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.

Emir Sanusi: When enough is enough

By Abubakar Jimoh

In recent times, one would have critically observed the persistent but unfair criticisms level by some Nigerians against the Emir of Kano State, HRH Alhaji Sanusi Muhammad Sanusi II for his constructive positions on pervasive socio-economic challenges permeating the Northern region or ill-advised government policies as they affect the nation at large.

We ought to appreciate the gallant and dogged Emir for standing firmly and articulating the mind-blowing but true positions about our stagnant socio-economic and political conditions for possible adjustments, even at the detriment of his throne. Such indeed, is a gift we should embrace and uphold.

Many have engaged written and other available means to advise him to shun public commentary and support every government’s decision or policy, not minding the dreadful consequences or probably to sail our already self-inflicted depressed economy towards a total recession.

The on-going verbal and written attacks against the Emir would however, not be a surprise as Yoruba adage puts its “Olooto kii ni eni” (i.e. the truthful one has nobody). Pardon me for the innate interpretation.

Some Nigerians are well known to hold strongly critics against any matter of public or policy concern without giving iota of proper and constructive digestion to the communal benefits of issue, as far as such is hitting on them. They make mockery of or conflagrate challenges facing one region in appreciation of their rosy ones.

Meanwhile, had the Emir been promoting obsolete or unrealistic socio-cultural practices backpedalling Northern development or commending every policy mistakes, the story would have of course won him encomium from every level of political sphere. Such is a society, where respect and dignity for traditional advice by the contemporary politicians are fast declining.

The lost respect and dignity would only be reverted in presence of some fundamental questions which often arise as: Who is the closest to the people? Who speak for the majority voiceless or poor?

We must on this note be mindful of some Northern leaders who, after the death of over 330 Northerners from Meningitis outbreaks, see themselves as angels, but poor citizens as sinners whose socio-economic problems can only be resolved by divine intervention, not good governance.

It is worrisome that our country has degenerated to a level where our socio-economic problems are not more of governance issues, but the wraths of God against the poor citizens.

We must remember that prior to ascending the throne, Sanusi was well known for his doggedness in articulating factual position on matters of public concern, even when such would cost his seat as then Governor of the Centre Bank of Nigeria.

Having observed the emergent socio-economic issues and archaic cultural practices as major impediments to the Northern region’s development and citizens’ well-beings, he comes openly and proffers holistic recommendations, instead of impressing political egos.

Giving the existing socio-economic problems backed by intrinsic cultural practices in the North, can we sincerely say Emir Sanusi is merely trying to impress the public? For instance, while adequate, accessible and affordable maternal and child is key to the development, survival and growth of every society, in various engagements by Civil Society Legislative Advocacy Centre (CISLAC) across North revealed that the region is faced high level maternal and child mortality arising from inadequate budgetary allocation, overstretched, inaccessible and dilapidated Primary Health Care system.

Similarly, childhood under-nutrition remains very high in the region 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.

Relevant studies across the Northern States have exposed mothers personally consuming or selling Ready to Use Therapeutic Food (RUTF) meant for the treatment of their severely acute malnourished children. The situation which is intensified by existing rising poverty level hampers both local and international efforts at addressing childhood malnutrition and mortality in the region.

Apart from the above, adequate budgetary allocation to the social sector in the region is impeded by the on-going widespread dwindling revenue allocation from Federation Account to the states and low State Internally Generated Revenue.

It is in presence of decreasing resources and the growing financial incapacitation of many families that Emir Sanusi advises each family to be realistic in marrying number of wives or bearing children it can best carter for.

No fewer than 3 million out of school children, roaming the streets of Kano state, as Almajirai – pupils of Quranic schools are converted to beggars. The resultant socio-economic challenges of the situation was recently confirmed and seriously bemoaned by the State Governor, Abdullahi Ganduje during the Kaduna State Economic and Investment Summit, where he stressed that the “Almajiri syndrome is one of the serious problems worrying the North-west geopolitical zone”.

This precarious backdrop prompts the Emir Sanusi’s tenacious public opinion calling for an end to the region’s obsolete socio-cultural and identification of the regional economic advantages for the region’s socio-economic prosperity.

Finally, while I commend the Emir’s giant stride, being the father of the a state and representative of the voiceless, he should as a matter of urgency consider reducing the Emirate’s expenditure to barest minimum to avert wrong signal or sensationalised public opinion.

2016: ‘Over 74, 000 children enrolled into Community Management of Acute Malnutrition programme in Jigawa’

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 MACARTHUR FOUNDATION, HELD AT ROYAL HOTEL, DUTSE JIGAWA STATE ON 6TH 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 Jigawa 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 State Primary Health Care Development Agency, Ministries of Budget and Economic Planning, Health, Education and Women Affairs, Civil Society Organizations, and the Media. After exhaustive deliberations on various thematic issues, the following observations and recommendations were made:

Observations:

  1. Jigawa State has allocated 13% (out of 15% Abuja Declaration) of its total budget to health sector in the 2017 Appropriation Act.
  2. The State Government recently engaged the services of 450 Primary Health Care workers of different cadres to be posted across Primary Health Care Centres in the state to improve accessibility to health care services.
  3. Out of 685 health facilities in the state, only 24 (12 General Hospitals and 12 PHCs) render free maternal and child health services to 878,581 under-5 and 1,020,407 women of reproductive age.

  4. The State Primary Health Care Development Agency is presently awaiting 15% allocation from the 1% Consolidated Revenue Fund for the provision and maintenance of Primary Health Care facilities, as enshrined under Section 11 (3)(c) of the National Health Act 2014.
  5. The State has received its share of $1.5million from the World Bank “Save 1Million Lives” program to address six different health indicators, of which maternal and child health is a key priority.
  6. High commercial value leverage on programmes, coverage and activities, especially by public media impedes efforts by other relevant stakeholders at raising policy and public awareness on maternal and child health in the state.
  7. Jigawa state records high level severe acute malnourished children with no fewer than 74, 000 children enrolled into the state’s Community Management of Acute Malnutrition (CMAM) programme in 2016.

Recommendations:

  1. Upholding high level corporate social responsibility by the media with prioritized attention to revitalize maternal and child health care service provision and accessibility in the state through dedicated programmes, coverage and activities.
  2. Proactive and joint advocacy by Civil Society groups for sustainable maternal health care services, giving congnisance of the existing unfavourable maternal and child health indices, to galvanise legislative and executive supports for the introduction and passage of Free MNCH.
  3. Increased collaboration among various Ministries, Departments and Agencies to define the workability for operationalisation of the state’s health care programmes and policies.
  4. Effective management and utilization of existing fund provision to the health sector to maximize maternal and child health care service delivery.
  5. Adequate supervision of health care facilities by relevant authorities to restore proper code of conducts among health workers to encourage attendance for maternal health service in the facilities.
  6. Establishing e-platform mechanism for feedback to support monitoring and evaluation system for possible improvement in maternal and child health service provision and delivery.

  7. Synergy among Ministries of Health, Education and Women Affairs for guiding and counseling of the girl child education.

Call to immediate action:

  • Project to increase accessibility to family planning contraceptives from 1% to 5%
  • Have functional Basic Health Centre in every Ward to attain Universal Health Coverage
  • Upgrade Primary Health Care facilities to Ward level
  • Provision of vehicle to improve accessibility to maternal health services
  • Increase weekly radio programmes from 1 to 4 to amplify issues on maternal and child health
  • Mainstream maternal health issues into the existing radio programme on youth

Signed:

  1. Auwal Ibrahim Musa (Rafsanjani)

Executive Director, CISLAC

  1. Adamu Muhammad Garun Gabas

Permanent Secretary, Jigawa State Ministry of Budget and Economic Planning

Nigeria: North West region is faced with serious human resource gaps in the health sector

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 MAKERA HOTEL, KATSINA STATE ON 12TH 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 Katsina 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 about 15 participants representing Ministries of Health, Budget and Economic Planning, Education and Women Affairs, Civil Society Organizations, and the Media. After exhaustive deliberations on various thematic issues, the following observations and recommendations were made:

Observations:

  1. While adequate, accessible and affordable maternal and child is key to the development, survival and growth of every society, North West region is faced with serious human resource gaps in the health sector with merely 507 out of required 4835 midwifes in Katsina state.
  2. Inter-ministerial collaboration among the State Ministries of Heath, Information, Education and Women Affairs remains paramount to effective and concerted intervention on maternal and child health in Katsina state.
  3. Impending factors such as information accessibility, lack of fund, capacity gaps and restrictive policies hamper investigative journalism, policy and public awareness on maternal and child health.
  4. In 2017 Appropriation Act, Katsina State Government has allocated 8.97% (out of 15% Abuja Declaration) to the health sector, which is an increase from the previous years.
  5. Under-performance in part of the established Budget Monitoring and Tracking Committee in the State is an impeding challenge to budget performance monitoring and evaluation.
  6. Inadequate supervision of health sector, capacity gaps among health workers, lopsidedness in human resource deployment paves ways for over-concentration of health care workers in the urban areas at the expense of rural counterparts hence, impeding accessibility to maternal and child health services.
  7. 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.

Recommendations:

  1. Mainstreaming maternal and child health as multi-sectoral issues through prioritized efforts among various Ministries in galvanizing advocacy for maternal and child health.
  2. Proactive media with appreciable curiosity through prioritized resource utilization to engage investigative journalism, and raise policy and public awareness on maternal health budget allocation, release and implementation.
  3. Capacity building for health reporters on investigative journalism on maternal and child health issues through training and retraining programmes; and leveraging International Days to amplify policy and public awareness on maternal and child health.
  4. Enhanced legislative advocacy on the domestication of National Health Act 2014 and translation of existing health policies into legislation to promote sustainable intervention on maternal and child health.
  5. Addressing human resource gaps through adequate funding and supervision, engagement of sufficient and qualified health workers with appropriate incentives to bridge human resource gaps, especially in the rural areas.
  6. Evidence-based advocacy by civil society groups in the state to understand, identify relevant facts and figures to effectively advocate and engage policy and legislative process on maternal and child health.
  7. Well-packaged and persistent maternal health programmes by the media through persistent and innovative coverage and reportage that captivate policy, legislative and public attention towards maternal and child health.
  8. Full capacity deployment and utilization of Media and Public Relations Department of various Ministries to encourage timely and appropriate information dissemination.
  9. Realistic health budget composition through appropriate consultation with communities and relevant stakeholders by the media and civil society groups to promote effective implementation.

Action points:

  • Enlightenment advocacy to the traditional and religious leaders on maternal and child health issues by the media and civil society groups.
  • Utilize Bill Board to galvanize issues on maternal and child health.
  • Issue based approach to maternal and child health by the media.
  • Incorporate State Ministry of Information and National Orientation Agency to catalyze public awareness on maternal health.
  • Increase allocation to health sector.
  • Appropriate documentation of coverage and reportage to ease data accessibility and utilization.

Signed:

  1. Auwal Ibrahim Musa (Rafsanjani)

Executive Director, CISLAC

  1. Ibrahim Maiwada

Katsina State Ministry of Health

  1. Muhammad Kabir Barau

Katsina Ministry of Budget and Economic Planning

  1. Hajara B. Kankara

Katsina State Ministry of Education

  1. Ibrahim Sogiyi

State Primary Health care Development Agency

  1. Abdulaziz Imam Suleiman

Katsina State Ministry of Women Affairs

  1. Sabiu Laidi

Health Reform Foundation of Nigeria (HERFON)

  1. Buhari Ahmed Badi

Katsina State Radio

Legislative Oversight and Primary Health Care Financing

By Abubakar Jimoh

While adequate, accessible and affordable health care system is paramount to the survival of the citizens, Nigerian health care system is one of the worsts hit by inadequate budgetary allocation, delayed release, lack of judicious utilisation of the existing funds, and poor monitoring that discourage transparency and accountability at all levels. The Primary Health Care component bears the major challenges confronting adequate health care delivery in the country. Efforts to ensuring adequate and timely delivery of qualitative health care services at all levels led to the promulgation of the National Health Act in 2014.

The National Health Act 2014 is a comprehensive legal document containing several pro-poor provisions for primary health care which if effectively implemented, will resuscitate the dwindling health care resources, facilities and services at all levels, especially giving the 1% Consolidated Revenue Fund (CRF) from national budget. Appropriate legislative oversight has therefore, becomes imperative to ensure effective implementation of the pro-poor Act.

It is on this premise that House of Representatives’ Committees on Health and Appropriation in collaboration with Civil Society Legislative Advocacy Centre (CISLAC) organised a two-day retreat in Accra, Ghana, to provide a platform for the Committees to discuss and review current challenges and opportunities in financing Primary Health Care in Nigeria.

Significance of Primary Health Care

In his opening remarks, the Chairman House Committee on Appropriation, Hon. Mustapha Bala Dawaki coined the importance of Primary Healthcare when he said, “the importance of Healthcare Delivery Services most especially in the rural areas where majority of our citizens’ lives cannot be over emphasized, most especially in developing societies like Nigeria.”

The Chairman continues: “Primary Health Care centres which should be in every cranny of our society are today absent due to poor funding of the exercise since after its creation. This has accounted for the failing Health Services and the resurgence of diseases that have long been eradicated in many countries like the resurgence of Polio…”

Lack of political will in the implementation

Also, the Chairman House Committee on Health Services, Hon Chike John Okafor did not conceal the fact that Primary Health Care without doubt remains the most acceptable approach for attaining universal health coverage in a health system. “Therefore, when this approach is adequately financed and implemented, it will not only have the capacity of reducing ill-health and increase affordability of quality healthcare but will ultimately, better productivity and economic status of our country.

“The critical elements Primary Health Care deserve adequate financing and pull od resources for planning, development and implementation. This is mostly relied on strong political will of governments which prioritises the health sector in budget appropriations,” he said.

The Chairman observed lack of political will of governments, resulting in the dearth of funding of the Primary Health Care and continuous dilapidating services and delivery especially in the areas of maternal and new-born, immunisation and malnutrition.

He added: “Nigerian Government has been signatories to several conventions and declarations in the past and made progress towards achieving the commitments made in those signatories. One of the most significant declarations is the Abuja Declaration of 2001, where African Union Heads of States met and pledged 15% of National Budget allocation to the health sector. However, despite being ranked the largest economy in Africa and having overall increase in the allocation of budget to health over the years, Nigeria health budget still hover around 5 to 6 percent of the total annual budget.

“Consequently, Nigeria is yet to fulfil its commitment to the 15% Abuja Declaration. It is worthy to note that there other African Countries with much less resources who have met and even surpass the pledge made at the declaration, with evidence of better health and economic outcomes. Some of these countries are Rwanda with an 18% of its national budget to the health sector, Botswana and Niger with a 17.8%, Malawi with 17.1%, Zambia (16.4%) and Burkina Faso (15.8%).

“This shows that reaching the Abuja Declaration is a realistic goal and the most important approach to achieving this goal is to encourage a strong political will from the Federal Government and continue to push for the provision of the 1% of the Consolidated Revenue Fund (CRF). From projections by experts, the 1% CRF will amount to billions of Naira from the Federal Government alone.”

In order to address the lingering financial challenges in the health sector, Hon. Okafor recommended among other things: step-up campaign for private donations; encouraged inter-sectoral collaboration between health sector and other sectors to channel alternative resources to health; encouraged public-private partnership; and improved value for money in health spending.

Adopting ICT in the health care management

The Chairman House Committee on Health Institutions, Hon. Betty Apiafi, called for the amendment of the National Health Act to ensure flexibility in the implementation through participatory and inclusive process. She recommended the adoption of ICT-based approach in the Nigeria health care system management and delivery to attain cost-saving, adequate, accessible and appropriate health service delivery at all levels.

A country with poor health indices in Sub-Saharan Africa

The Honourable Minister of Health, Prof. Isaac Folorunso Adewole represented by … reiterated that Nigeria as a unique country in Africa deserves world class health system that provides good quality health care to improve health outcomes, reduce inequity in health access and outcomes.

He bemoaned the poor health indices attributed to Nigeria in Sub-Saharan Africa such as Maternal Mortality and Infant Mortality totalling 576 per 100,000 and 69 per 1,000 respectively comparing to those of other countries like Ghana, 319 and 43; Ethiopia, 353 and 41; Kenya, 510 and 36; and South Africa, 138 and 34.

These poor outcomes according to the Minister are largely driven by low coverage rates of key basic health services, adding that limited access to basic health services by lower quartile contributes to mortality rates.

Prof. Adewole identified as part of the impediments to effective performance of health care system in Nigeria: overlapping responsibilities across the different levels of government with each tier of government intervening transversely in primary, secondary and tertiary care; lack of inter-governmental accountability to enhance health systems performance; fragmentation of accountability systems; limited capacity to drive and execute policy ; poor budget process and planning; lack of demand for data and weak performance management systems; focus on inputs rather than results and outcomes; lack of pooled payment systems to support risk equalization and cross subsidisation; and high Out-of-Pocket expenditure, which increases citizens exposure to financial catastrophe.

Dreadful impacts of the inadequate financing

The Executive Director of CISLAC, Auwal Ibrahim Musa (Rafsanjani) noted that the retreat was timely as the nation moves towards another fiscal year, where critical inputs are expected into the nation’s budgetary process, especially by the executive and legislative arms of the government.

He said: “Health remains a major challenge in the development of Nigerian’s economy. This fact is buttressed by the study conducted by Civil Society Legislative Advocacy Centre (CISLAC) in 2013. The study shows that in Nigeria, one in 13 women dies during pregnancy or childbirth, and 12% of children die before reaching the age of five. The study observed that every 10 minutes one woman dies from conditions associated with childbirth.

“According to the study, only 39% births take place with assistance of medically trained personnel, coupled with the scarcity of skilled attendants, absence of personnel, among other factors impeding the effectiveness of health services in the country. In a situation where by nearly half of the population loses only plunges the economy and impedes development as every one person counts in any country’s development.

“Similarly, while it is confirmed that Child Spacing has direct impact on the health of the family and grossly the economy of a nation as a whole with tendency to mitigate maternal and child deaths in the country, yet, budgetary allocation to Child Spacing in the context of Nigeria Family Planning Blueprint and the Costed Implementation Plans is an endemic challenge at all levels.

The Executive Director bemoaned the announcement by the World Health Organisation (WHO) declaring Nigeria free in 2015 from the long-time dreadful polio epidemic which was recently reversed as two different cases of wild polio virus reportedly resurfaced in Borno state in the absence of adequate financing and timely release of fund by the government to sustain gains of halting polio in the country.

Existing legal and financial provisions

The CISLAC’s boss recalled that the National Health Act 2014, a comprehensive legal document, which implementation was supposed to have commenced since 2015 is yet to see the light of day even in the 2016 Appropriation Act. “Though financing health care system remains a major challenge across the world, but Nigeria is yet to demonstrate the ability to face this challenge so that the health system can benefit citizens at all levels”.

It is against this backdrop that the Health Minister noted that the National Health Act came to limelight as part of the efforts to address specific challenges confronting adequate health care delivery such as responsibility for health and eligibility for health services and establishment of National Health System; health establishments and Technologies; rights and obligations of users and health care personnel; National Health Research and Information System; Human Resources for Health; Control of use of blood, blood products, tissue and gametes in humans; and regulations and miscellaneous provisions

The Act according to him increases the fiscal space for health through the Basic Health Care Provision Fund, as established under Section 11 of the National Health Act will increase  the  fiscal  space  and  overall   financing  to  the  health  sector  to  assist  Nigeria achieve Universal Health Coverage (UHC); and enhance the principal  funding  vehicle   for  the  Basic  Minimum  Package  of  Health  Services   (BMPHS).

Deliberating on Provision Plan for Financing Basic Health Care, the Director-General, Budget Office of the Federation, Mr. Ben Akabueze noted that the overarching health sector goal for Nigeria, as for most nations, is Universal Health Coverage (UHC), which is achievable through provision of an estimated $86 per person in providing basic health services.

In his analysis, though the recommended public expenditure on health is 5% of a nation’s Gross Domestic Product (GDP), but Nigeria currently spends only about 1% of GDP. “Consequently, the burden of paying for healthcare in Nigeria is disproportionately borne by households, most of which have no health insurance.”

On the present economic downturn, which reduces ability of Nigerian households to fund out-of-pocket healthcare expenses, and hence generally excludes the poorest and most vulnerable from access to healthcare, the Director-General noted the importance of National Health Act (2014). The Act provides for the creation of the Basic Health Care Provision Fund (BHCPF) as part of efforts to improve public funding of healthcare. The Fund was established to finance various health programs, and specifically to improve access to quality Primary Health Care (PHC) across the country.

He explained that 50% of the fund will be transferred to the National Health Insurance Scheme (NHIS) to cover basic health care services; 45% will be disbursed to the National Primary Health Care Development Agency (NPHCDA) for essential drugs/vaccines/consumables, maintaining PHC facilities, equipment, transportation, and strengthening human resource capacity at primary healthcare facilities around the country; and final 5% will be used by the Federal Ministry of Health (FMOH) to respond to health emergencies and epidemics.

As stipulates by Section 11 of the National Health Act, the Fund will be largely sourced from a “Federal Government Annual Grant of not less than one percent of its Consolidated Revenue Fund.”

Based on the draft Medium Term Expenditure Framework and Fiscal Strategy Paper (MTEF&FSP) 2017-2019, the Budget Office’s boss mentioned that 1% of CRF translates to an average of N35bn per annum over the next 3 years, stating that additional sources of funding the BHCPF include grants by Development Partners and funds generated from innovative sources such as taxes on cigarettes and alcohol.

He is however bothered by implementation challenges such as the judicious utilisation of the funds to achieve the desired objectives; ability of the states to provide counterpart funds; widely differing map of status of primary healthcare across the states; ability of the most vulnerable to subscribe to the 0.5% National Health Insurance Scheme of Consolidated Revenue Fund; the existing administrative structure of fund between the State and Local Governments.

Declining budgetary allocation to health sector

Recalling the poor allocation to health sector in the 2016 national budget, the Executive Director, Budgit Nigeria, Mr. Seun Onigbinde lamented that health    as a critical sector received as low as N257bn (4.13%) when infrastructure, defence, education, police was allocated N467bn (7.7%), N429bn (7.07%), N406bn           (6.7%), and N300bn (4.95%).

Comparing data from various health allocations since 2013, he observed that the health budget peaked in 2013 at N280bn but despite the rise in  the budget size, health budget has declined from N257bn.

“Health allocation as share of National Budget has been declining and huge dip in 2016 (4.13%) from 5.78% in 2015. It is baffling to note that recurrent expenditure accounts for 88-95% of the budget since 2011. Federal Government has been spending so little on capital components of health budgets.

“Federal Government’s actually budgets N1, 438 annually for health per Nigerian.  With over 100m Nigerian without health insurance, the country grapples with weak infrastructure mostly at the primary health level.

“While the budget grew by 36% in 2016, health budget declined by 0.7%; 84% of the budget is still meant for personnel costs and    too little less than 14% spent  on capital expenditure. The Ministry of Health has 128 units            but 60% of the health  CAPITAL budget is allocated to the Federal Ministry of Health and National Primary Health Care Development Agency (NPHCDA),”the Budgit’s boss complained.

Understanding citizens’ rights to demand accountability  

In a paper titled “National Health Act & Provisions: How it will impact the Health Sector”, Dr. Muhammad Muhammad Saleh, a Technical Consultant on Health noted that the National Health Act is one single instrument required to unlock economy and the greatest transformation for the health sector in Nigeria.

He stated that the Act has established the Nigerian National Health System specifying all the key players and actors therein and their roles and responsibilities.

“An aggrieved person may lay a complaint about the manner in which he or she was treated at a health establishment and have the complaint investigated. Public officers are barred from medical checkup, investigation or treatment abroad at public expense, except in exceptional cases approved by a medical board and Minister or Commissioner of Health.

“The manipulation of genetic material (“cloning”) and the import/export of embryos are prohibited. Post mortems and autopsies can only be authorized by the following; spouse, child, parent, guardian, brother or sister – in that order,” the Consultant explained.

Dr. Saleh observed the Act as a very important development to change the status quo to guarantee the Right to Health for all citizens.

“Health services are classified as essential services and the Minister of Health is required to apply all reasonable measures to ensure return to normalcy after disruption within 14 days (i.e. Strikes). You can hold government accountable on their responsibilities to provide you with good health care service(s). All organizations, people and actions whose primary intent is to promote, restore and maintain health in Nigeria,” he noted.

Appropriate HIS to aid citizens’ decision

Similarly, Dr Jibril Muhammad Bashar, a Consultant at Health Policy and System Development recounted the prominence of the National Health Act when he added: “a comprehensive Health System that is promotive, protective, preventive, restorative and rehabilitative. Health System Based on Primary Healthcare reflecting the economic conditions, socio-cultural and political characteristics of the communities, addressing the main problems in the communities.”

Dr. Bashar An Integrated and Co-ordinated National Health Care System that is multi-sectoral, with community involvement, and collaboration with non-governmental organisations. He observed as key to effective health system management: planning, organisation, directing, staffing, coordinating, and budgeting.

In order to attain the national goal of achieving health for all Nigerians, he recommended appropriate Health Information System, which includes the availability of accurate, timely, reliable and relevant health information to inform public health action.

He added: “The planning, monitoring and evaluation of health services are hampered by the dearth of reliable data at all levels. A national health information system has been established, effort however, should be made to ensure data collected are accurate and timely and ownership should be institutionalised by Nigerian government. Efforts should be made to implement community based systems for the collection of vital health statistics of births and deaths.”