State Government has been working to cascade CMAM program across the local governments yet to be covered in the state.

The State’s Commissioner for Health, Dr. Abba Z. Umar made this known during an advocacy visit to the Ministry by Civil Society Legislative Advocacy Centre (CISLAC) in Jigawa state.

He urged UNICEF to fast-track the procurement and delivery of RUTF to relevant facilities as 150million had hitherto been released by the State Government.

“The counterpart balance of N150miilion for the procurement of RUTF is being processed as we speak; and will be release once the approval is secured to that effect.

“We are committed to eradicate malnutrition in the state. The state is more willing to scale up the CMAM to cover the remaining local government in the state,” the Commissioner promised.

Speaking during the visit, the Project Coordinator, Chioma Kanu represented by Asst. Program Officer, CISLAC, Murtala Muhammad explained that while Nigeria currently records 2.1 million malnourished children with nearly 1000 Nigerian children dying from malnutrition-related causes every day, Jigawa state currently records over 67,716 malnourished children.

He revealed that UNICEF has set aside $2,915,718 for the treatment of severely malnourished children in Jigawa state while the state government is expected to contribute $567,317 under the existing counterpart agreement.

Muhammad said: “Immediate release of Funds by the Government for nutrition is required to save lives. The CMAM programme still needs to be scaled up. With more resources, government can save more lives, and UNICEF will also contribute more.

“Government needs to also create and dedicate budget line for nutrition as the 2018 budget process kick starts.

“The state needs to also adopt multi-sectoral costed nutrition strategic plan to address the long term nutrition problem in the state. Government needs to ensure nutrition is fully integrated into the Primary Health Care per ward initiative.

“We urge sustained effort to promote Infant and Young Child Feeding (IYCF) and Exclusive Breastfeeding practices in the state. We request that you influence increase funding for nutrition in the state.”

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Stringent tax regime and the unwanted fatalities from tobacco use

By Abubakar Jimoh

The dreaded but preventable impacts of tobacco use like diseases and premature deaths in Nigeria with various studies showing potential opportunities for the country, if redirected focus on preventive rather than curative measures to mitigate effects of tobacco led to the intensive advocacy by Civil Society group for comprehensive National Tobacco Control Act to domesticates the World Health Organization’s Framework on Tobacco Control (WHO-FCTC).

Reports by WHO have shown that tobacco use costs national economies immensely through increased health-care cost and decrease productivity. It worsens health inequalities and increase poverty as the poorest people spend less on essentials such as food, education and health care.

While stringent measures like increasing taxes and levies on tobacco products have proven to reduce consumption and generates revenue which can be used to finance universal health coverage and other developmental health programme.

In order to mitigate illicit importation, distribution and sales of tobacco product through tax avoidance, WHO Protocol to Eliminate Illicit Trade in Tobacco Products was introduced to prevent tobacco illegal trade and secure supply chain of tobacco products through a series of government measures.

Effort to devise implementation strategy and adopt holistic fiscal measures to discourage consumption of tobacco and its associated risks in accordance with provisions of the National Tobacco Control Act, 2015 brought to limelight a two-day workshop of Technical Working Group on Tobacco Taxation in Nigeria.

The workshop organised by the Federal Ministry of Health in collaboration with Civil Society Legislative Advocacy Centre (CISLAC) with support from African Capacity Building Foundation (ACBF) in Keffi, Nassarawa state specifically aimed at enlightening relevant health institutions on financial benefits of increased tobacco tax, advocate for and recommend new tobacco tax regime to Government, canvass for the removal of tobacco industries from enjoying any government incentive, while highlighting the roles of Ministries, Departments and Agencies as critical stakeholders in the successful implementation of the National Tobacco Control Act.

Giving the importance of policy advocacy to achieving effective implementation of the Act, Okeke Anya, Program Manager (ECOWAS & AU), CISLAC, disclosed that policy advocacy would help in building knowledge on the devastating consequences of Tobacco on Health, taxation in general, and create a multi-sectoral partnership for effective implementation of laws, policies and guidelines.

He listed as part of advocacy achievements on Tobacco Control in Nigeria: the implementation of Signing and Ratification of World Health Organisation- Framework Convention on Tobacco Control (WHO-FCTC), passage and assent of the National Tobacco Control Act, appropriate support rendered in the draft of Tobacco Control Regulations, initiation of legislative framework that expunged weak provisions of the Act, and improved media coverage of tobacco control issues.

Recounting the socio-economic losses to tobacco use in the country, Dr. Chukwuka Onyekwena representing the Centre for Study of Economies of Africa (CSEA), stated that economic losses in the form of medical treatments and loss of productivity from tobacco-related disease amounted to US$ 591 million in 2015 with no fewer than 17,500 deaths annually.

Dr. Onyekwena tried to establish relationship between poverty and tobacco use, sting that tobacco use and poverty are intertwined as observed in recent development.

“An average smoker spends 7.8% of national median income to purchase 10 sticks of the cheapest cigarettes each day, making less money available for other basic items,” he lamented.

Examining the current status of tobacco taxes in Nigeria, Dr. Onyekwena said about 80% of legally consumed tobacco products were domestically produced with British America Tobacco Nigerian (BATN) taking largest market share of 75%, followed by Leave Tobacco and Commodities Nigeria Ltd and International Tobacco Company (ITC).

He observed weak tax structure for tobacco use with low tax rate of 25% as against as against the 75% of retail price recommended by WHO as baseline, adding that Nigeria recorded one of the lowest Value Added Tax rates in the world.

“Nigeria runs an ad valorem tax structure, while WHO recommends specific tax structure. Ad valorem tax structure is susceptible to undervaluation; encourages price reductions; disincentivizes costly ‘quality’ improvements; and encourages ‘trading down’ in favour of cheaper tobacco products.

“It does not incorporate a minimum retail sales price and tax administrative system remains weak,” Dr. Onyekwena.

He posited that such comprehensive strategy as stronger tax administration, improved boarder control, appropriate monitoring and tracking systems, and significant increase in excise tax in line with WHO benchmark could yield optimal outcomes for public health and government revenue.

Giving the level of implementation of the National Tobacco Control Act, 2015, Dr. M.T. Malau, Branch Head, Tobacco Control Unit, Federal Ministry of Health bemoaned among other things delayed in the development of Strategic Plan of Action for implementation, Tobacco Control Fund, and absence of Tobacco Control Coordinating Mechanism at States and Local Government Areas, as required under the Act.

He advised that implementation of the National Tobacco Control Act 2015 would protect present and future generations of Nigerians and residents of Nigeria from the devastating health, social, economic, and environmental consequences of the use of tobacco products and exposure to second-hand tobacco smoke.

Dr. Malau itemised as part of the underlined strategies to achieve effective implantation: development National Tobacco Control Strategic Plan of Action, implementation of tobacco taxation, ratification of protocol on illicit trade, commencement of process to adopt tracking and tracing system to reduce illicit trade on tobacco products, establishment and operationalization of the Tobacco Control Fund.

Other strategies include issuance of license to tobacco industry, development of guidelines on tobacco cessation and integration of tobacco dependence and cessation services into existing health facilities, and intensified awareness campaign against tobacco use.

Stakeholders at the summit called for policy consciousness on the illicit importation of tobacco, a growing misconduct prohibited by law, found in the production, shipment, receipt, possession, distribution, sale or purchase of tobacco products.

They warned the government against the continued trading of tobacco products across and within borders without payment of local excise taxes through such illicit practices as illegal manufacturing, distribution and sales that could further exacerbate the precarious socio-economic impacts of tobacco use in the country.

“A way to penetrate new markets is achieved by selling cigarettes without paying all applicable taxes. Illicit trade is a threat to public health and the achievement of Sustinable Development Goals (SDGs). It can be addressed even in the presence of higher or rising tobacco taxes,” they cautioned.

Discussing illicit market penetration for tobacco importation, they observed that Nigeria formed part of large markets for illicit importation of tobacco products in Africa.

They observed other underlying factors for illicit importation of tobacco products like high level of corruption, lack of commitment to addressing illicit trade, ineffective customs and tax administration.

“Tobacco tax avoidance is determined by corruption, weak tax administration, poor enforcement, presence of informal distribution channels, presence of criminal networks, and increasingly access to cheaper sources,” they added.

 

Tobacco Control: Report unlocks progress across Sub-Saharan Africa

By Abubakar Jimoh

As the driving force behind the success of domesticating and implementing tobacco control policies in accordance with provisions of the Framework Convention on Tobacco Control (FCTC) across Sub-Saharan African countries, the appreciable interventions by Civil Society Organisations cannot be undermined, especially in sustained advocacy, coalition buildings, service provision, evidence-based information, and monitoring efforts.

A recent report titled “Enhancing the effectiveness of civil society organisations in tobacco control in targeted African countries” published by African Capacity Building Foundation (ACBF) has revealed progress in the domestication and implementation of FCTC in most countries in Sub-Saharan Africa.

Assessing efforts and interventions by the supported civil society groups, the report acknowledges a sustained legislative platform for influencing Tobacco Control regulations by the Civil Society Legislative Advocacy Centre (CISLAC) through persistent sensitisation of key actors to finalize regulations for guiding implementation of the National Tobacco Control Act.

According to the report, CISLAC has successfully deployed various viewer-friendly social media platforms in real time legislative and policy advocacy on tobacco control in Nigeria, encouraging other civil society group across Sub-Sahara Africa to follow the trend in social media mobilisation given its limited financial burden in achieving effective domestication and implementation of the FCTC.

On related development, with impressive progress in Tobacco Control, apart from gazetting Tobacco Control Regulations in 2015, Kenya has taken a step further in ensuring graphic health warnings as provided for in the Regulations appear on tobacco packaging.

In order to sustain the recorded achievements in Kenya, the report recommends capacity building for Tobacco Control enforcement teams to effectively enforce the provisions of national law and in view of the forthcoming county specific legislation.

The report bemoans the growing rate of tobacco industry, and the delayed implementation-complaint proclamation of FCTC and other Tobacco Control policies in Ethiopia, calling for appropriate measures to “pre-empt, counter, and discredit interference from the industry”.

It stated: “The directive from the Ethiopia Foods, Medicines and Health care Administration and Control Authority (EFMHACA) in 2015 lacks enforcement mechanisms. The new FCTC- has been delayed. In addition, creation of 100 percent SFEs in universities requires multi-sectoral collaboration from them and outside stakeholders.”

Recounting the achievements on Tobacco Control in Benin, the report commends massive sensitisation of key stakeholders and ministry officials leading to the passage of the Tobacco Control law in September 2017, while recognizing the essential role of the Ministry of Health in advancing Tobacco Control through sustained engagements with media professionals to relay messages, stress risky attitudes and behaviours and denounce illegal practices of distributors and retailers of tobacco products.

Through the advocacy interventions of RAID, Gambia passed the Comprehensive Tobacco Control Act in 2016, consolidating existing laws and regulations with subsequent significant steps in combating tobacco use, and transformation of RAID to a very effect Tobacco Control actor in influencing policy decision.

In Botswana, the report observes the current intervention by ANTI-Tobacco Network (ATN) focusing tobacco industry monitoring, sensitisation of key stakeholders, research and fact-findings on situation analysis on tobacco control to further support resources, structures, key actors and governance issues.

As part of lessons learnt in Tobacco Control interventions across Sub-Saharan Africa, the report notes that the indispensable high level partnership and coordination of all TC actors through exchange platforms had led to a greater impact. “Also crucial are commitment and mobilisation of government authorities, and of religious and traditional leaders in working with CSOs.”

It recommends massive public awareness to de-normalizing tobacco and increase knowledge among people, especially youth, on the negative effects of tobacco use, so as to prevent initiation and to promote cessation.

Trump’s aid cuts, a setback to humanitarian supports in Africa

By Abubakar Jimoh

Recently, the humanitarian world was thrown in a sober reflection by a shocking but unpleasant development arising from President of the United States, Donald Trump’s financial decision to cut-down global aid spending by 32 percent as contains in the proposed budget plans for the Fiscal Year 2018.

The decision which was thankfully subjected to extensive criticism by both Republicans and Democrats in the legislature was as well instantly denounced by a global movement—ONE Campaign, which through its works on good governance across globe including Africa has been able to ascertain the detrimental impacts such proposed plans will pose to the existing efforts at successfully combating poverty, diseases and marginalisation, and boosting social investments, especially in Africa.

While the fundamental purpose of humanitarian aid by any government is to complement the efforts of a receiving nation at revitalising her social sector as well as uplifting the poor from extreme poverty, which renders them incapacitated to attain self-reliance and effectively fight diseases, the on-going financial decision by President Trump, if not instantly addressed and reversed will, without doubt result in counter-productivity to the United States’ tracked and commendable records in supporting and sustaining enabling environment for political and socio-economic stability, particularly in Africa.

As a continent with emerging democracies and pervasive inadequate funding for social sector, experiences have revealed that most African governments rely on international aids, which are largely secured from United States through various counterpart-funding agreements to augment their budgets for social sector. A good example is the recent tripartite agreements among some Nigerian state governments, Bill and Melinda Gates Foundation and Dangote Foundation to sustain the fight against dreaded polio virus, which was prevalent in northern part of the country owing to lack of funding for the procurement and administration of vaccines.

Meanwhile, working alongside the aforementioned donors, Global Alliance for Vaccine (GAVI) has been supporting African governments in routine immunisation through procurement and donation of polio vaccines, leading to a major success in the fight against polio virus in various parts of Africa including Nigeria

It is noteworthy to highlight that GAVI receives 79% of its funding from contributions by governments with United States as a key donor significantly contributing no fewer than 9.2% amounting to US$ 800.0 million as at March 2017 that according to GAVI, “will greatly enhance Gavi’s capacity to purchase and deliver life-saving vaccines for children and help in immunizing millions of children in developing countries against vaccine-preventable diseases, which claim 1.5 million lives every year”. The contribution as disclosed in an acknowledgment by GAVI was part of the US$ 814.5 million approved for USAID’s Maternal and Child Health programs for 2017.

Apart from direct financial aid to the governments, the sincere efforts of other agency like USAID has been recognised and widely acknowledged most especially in promoting good governance through its project and activity labelled “Strengthening Advocacy and Civil Engagement” (SACE), which has helped to increase the capacity of citizens across the continent to be more involved in democratic reform processes by influencing institutions whose function are to serve public interests.

Not only have funds from USAID assisted in enhancing participation of marginalized populations — such as women, youth, and the disabled — and emphasizing the importance of leadership and innovation, the agency is famous in addressing developmental challenges in Nigeria by promoting political and socio-economic stability through improved social services, transparent and responsive government, and humanitarian assistance to the crises affected zone like North Eastern part of the country.

In 2011, a report entitled “U.S. Foreign Assistance to Sub-Saharan Africa: The FY2012 Request” published by Congressional Research Service, reveals a total bilateral U.S. development assistance from USAID and the State Department to sub-Saharan Africa amounting to an estimated $7.08 billion in 2012 as against $1.94 billion in 2002 Financial Year. The rapid increase in development assistance which was later explained in another corresponding report titled “Overview of the President’s Emergency Plan for AIDS Relief (PEPFAR)” by Center for Global Development, was largely driven by global health spending, which concentrates on resources to combat the fast spreading HIV/AIDS primarily to 14 countries, 12 of which are in sub-Saharan Africa.

Consequently, another major success has been recorded in the fight against HIV/AIDS in the region. An instance is Nigeria which in a 2016 report entitled “Combat HIV/AIDS, malaria and other diseases: Where we are” published by United Nations Development Programme (UNDP) was applauded for the falling trend in HIV/AIDS satisfying the criteria for the attainment of Goal 6 of Millennium Development Goals (MDGs).

Similarly, while HIV and AIDS have had a significant negative impact on life expectancy in South Africa, leaving many families and children economically vulnerable and often socially stigmatized, it has received the largest Anti-Retroviral Therapy programme in the world through the effort of United States PEPFAR and has contributed towards stabilizing HIV prevalence in Africa. This fact was buttressed in another study by the Science Desk of National Public Radio (NPR) that “PEPFAR, really, has saved a huge number of people’s lives. This has been one of the most effective public health inventions outside of clean running water, decent nutrition and vaccine programs. This has made an unbelievable difference”.

Moreover, of $48 billion to PEPFAR in 2008, $500 million was allocated to fight HIV/AIDS in Kenya. In fact, single biggest change for public health in Kenya was according to Center for Disease Control and Prevention (CDC) Kenya, achieved by the founding of PEPFAR.

It is also important to mention that in 2013, following a political crisis that claimed tens of thousands of South Sudanese lives and left about 4 million displaced, USAID had charted a strategy that increased humanitarian assistance and support for fundamental needs including access to water, health and education services. With continued support through direct service delivery and technical assistance, the agency has helped in saving South Sudan from deteriorating into famine conditions in addition to significant progress recorded in the quality, coverage, and impact of the national HIV/AIDS response.

Additionally, these facts were reiterated and highlighted when in Fiscal Year 2015 report, the Office of U.S. Foreign Disaster Assistance (OFDA) could not conceal but to state that through available funds, USAID sustained provision of critical, life-saving assistance in response to conflict and displacement in South Sudan and Sudan’s Darfur Region; met conflict-related needs in the Central African Republic, the Democratic Republic of the Congo, and Somalia; provided nutrition assistance in Kenya; and supported flood-affected communities in Madagascar, Malawi, and Mozambique.

The opposite of this backdrop is a clear indication of horrific conditions Africans will be subjected should President Trump get his proposed plans passed. We therefore call for a rethink on the proposed financial plans by President Trump.

 

2016: Kaduna health budget performance above average

COMMUNIQUÉ ISSUED AT THE END OF A ONE-DAY EXECUTIVE AND MEDIA DIALOGUE ON MATERNAL HEALTH ORGANIZED BY CIVIL SOCIETY LEGISLATIVE ADVOCACY CENTRE (CISLAC) WITH SUPPORT FROM THE MACARTHUR FOUNDATION, HELD AT CHIMCHERRY HOTEL, KADUNA STATE ON 4TH MAY, 2017.

Preamble:

Civil Society Legislative Advocacy Centre (CISLAC) organized a One-day Executive and Media Roundtable on Maternal Health. The Roundtable aimed at bringing Kaduna State’s executives, civil society and the media under one roof to brainstorm on necessary action for timely release and effective implementation of maternal and child health budget in the state for efficient intervention and maximum impacts on the citizens. The meeting drew participants representing Ministries of Health, Education, Women Affairs, Civil Society Organizations, and the Media. After exhaustive deliberations on various thematic issues, the following observations and recommendations were made:

Observations:

  1. Kaduna State Government has clearly articulated its readiness to ensure accountability in maternal and child health care service delivery through the state’s Three Years (2016 to 2019) Performance Management Framework.
  2. While the state’s 2016 overall health budget performance was reportedly above average, large sum of the health allocation is used for debt servicing.
  3. Poor individual awareness or inappropriate understanding of the existing policy like Free Maternal and Child Health is an impending challenge to maternal and child health services accessibility in the state.
  4. In 2007/08, the State Government had signed a memorandum of understanding with 23 local governments in the state on funding for FMCH.
  5. Identified challenges to Free MCH in the state include inadequate funds, non/irregular collection of drugs from the state medical store, poor record keeping, lack of monitoring and supervision, delay in release of appropriated funds, poorly motivated staff.
  6. Weak working relations between the media and MDAs remain an inherent systemic challenge to appropriate information dissemination on FMCH.
  7. Absence of information on MCH in schools has further intensified maternal mortality through early marriage in the state.
  8. Unfriendly health facilities deny adequate accessibility to maternal and child health services to vulnerable groups and people with special needs.

Recommendations:

  1. Mainstreaming media for training and retraining programmes on budget tracking and monitoring to enhance their capacity to demand accountability on the implementation of maternal and child health budget.
  2. Appropriate understanding of the existing policies on maternal and child health by the media and civil society to effectively advocate and raise public awareness on the selected Free Maternal and Child Health services in the state.
  3. Prioritized budgetary allocation to health sector to promote accessible, effective and affordable maternal health care service delivery in the state.
  4. Timely request and release (Cash Backing) of health budgetary allocation by relevant Ministries, Department and Agencies to fast-track maternal and child health interventions and services.
  5. Leveraging the existing funding opportunities to reduce health fund burden such as Saving One Million Lives scheme by the World Bank, National Health Act, development partners.
  6. Leveraging existing legislation like Freedom of Information Act (FOI) in accessing public information and demand accountability on maternal and child health, in absence of willingness to provide information.
  7. Strengthen collaboration or partnership among the media, civil society and the ministries, departments and agencies, with specific focus on ministry of health to project the issue of maternal health.

Action points:

  1. Adequate sensitization on maternal health by Ministry of Education across all schools
  2. Mainstreaming women and youth in the existing programmes by Ministry of Women Affairs and Social Development.
  3. Mainstreaming the media in programmes and activities of Ministry of Health to help in maternal health information dissemination.
  4. Enhanced advocacy to prioritise civil society, media and MDAs synergy
  5. Engage stakeholders on maternal health through awareness creation and sensitization
  6. More socially responsive media to health related issues through strengthen relationship with relevant stakeholders.

Stakeholders renew commitment to prioritize malnutrition as a major developmental challenge in the north

DECLARATION OF ACTION AFTER A TWO-DAY NUTRITION BUDGET TRACKING WORKSHOP FOR 12 NORTHERN STATES OF NIGERIA ORGANISED BY THE FEDERAL MINISTRY OF BUDGET AND NATIONAL PLANNING IN PARTNERSHIP WITH CIVIL SOCIETY LEGISLATIVE ADVOCACY CENTRE (CISLAC) AND UNITED NATIONS CHILDREN’S FUND (UNICEF) HELD AT GRAND CENTRAL HOTEL, KANO STATE ON 10TH AND 11TH MAY 2017

The Federal Ministry of Budget and National Planning in partnership with Civil Society Legislative Advocacy Centre (CISLAC) and United Nations Children’s Fund (UNICEF) organized a two-day Budget Tracking Workshop for 12 northern states’ Policy Makers and Civil Society. The Workshop aimed at bringing the States Ministries of Health, Agriculture, Budget and Planning, Water Resources, Education, Women Affairs and Social Development and Primary Health Development Agencies with specific nutrition budget under one roof to: collate focused states nutrition budget data (2010-2016 financial year), share and agree on budget tracking methodology and tools to track and analyse nutrition budget allocation, releases and expenditure in state government ministries, departments and agencies and other stakeholders to inform policy and advocacy towards increasing funding to scale up nutrition interventions in the selected states.

The meeting drew over 70 participants from States Ministries of Health, Agriculture, Budget and Economic Planning, States Primary Health Care Development Agencies, Ministry of Budget and National Planning, Federal Ministry of Health, UNICEF Chiefs of Field Office Sokoto and Katsina, Civil Society Organisations and the Media. After exhaustive deliberation on various thematic issues, we the participants:

Recognised that proper nutrition, especially within the first 1000 days, provides a sound footing for a brighter start of life with greater potentials of attaining a healthier life, better educational outcomes, and improved productivity in adulthood leading to higher Gross Domestic Product (GDP) of countries

Also recognised that while adequate and sustainable funding for nutrition remains paramount to promote healthy and secured society, sustainable growth in the twelve  Northern States that participated in this workshop cannot be achieved without prioritised attention to nutrition investment at all levels.

Further recognised that embracing multi-sectoral approach through adequate budgetary allocation to nutrition related activities in the line Ministries, Departments and Agencies will enhance concerted nutrition sensitive intervention as a delivery platform for nutrition specific intervention to address malnutrition scourge in the states.

Expressed concern over delay in domestication and implementation of the existing national policy guidelines on nutrition such as the National Policy on Food and Nutrition and the National Strategic Plan of Action for Nutrition by the States, that hampers efforts to addressing nutrition through a multi-sectoral approach.

Also expressed concern over inadequate Ready to Use Therapeutic Foods (RUTF) across the States that further poses a threat to saving lives of children with conditions of Severe Acute Malnutrition, thus drawing back the efforts in addressing childhood malnutrition and mortality.

Noted that inadequate budgetary allocation to nutrition and delay or non-release of funds allocated for nutrition related activities by some state governments are inherent systemic challenges in complementing donors’ efforts in scaling up interventions in nutrition in view of the fact most of the current interventions are donor-driven which has serious implications for sustainability.

Also noted that timely release of funds for 2017 nutrition budget implementation will help to scale-up nutrition interventions and leverage donor resources for treatment of Severe Acute Malnutrition, scale up of infant and young child feeding practices and the control of micronutrients deficiency.

Affirmed that supporting domestication and effective implementation of the National Policy on Food and Nutrition with functional State Committee on Food and Nutrition as well as costed Nutrition Plan of Action by the States will provide guidelines and enhance planning for policy formulation towards maternal and child nutrition intervention and financing.

Committed to effectively deploy skills and knowledge gathered from this Workshop to inform evidence-based advocacy in tracking, monitoring and reporting nutrition budget for timely release and judicious utilisation of nutrition budgetary allocation to both nutrition sensitive and nutrition specific interventions in our respective states.

Also committed to work towards adequate budgetary allocation for the procurement of RUTF for Community Management of Acute Malnutrition (CMAM) continuation and scale-up nutrition activities.

Further committed to leverage support from UNICEF to help states develop a budget tracking document to enhance appropriate tracking and monitoring process.

Will prioritize malnutrition as a major health and developmental challenges that is contributing to impeding socio-economic development of Northern Nigeria

Shall effectively strengthen collaboration among the line Ministries, Departments and Agencies, with specific focus on key developmental sectors and Local Government Authorities to project the nutrition sensitive and nutrition specific interventions

Resolved to work with Director of Planning with the support of UNICEF in our respective states to utilise the budget documents (2010-2016) to develop a substantive budget tracking document to inform policy decision.

Signed:

S/N NAME STATE MDAs
1. Hussaini Maisamari Yelwa Kebbi MBEP
2. Suleiman Mamman Gmobe State Nutrition Officer
3. George M. Sha’a Adamawa ASPC
4. Dahiru Sambo Usman Bauchi SPC
5. Aminu SARKIN-HATSI KUDAI Jigawa BEPD
6. PHOEBE SUKAI YAYI Kaduna MOBP
7. Abubakar Abande Yobe YOSADP
8. Hyelapila Bwala Borno Budget and Planning
9. Samaila Bakwai Umar Zamfara Zamfara SPHCB
10. Faruku Dandare Sokoto MOA
11. Muhammad Ya’u Kano MOPB
12. Muhammad Kabir Bara’u Katsina Budget and Economic Planning

 

 

50% child mortality in the country has malnutrition as underlining cause

COMMUNIQUE ISSUED AT THE END OF A TWO-DAY SUMMIT FOR STATE POLICY MAKERS ON FINANCING NUTRITION IN NORTHERN NIGERIA ORGANIZED BY THE FEDERAL MINISTRY OF BUDGET AND NATIONAL PLANNING IN PARTNERSHIP WITH CIVIL SOCIETY LEGISLATIVE ADVOCACY CENTRE (CISLAC) AND UNITED NATIONS CHILDREN’S FUND (UNICEF) WITH SUPPORT FROM UKAID AND CHILDREN’S INVESTMENT FUND FOUNDATION OF UK HELD AT TAHIR GUEST PALACE, G.R.A KANO STATE ON 24TH AND 25TH NOVEMBER, 2016.

Preamble

The Federal Ministry of Budget and National Planning in partnership with Civil Society Legislative Advocacy Centre (CISLAC) and United Nations Children’s Fund (UNICEF) organized a two-day Summit for State Policy Makers on Financing Nutrition in Northern Nigeria. The Summit aimed at bringing the States legislators and high level policy makers from various states under one roof to: understand the complexity and multi-sectoral nature of nutrition; identify opportunities for financing nutrition in the 2017 budget in their respective states, understand existing efforts by the States towards sustainably increasing nutrition investment including nutrition emergency in Northern Nigeria. The meeting drew over 70 leaders from State Houses of Assembly, States Ministries of Health, Budget and Economic Planning, State Executive Secretaries, Federal Ministry of Budget and National Planning, Federal Ministry of Health, civil society groups and the media.

The Summit was attended by Members of the State Houses of Assembly such as Gombe State Chairman House Committee on Health, Hon. Bature G. Usman; Gombe State Chairman House Committee on Finance, Hon. Adamu J. Saidu; Chairman Katsina State House Committee on Health, Hon. Abubakar Mohammed; Yobe State Chairman House Committee on Appropriation, Hon. Bukar Mustapha; Chairman Yobe State House Committee on Health, Hon. Ya’u Usman Dachia; Chairman Kaduna State House Committee on Health, Hon. Dr. Baal Z. Auta; Chairman Kaduna State House Committee on Appropriation and Implementation, Hon. Ahmed Mohammed; Chairman Kano State House Committee on Budget, Rt. Hon. Abdul G. Azeez; Deputy Chairman Bauchi State House Committee on Health, Hon. Sale A. Umar; Deputy Chairman Bauchi State House Committee on Appropriation, Hon. Abdullahi S. Abdulkadir; Chairman Sokoto State House Committee on Finance and Appropriation, Hon. Malami Ahmed Mohammed, Sokoto State Chairman House Committee on Health, Hon. Bature B. Muhammad.

The Summit was also attended by members of the States’ Executives; Kano State Honourable Commissioner for Health, Dr. Kabiru I. Getso; Jigawa State Honourable Commissioner for Health, Dr. Abba Z. Umar; Kebbi State Honourable Commissioner for Health, Umar Usman Kambaza; Yobe State Honourable Commissioner for Budget and Planning, Mr. Idi Barde Gubana; Yobe State Honourable Commisioner for Health, Dr. M.B. Kawuwa; Economic Adviser to the Kaduna State Governor, Alhaji Murtala M. Dabo; Special Adviser to the Bauchi State Governor on Donors and NGOs, Alhaji Mansur Manu Soro; Special Adviser on Budget and Planning to the Bauchi State Governor, Mr. Bello Gidado; Special Adviser on Finance and Budget to the Adamawa State Government, Mr. Umar Bakari; Permanent Secretary, Jigawa State Ministry of Budget and Economic Planning, Mr. Adamu Muhammad Garun Gabas; Permanent Secretary Borno State Ministry of Budget and Planning, Alhaji Mustapha T. Abba; Permanent Secretary Bauchi State Planning Commission, Mr. Yahuza Adamu; Special Adviser on Health to the Jigawa State Governor, Hon. Bello Umar; Acting Permanent Secretary, Sokoto State Ministry of Budget, Usman Arzika Bodinga.

After exhaustive deliberations on various thematic issues, the following observations and recommendations were made:

 Observations:

  1. Malnutrition impacts negatively on the socio-economic development of a nation, and sustainable growth in Northern Nigeria cannot be achieved without prioritised attention to nutrition investment at all levels.
  2. Undernutrition remains high in Northern Nigeria with about 2.2 million out of the 2.5 million severely acute malnourished children being from Northern Nigeria. Majority of children do not receive minimum acceptable diet. While 50% child mortality in the country has malnutrition as underlining cause, no fewer than 1200, out of 2600 estimated daily deaths are caused by malnutrition.
  3. Delay in domestication and implementation of the existing national policy guidelines on nutrition such as the National Policy on Food and Nutrition and the National Strategic Plan of Action for Nutrition by the States, hampers efforts to addressing nutrition through a multi-sectoral approach by the relevant sectors including health, education, agriculture, water and sanitation, social protection, among others.
  4. Inadequate budgetary allocation to nutrition and delay or non-release of nutrition appropriated funds by the state governments are inherent systemic challenges in complementing donors’ efforts in scaling up interventions in nutrition.
  5. Having visited treatment site for children with severe acute malnutrition to observe the severity of undernutrition in Northern Nigeria, we are deeply touched and worried that inadequate Ready to Use Therapeutic Foods (RUTF) across the States is a threat to saving lives of children with conditions of severe acute malnutrition, thus defeating the efforts in addressing childhood malnutrition and mortality.
  6. Lack of legal framework on nutrition budget appropriation and oversight.
  7. Food insecurity, inappropriate feeding habits, poor awareness on acceptable adequate diet, insufficient health facilities and services are contributory factors to maternal and child malnutrition across the North.

Recommendations:

  1. Prioritize malnutrition as a major health crisis in Northern Nigeria.
  2. We commit working towards ensuring government provides funding for procurement of RUTF for CMAM continuation and scale-up in 2017 as well as encourage government to explore opportunities for local production of RUTF.
  3. Consider nutrition as a multi-sectoral issue; develop and adopt multi-sectoral policies and implementable costed plans to address the high rates of malnutrition in Northern Nigeria.
  4. Immediate release of funds for 2016 nutrition budget and put adequate funds in the 2017 states’ budgets to scale up nutrition interventions, giving consideration to adequate fund provision to maximize and leverage donor resources for treatment of severe acute malnourished children, scale up of infant and young child feeding practices and micronutrients deficiency.
  5. Development of legal framework by the State Houses of Assembly to create ownership and institutionalize dedicated nutrition budget lines.
  6. Prompt domestication and effective implementation of the National Policy for Food and Nutrition with functional support system and costed Nutrition Plan of Action by the States to provide guidelines and enhance planning for policy formulation towards maternal and child nutrition intervention and financing.
  7. Encouraging appropriate and exclusive breastfeeding system through individual re-orientation, community participation and ownership, to address childhood malnutrition and combat childhood killer diseases at all levels.
  8. Embracing local capacity in addressing malnutrition through diversification into agricultural sector to boost local remedies, enhanced financial support for Small-Scale farming and Small Scale Enterprises; and appropriate community mobilization, sensitization and awareness.
  9. Mainstreaming well-funded nutrition components in the State Primary Health Care systems to ensure that minimum package of nutrition is institutionalized through policy transformation and service delivery.
  10. Organize and arrange visits to CMAM sites for our respective colleagues (SHOA, Commissioners and Executives) to better understand the severity and complexity of the malnutrition crisis in our states.
  11. Build synergy between the state legislative and executive arms on nutrition interventions

Signed:

  1. Umar Bakari

Special Adviser on Finance and Budget to Adamawa State Governor

  1. Adamu Muhammad Garun Gabas

Permanent Secretary, Jigawa State Ministry of Budget and Economic Planning

  1. Musa Sule Dutse

Member of Jigawa State House of Assembly

  1. Bello Gidado

Special Adviser on Budget and Planning to the Bauchi State Governor

  1. Yahuza Adamu

Permanent Secretary, Bauchi State Planning Commission

  1. Abdullahi Sa’ad Abdulkadir

Deputy Majority Leader, Bauchi State House of Assembly

  1. Rabiu Musa

Member, Katsina State House Committee on Appropriation

  1. Nuhu Musa Tama

Member of Bauchi State House of Assembly

  1. Zayyanu Sayyadi

Secretary, Zamfara House Appropriation Committee

  1. Abubakar Wakili

Director, Gombe State Ministry of Economic and Planning

  1. Idi Barde Gubana

Yobe State Honourable Commissioner for Budget and Planning

  1. Alhaji Mansur Manu Soro

Special Adviser to the Bauchi State Governor on Donors and NGOs,

  1. Salisu U. Maraji

Director Admin & Finance, Kaduna State Ministry of Budget

  1. Ahmed Mohammed

Chairman, Kaduna State House Committee on Appropriation and Implementation

  1. Dr. Isaac Z. Auta

Member of Kaduna State House Committee on Health

  1. Murtala M. Dabo

Special Adviser on Economic to the Kaduna State Governor

  1. Umar Usman Kambaza

Kebbi State Commissioner for Health

  1. Bature G. Usman

Chairman Gombe State House Committee on Health & Human Service

  1. Mohammed M. Katanga

Secretary Jigawa State House Committee on Health

  1. Faruk Namalam

Director, Sokoto State Primary Health Care Development Agency

  1. Kubura Ahmad Bichi

Director of Planning and Research, Kano State Planning Commission

  1. Sule A.U

Member of Bauchi State House Committee on Health

2017 budget: Kano allocates 12.6% to health

COMMUNIQUÉ ISSUED AT THE END OF A ONE-DAY EXECUTIVE AND MEDIA ROUNDTABLE ON MATERNAL HEALTH ORGANIZED BY CIVIL SOCIETY LEGISLATIVE ADVOCACY CENTRE (CISLAC) WITH SUPPORT FROM THE MAC ARTHUR FOUNDATION, HELD AT NASSARAWA GUEST HOUSE, KANO STATE ON 27TH APRIL, 2017.

PREAMBLE:

Civil Society Legislative Advocacy Centre (CISLAC) organized a One-day Executive and Media Roundtable on Maternal Health. The Roundtable aimed at bringing Kano State’s executives, civil society and the media under one roof to brainstorm on necessary action for timely release and effective implementation of maternal and child health budget in the state for efficient intervention and maximum impacts on the citizens. The meeting drew over 20 participants representing Ministries of Health, Planning and Budget, Women Affairs, Civil Society Organizations, and the Media. After exhaustive deliberations on various thematic issues, the following observations and recommendations were made:

Observations:

  1. The State presently records adequate Health Management Information System, which is subjected to periodic review by the instituted Maternal Death Review Committee to ensure qualitative and accurate maternal health data collection and use in policy decision.
  2. In 2017 Appropriation Act, the state has allocated 12.6% (an increase from 9.7% in 2016) of its total budget to the health sector with 180, 000,000 naira dedicated for maternal and child health.
  3. Medical students are through the state’s scholarship engaged on overseas training programmes to bridge the high patients-to-doctor ratio and boost human resources for heath in the state; and established Community Midwifery College in Gwarzo for training of young girls to augment existing skilled birth attendance.
  4. The State Government has created the State Health Contributory Scheme with an established Agency to administer the Scheme, as a palliative measure to address the emerging dwindling revenue resources from Federation Account to the health sector.
  5. The sum of 50 million naira has been provided by the State Government to UNICEF through co-funding arrangement for the procurement of Ready to Use Therapeutic Food (RUTF) to mitigate child death from malnutrition.
  6. Unfriendly attitudes of some health workers remain endemic challenges impeding adequate attendance for health care services at health facilities in the state.
  7. Migration of the state’s trained skilled health workers to other states or international community at the expense of state’s dire needs for adequate and accessible health care services hampers efforts at addressing high patients-to-doctor ratio.
  8. In recent times, the state has witnessed appreciable decrease in maternal death rate.
  9. The State Government has provided tri-cycles; and in collaboration with National Union of Road Transport Workers is addressing referral system to create timely accessibility to health facilities across the state.

Recommendations:

  1. Adequate monitoring and supervision of health care workers in the state to forestall appropriate professional codes of conduct and constructive working relations between patients and health workers.
  2. Embracing other means like social media, drama and film production in the advocacy and dissemination of maternal and child health information to ensure wider circulation and outreach.
  3. Leveraging the State Civil Service code with specific provision for civil servant to serve anywhere in the state in the dissemination of health workers to avert persistent migration of health workers to urban areas at the expense of rural counterparts.
  4. Formidable effort by the media through evidence-based advocacy and investigative journalism in demanding accountability from relevant stakeholder to sustain existing achievements and enhance judicious utilization of maternal health funding in the provision of adequate, accessible and affordable health care services.
  5. Provision of appropriate monitoring system for the procurement and dissemination of commodities with timely release of appropriated fund for maternal and child health interventions.
  6. Ensuring transparency in the utilization of health care funds through appropriate audit; and provision of proper monitoring mechanism to address stock out of essential maternal health commodities.

Signed:

  1. Auwal Ibrahim Musa (Rafsanjani)

Executive Director of CISLAC

  1. Mallam Dahiru Musa

Permenent Secretary, Kano State Ministry of Health

  1. Zuwaira Omar

CHRICED

  1. Semira W. Kuaa

Kano State Ministry of Women Affairs

‘Inter-ministerial collaboration is key to progress in maternal health’—Experts

By Abubakar Jimoh

The Chairman, Katsina State Coalition of Civil Society Organisations, Muhammad Bashir Usman has said inter-ministerial collaboration among the State Ministries of Heath, Information, Education and Women Affairs was paramount to effective and concerted intervention on maternal and child health in the state.

The Chairman made this known during an Executive-Media dialogue organised by Civil Society Legislative Advocacy Centre (CISLAC) aimed at bringing the State’s executives and media under one roof to brainstorm on necessary action for timely release and effective implementation of maternal and child health budget for efficient intervention and maximum impacts on the citizens.

He said: “While successive governments have made several efforts to reduce maternal and child mortality, inter-ministerial partnership and engagement among the health related Ministries, Department and Agencies (MDAs), especially around budget and its implementation is key to efficient healthcare delivery.”

Acknowledging that North West region is faced with serious human resource gaps in the health sector, Usman said Katsina state recorded merely 507 out of 4835 midwifes required to provide maternal health services across the state.

He however, commended the recent policies, frameworks and guidelines initiated by the State Government to improve the situation such as persistent recruitment of additional health care personnel and introduction of health care education across higher institutions, as measures to mitigate high patients-to-doctor ratio in the state.

“The State in recent times has taken drastic step towards mitigating high patient-to-doctor ratio through persistent recruitment of additional health care personnel and introduction of health care education across higher institutions.

“As part of the strategy to create accessible, affordable and improved health care system, especially in the grassroots, Katsina State House of Assembly has taken a step to harmonize the State’s Primary Health Care through a Bill presently receiving legislative inputs,” Usman explained.
According to him, with over 6million population, the state’s maternal mortality rate stands at 634 per 100,000; infant mortality, 22 per 1000; and under-5 mortality, 36 per 1000 live births.

He urged realistic health budget composition through appropriate consultation with communities and relevant stakeholders by the media and civil society groups to promote effective implementation.

Also, Mr. Ibrahim Maiwada representing the State Ministry of Health added that mainstreaming maternal and child health as multi-sectoral issues through prioritized efforts among various Ministries, Departments and Agencies in the state would help in concerted effort to address maternal and child health.

The Snr. Program Officer (Gender and Reproductive Health), CISLAC, Chioma Kanu expressed concerns over impending factors such as information accessibility, lack of fund, capacity gaps and restrictive policies hampering investigative journalism, policy and public awareness on maternal and child health, encouraging full capacity deployment and utilization of Media and Public Relations Department of various Ministries to encourage timely and appropriate information dissemination.

The State Ministry of Budget and Economic Planning, represented by Mr. Muhammad Kabir Barau revealed that in 2017 Appropriation Act, the State Government has allocated 8.97% to the health sector, which is an increase from the previous years.

He observed under-performance in part of the established Budget Monitoring and Tracking Committee as an impeding challenge to budget performance monitoring and evaluation in the state.

“Katsina State has received its share of the World Bank’s “Save 1 million Lives” fund and established implementation Committee with maternal and child as a key priority for intervention,” Barau added.

Health Reform Foundation of Nigeria (HERFON) represented by Dr. Sabiu Laidi explained that evidence-based advocacy by civil society groups in the state would assist them to understand, identify relevant facts and figures to effectively advocate and engage policy and legislative process on maternal and child health.

He further advised the media on well-packaged and persistent maternal health programmes by through persistent and innovative coverage and reportage that captivate policy, legislative and public attention towards maternal and child health.

‘There should be zero tolerance for maternal death’– Perm Sec, KSMoH

By Abubakar Jimoh

“There should be zero tolerance for maternal death in presence of the on-going renewed efforts by the Kano State Government to ensure adequate, accessible and affordable health care services in the state”, the Permanent Secretary Kano State Ministry of Health, Mallam Dahiru Musa has said.

The Permanent Secretary disclosed this during an Executive and Media dialogue on Maternal Health organized by Civil Society Legislative Advocacy Centre (CISLAC) in Kano state to bring the state’s executives and media under one roof to brainstorm on necessary action for timely release and effective implementation of maternal and child health budget in the state for efficient intervention and maximum impacts on the citizens.

He said: “There should be no maternal death. The state has put in place adequate Health Management Information System, which is subjected to periodic review by the instituted Maternal Death Review Committee to ensure qualitative and accurate maternal health data collection and use in policy decision.

“Medical students are through the state’s scholarship engaged on overseas training programmes to bridge the high patients-to-doctor ratio and boost human resources for heath in the state; and established Community Midwifery College in Gwarzo for training of young girls to augment existing skilled birth attendance.

“The State Government has created the State Health Contributory Scheme with an established Agency to administer the Scheme, as a palliative measure to address the emerging dwindling revenue resources from Federation Account to the health sector.”

Musa added that the sum of 50 million naira was recently provided by the State Government to United Nations Children Fund (UNICEF) through co-funding arrangement for the procurement of Ready to Use Therapeutic Food (RUTF) to mitigate child death from malnutrition.

Also speaking during the Dialogue, Mrs. Zuwaira Omar, representing CHRICED, however, debunked unfriendly attitudes of some health workers as endemic challenges impeding timely realisation of adequate attendance for health care services at health facilities in the state.

She said migration of the state’s trained skilled health workers to other states or international community at the expense of state’s dire needs for adequate and accessible health care services had hampered efforts at addressing high patients-to-doctor ratio.

Presenting the issues affecting effective utilization of health budget, Muhammad Inuwa Shu’aib noted that maternal deaths account for 32 percent of all deaths among women between 15 and 49 years.

While commending the State Government’s effort at increasing budgetary allocation to health sector, amounting to 12.6% in current year as against 9.7% in 2016, he revealed that the sum of 180, 000,000 naira has been dedicated for maternal and child health services.

He noted: “In the past, the release was on quarterly basis. Some efforts demonstrated to use findings from Operational Research in 2008 played a vital role to influence decision making, where release was reviewed to monthly basis.

“Although there were some factors—bureaucratic process, poor timing that caused delay in the release of fund up till 2016, delay resulted in more death of pregnant women in the State. Currently, there is consistency in the release of Maternal Health fund particularly in this quarter January-March 2017.”

Shu’aib explained that high maternal and child mortality rates reported for the state could easily be attributed to “the fact that only 13% of deliveries in Kano were attended to by a skilled birth attendant, only 11% of deliveries in the state take place in a health care facility”.

According to him, the state’s Maternal Mortality Rate (MMR) data is 1,025 deaths per 100,000 live births.

He added added: “The free maternal health is provided mostly in designated secondary health facilities far away from majority of the rural settlements. It is not currently seen as a programme that can go beyond the present health facility-based implementation approach.

“The free maternal health is facing severe operational problems including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure and lack of participation of the local governments authorities in the provision of free maternal health.

“There is inadequate community involvement and participation in the planning and implementation process which has resulted to a lack of community ownership of the free maternal health.”

He attributed the challenges facing maternal health in the state to inadequate analyzed data for expected target beneficiaries—pregnant women; inadequate projection of costing per head; over dependence on development/donor partners for support on health related issues; low involvement of community existing structures Civil Society Organisations, Community Based Organisations and media in Maternal Health budget process.

Shu’aib He urged formidable effort by the media through evidence-based advocacy and investigative journalism in demanding accountability from relevant stakeholder to sustain existing achievements and enhance judicious utilization of maternal health funding in the provision of adequate, accessible and affordable health care services; and provision of appropriate monitoring system for the procurement and dissemination of commodities with timely release of appropriated fund for maternal and child health interventions.

The dialogue drew over 20 participants representing Ministries of Health, Planning and Budget, Women Affairs, Civil Society Organizations, and the Media.