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2017: Same old story in healthcare



2017: Same old story in healthcare

      …as National Health Act, UHC remain in limbo

The health sector in 2017 was characterised by undue delays and hiccups in terms of policy formulation and implementations, resulting in only motion without concrete achievements, reports APPOLONIA ADEYEMI


As Nigerians prepare to bid farewell to 2017, key stakeholders in the health sector are concerned over the non-implantation of the National Health Act (NHA), which was passed into law in 2014. Seen largely as an instrument that could boost health care funding while easing the current burdensome out-of-pocket pocket payment by patients, how to make it operational has been a major concern in 2017.

Although, the emergence and re-emergence of infectious diseases in the country had begun in 2016, the outbreak of Monkeypox remains the most dreadful, in terms of the impact of the disease of the pox family in the psyche of human beings .

Till date Nigeria aligns with the global community in finding lasting solution to the health challenge posed by Monkeypox. It’s known that death rate from the condition is near zero; the emergence of the medical condition is a sore point for the country’s disease surveillance system. This trend emerged in spite of expert projections in the past two years that infectious diseases of old could re-emerge.
Monkeypox is an infectious disease caused by the monkeypox virus. Symptoms begin with fever, headache, muscle pains, swollen lymph nodes, and feeling tired. This is then followed by a rash that forms blisters and crusts over.

Monkeypox is not the only disease that plagued Nigerians this year, many citizens similarly came down with Lassa fever, the most dreadful medical condition in the country presently on account of the high death rate arising from it. This is the disease that even medical doctors and other health workers dread most because of its highly contagious nature. Several health workers in the course of duty have been infected and died.

However, the Federal Ministry of Health (FMOH), the Nigerian Centre for Disease Control (NCDC) in partnership with international partners have increased surveillance to track both the old and new emerging diseases.
The FMOH and NCDC have however been providing free treatment for Nigerians that came down with these diseases including dengue fever, the outbreak of which did not reach epidemic level throughout the year. These are not the only diseases that troubled Nigerians in 2017.

Malaria fight is another area where Nigeria recorded poor performance. The latest World Malaria Report 2017, issued by the World Health Organisation (WHO) in November, shows that after an unprecedented global success in malaria control, progress has stalled.

Going by details of the report, there were an estimated five million more malaria cases in 2016 than in 2015 and malaria deaths stood at around 445 000, a similar number to the previous year.
The Director-General of the World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus said, “In recent years, we have made major gains in the fight against malaria. We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond.”

Based on WHO’s Global Technical Strategy for Malaria which had called for reductions of at least 40 per cent in malaria case incidence and mortality rates by the year 2020, the WHO’s latest malaria report is an indication that the world community is not on track to reach these critical milestones.

However, at the centre of the problem is insufficient funding at both domestic and international levels, resulting in major gaps in coverage of insecticide-treated nets, medicines, and other life-saving tools.
An estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016. That is well below the US $6.5 billion annual investment required by 2020 to meet the 2030 targets of the WHO global malaria strategy.

In 2016, governments of endemic countries including Nigeria provided US$ 800 million, representing 31 per cent of total funding. The United States of America was the largest international funder of malaria control programmes in 2016, providing US$1 billion (38 per cent of all malaria funding), followed by other major donors, including the United Kingdom (UK) of Great Britain and Northern Ireland, France, Germany and Japan.
The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries, up from 211 million cases in 2015. The estimated global tally of malaria deaths reached 445 000 in 2016 compared to 446 000 the previous year.

The WHO estimates that the African Region continues to bear an estimated 90 per cent of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80 per cent of the global malaria burden.

“Clearly, if we are to get the global malaria response back on track, supporting the most heavily affected countries in the African Region including Nigeria must be the primary focus,” said Dr. Tedros.
According to the report, the African Region has seen a major increase in diagnostic testing in the public health sector: from 36 per cent of suspected cases in 2010 to 87 per cent in 2016. A majority of patients (70 per cent) who sought treatment for malaria in the public health sector received artemisinin-based combination therapies (ACTs) – the most effective antimalarial medicines.

However, in many areas, access to the public health system remains low. National-level surveys in the African region show that only about one third (34 per cent) of children with a fever are taken to a medical provider in the public health sector.

National Health Insurance Scheme (NHIS)
Similarly, another key aspect that could have facilitated wider access to care is the expansion of the National Health Insurance Scheme (NHIS). From the inception of the scheme 12 years ago, only about five per cent of the nation’s population was captured as enrollees, which has presently reduced to about three per cent following the exit of some that have outgrown the scheme. Instead of expanding the scheme to include more Nigerians, 2017 witnessed allegations of large scale fraud involving key operators of the NHIS all of which openly traded blames of fund misappropriation.

Among those named for alleged misappropriation are Prof. Usman Yusuf., the now suspended executive secretary of the NHIS, members of the Health and Managed Care Association of Nigeria (HMCAN), an umbrella body of Health Management Organisations (HMOs), lincensed operators of the NHIS. Yusuf, was appointed by President Muhammadu Buhari as the Executive Director of the NHIS.

In the heat of the allegations which drew numerous petitions against Yusuf, he was alleged to have misappropriated N292 million which he allegedly spent on health care training “without recourse to any appropriate approving authority.

The Mister of Health, Prof. Isaac Adewole subsequently suspended him in July, to pave way for fair and uninterrupted investigation of the panel constituted to probe him. After the committee found Mr. Yusuf “culpable in many areas” of his performance, the minister of health extended his suspension indefinitely pending the decision of President Buhari on the matter.
Subsequently, the Federal Government appointed Mallam Attahiru Ibrahim as acting executive secretary of the NHIS.

Counterfeit drugs
In the year under review, the menace of fake drug continued unabated. During their 90th 2017 Annual National Conference, the Pharmaceutical Society of Nigeria (PSN) which held in Umuahia, Abia State from November 6 to 11, the Chief Economist of PricewaterhouseCoopers (PwC), Andrew S. Nevin, in a keynote address, said that counterfeit medicines account for 17 per cent of the generic drugs in supply, noting that various sources have made varying claims at different times on this figures. What the true figures are is a very contentious issue.

While calling for the drug regulatory environment in the country to be strengthened, a National Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Dr. Albert Kelong Alkali said all open drug markets should be closed down, while calling on Federal Government to support the Pharmacist Council of Nigeria (PCN), the National Agency for Food and Drug Administration and Control (NAFDAC) in this regard. According to him, a lot of Nigerians were either dying or being maimed as a result of ingesting fake medicines.

To this end, he called on the Federal Government to declare emergency on the issue of fake drugs, adding that the Federal Task Force on Fake and Counterfeit Drugs should be inaugurated and reinforced.
Although, a June 2017 timeline had been fixed to dismantle all open drug markets located in Onitsha, Aba, Sabongeri in Kano State, among others, the Federal Government and key partners did not meet that deadline due to lack of political will Alkali asserted.

Traditional Medicine
In spite of a United Nations (UN) declaration more than 10 years ago to adopt traditional Medicine as part of acceptable medications because their accessibility, affordability and local acceptance, several factors continue to hinder wider use of traditional medicine products. Key practitioners still lament the hindrance in including traditional medicine into mainstream health system as an alternative medicine, of choice for consumers of health. That lack of inclusion and practioners’ delay in modernising their production in terms of providing scientific backing for their claims and hinderance in adopting modern and up-to-date packaging, still limit the wider acceptance of the products throughout the year in review.

In 2017 the traditional medicine practitioners under the auspices of the National Association Of Nigerian Traditional Medicine Practitioners (NANTMP) partnered the Nigerian Institute of Medical Research (NIMR) which is doing clinical trials of their medications to standardise the products’ claims. Similarly, the Pax Herbal Laboratories similarly signed an MoU with NIMR this year in this regard. More practitioners are expected to key into this development with a view to enhance their practice.

In his assessment of how the health sector faired in 2017, President of the Nigeria Medical Association (NMA), Prof. Mike Ogirima said the country’s health indices were far from getting better. “We have had issues with government not implementing certain programmes that would have improved the indices of the health of Nigerians, particularly the NHA.

Highlighting those to benefit more from the rapid implementation of NHA and the of Universal Health Coverage (UHC), he said: “We thought the 2018 budget will capture certain privileges for the vulnerable population: The pregnant women, children under five and road accident victims.

“One per cent of the consolidated revenue should have been set aside from the NHA as basic health trust fund for such group of people.”
This is the third year since the NHA was enacted; so, we need constant advocacy not only from health practitioners but also from the people in the media to remind government to do the needful because, even if you have three per cent of our population captured under the NHIS as it is today, “Without extra funding, we cannot get it right. We can now talk of Universal Health Coverage (UHC), which means every Nigerian should be able to access health, no matter how little, from the comfort of his room and get better.”

Poor health Budget
Furthermore, the President of the NMA lamented continued poor budget allocated to health. Irrespective of African government’s Abuja Declaration in 2001 to budget 15 per cent of annual budgets to health, Ogirima lamented that Nigeria has continued to earmark between three to four per cent of its annual budget to health.

Brain Drain
The brain drain of medical doctors and other health care practitioners including nurses, pharmacists, among others rose to unprecedented levels in the year under review.
The NMA similarly urged governments at all levels to intervene to stem the tide. Ogirima noted that in two years – 2016 and 2017, over 600 Nigerian trained doctors dumped the country to take better paid employment abroad. All government must therefore prioritise the welfare of doctors and other health care workers to curb this unwarranted exodus, Ogirima said.

On his part, President of the Joint Health Sector Unions (JOHESU), Biobelemoye Josiah said: “there is a bleak future in the area of industrial harmony due to Federal Government’s insensitivity and lack of will to address the demands of JOHESU, a cluster of health care workers constituting 95 per cent of professionals in the health system.

He noted that health workers operating under JOHESU have been seriously marginalised in the health sector without any sign of ending the ordeal of affected persons.
“Considering the bias of the Federal Government against our members since 2015, our patience has gotten to breaking level. “This year, there were some efforts to sit down and talk, but as I speak with you some of the cardinal issues arising since 2014, such as the adjustment of the Consolidated Medical Health Salary Scale (CONHESS), has not been resolved.

“We would have been on strike this festive season but we rejected that option because we have to keep the Holy period holy; hence we have restrained ourselves from resuming our strike action.”
However, Josiah noted that while the Federal Government has not implemented the key aspect of the agreement on adjusting CONHESS before the next minimum wage comes out, there were approvals for the demands from the National Association of Resident Doctors (NARD) on December 21 for which a circular was issued because of NARD’s strike action.

However whenever such demand involves JOHESU members, Josiah lamented that the Federal Government would say the economy was bad; there was recession; and that it takes time for President Buhari to approve the demand.
On the contrary, similar demand from NARD since 2014 has been approved. While a related demand from JOHESU was pending, the Federal Government has again approved another related demand for medical House Officers. “So, you can see the bias in the Health sector,” he lamented.

Lopsided appointments
Tracing the background of the marginalistion of health workers, Josiah blamed the development on political appointments which gives the positions of minister of Health, the Minister of State for Health and that of the Minister of Labour and Employment solely to medical doctors, a development that shuts out JOHESU members from being represented at the top managerial level of the health sector.

“Where the less than five per cent of health sector staff alone occupies all the decision-making level, he noted: “certainly JOHESU cannot get a fair deal from the system,” adding that sustaining this situation cannot promote peace in the health sector.”
President of JOHESU therefore called for fair treatment for all including professionals and the non-professionals.

Based on the deliberate delays in meeting the demands of JOHESU, which predates the administration of the current JOHESU executives, Josiah said the Federal Government was forcing health workers under JOHESU to make the forth-coming year a strike-infested 2018, adding, “We shall not shy away from that. Nigerians will understand our plight. If they push us that far, we will give it back to them because we are not slaves in the health sector.”

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