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Nigeria’s Near Miss With Poliomyelitis – What Is the Elephant In the Room?, By Muhammad Ali Pate

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The resurgence of polio is very much also a symptom of a neglected health system. That is the elephant IN THE ROOM. A stronger, more resilient national health system may have been able to withstand or adapt to the instability in the North-East.

There is no doubt that the poor security situation in the North-East, driven by the brutal North-East insurgency is a driver of the tragic resurgence of polio in Nigeria. For years the insurgents have destroyed healthcare infrastructure and targeted health workers, hindering the immunisation against preventable disease of two million children in the North-East and now Nigeria has had three confirmed polio cases. In August, a four year-old girl named Aisha from Jere district in Borno State became the first victim.

This was crushing news for the thousands of dedicated men and women who have been at the frontlines of the multibillion-dollar effort to eradicate polio from the world. It has also forced Nigeria to speed up its massive and costly polio eradication effort, just one year after it was removed from list of polio endemic countries by the World Health Organisation (WHO). After two years of being polio-free Nigeria is likely to be seen as a polio endemic country once again.

But while the NorthEast insurgency and attendant humanitarian crises are a major contributor to the resurgence of polio virus, this must not be used as a scapegoat for our weak public health system. The resurgence of polio is very much also a symptom of a neglected health system. That is the elephant in the room. A stronger, more resilient national health system may have been able to withstand or adapt to the instability in the North-East.

For years, Nigeria’s health system has suffered from inconsistent and insufficient funding, particularly at the states and Local government levels. It often takes internationally recognised emergency situations, like Ebola or the resurgence of polio, to make the governments spring into action.

As planning for the 2017 budget takes hold, both our federal executive and legislature can change this, and boldly move health up the ladder of national government priorities that cannot wait any longer. This is because there are numerous health emergencies festering outside the global spotlight that the government must also treat with the same level of urgency.

In 2015 alone, 58,000 estimated Nigerian mothers may have died from pregnancy – or childbirth-related causes – more than any other country on the planet. In the same year, more than 41,000 children became infected with HIV – more than any other country. Millions of Nigerian children under five years of age remain vulnerable to disease and are dying from preventable cause because of gaps in routine immunisation. Almost four out of 10 of these children are stunted due to malnutrition, affecting their cognitive as well as physical abilities, detracting from Nigeria’s pool of human capital into the future.

On average, a Nigerian is only expected to live to be 54 years – among the worst life expectancy in the world.

Providing one percent of the Consolidated Revenue Fund for health in the 2017 budget would be an overt commitment from the Federal Government to improve the health of Nigerian people. Drawing from the polio resurgence, it would also require other tiers of government, at the state and local levels, to provide funding and demonstrate a similar commitment.

We know that high-level political will and funding can successfully turn around this situation and improve health outcomes. After all, the right to life through good health should be one of the most basic human rights.

We saw in 2014 how, by mobilising national political will, Nigeria sucessfully thwarted the Ebola epidemic because the government acted quickly and decisively – approving a special intervention plan and releasing funding.

Even the fight against polio proves this point: In 2012, Nigeria was home to half of all confirmed polio cases globally. And as the world watched expectantly, Nigeria made huge strides in eradication efforts, thanks largely to firm commitments from the highest level of government and the sustained support of international partners. The Nigerian Presidential Task Force on polio, which made sure that the attendant level of political will was translated into action on the ground, was no doubt a major reason why Nigeria was declared free of the polio virus for two years.

But for health security to be maintained, political will and funding must also be maintained.

The removal of Nigeria from the WHO polio endemic list in 2014 may have made the country more complacent. The Nigerian Presidential Task Force on Polio failed to meet for nearly a year before the current outbreak. Political commitments at the state and local levels started to waiver, with late releases of counterpart funding for the implementation of planned activities for the eradication effort.

With the resurgence of polio in the North-East, the government has renewed efforts, launching a massive response to revive vaccination efforts in the four states in the North-East and neighbouring countries which are most affected by insurgency to regain lost ground. These efforts aim to reach over four million children and will cost upwards of US $116 million. These efforts will likely stop the polio outbreak once more, but leave open the question of other important health priorities.

The ebb and flow of prioritisation and funding for health must stop. We must not and cannot wait for emergency moments to demonstrate a national commitment to health.

Inadequate funding of primary healthcare is among the banes of the Nigerian health system. The Nigeria National Health Act was designed to ameliorate this problem by mandating a minimum one percent of the national Consolidated Revenue of the Federation (CRF) be allocated toward the health sector every year. This funding would provide a basic minimum package of health services to all citizens in Primary Health Care facilities, as well as essential drugs. But the government is yet to provide the required funding to implement the Act since it became law in 2014.

We will only get the health system we want if we put money where it matters – toward vaccines, medicines and health systems that will keep mothers and children healthy; toward efforts to prevent and treat polio as well as other diseases like HIV, tuberculosis, and malaria…

If the government had acted last year, 38 billion naira could have been directed to primary healthcare for those most in need. Nigeria would have been further along in its quest for universal health coverage through a strengthened primary healthcare system.

As we regroup for another push to eradicate the polio virus from our country, we must be clear that the health system must be strengthened to create more resilience and buffers to other diseases.

The implementation of the National Health Act is the gateway needed to catalyse that process. Once the Act is implemented, then national health institutions must use the additional resources efficiently to give Nigerians more health for the money spent. Dealing with inefficiencies in public health expenditure management and addressing systemic loopholes for corruption would enhance the bang Nigerians will get for the funds allocated.

Providing one percent of the Consolidated Revenue Fund for health in the 2017 budget would be an overt commitment from the Federal Government to improve the health of Nigerian people. Drawing from the polio resurgence, it would also require other tiers of government, at the state and local levels, to provide funding and demonstrate a similar commitment. And it would help ensure that this funding is spent more efficiently, getting us better health for every naira spent.

We will only get the health system we want if we put money where it matters – toward vaccines, medicines and health systems that will keep mothers and children healthy; toward efforts to prevent and treat polio as well as other diseases like HIV, tuberculosis, and malaria; and toward investing in health care workers that will ensure every Nigerian has the care they need when they need it most.

After security, health is the most important elements for determining the effectiveness of government and building the trust of the people. Without guaranteed access to basic, life-saving healthcare, government will continue to struggle in asserting its output legitimacy, as well as earning the fundamental trust of the people that it is working in their best interests. Implementing the National Health Act will be a good step forward. It will signal the coming to reality of the change that Nigerians yearned.

Muhammad Ali Pate, a former Nigerian minister of state for Health between 2011 and 2013, is currently a Menschel Senior Leadership Fellow at the Harvard Chan School of Public Health and CEO of Big Win Philanthropy.

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