Dear Honorable Minister,
Allow me to pour out my heartfelt congratulations on your appointment as our new coordinating Minister of Health. I’m sure many Nigerians, especially those with a fervent interest in public health, would agree with how exciting it is to witness this new but familiar journey you are about to embark upon to shape the health landscape of our dear nation.
There is no doubt about your outstanding credentials and expertise, which were well on display during your ministerial screening at the Senate. Personally, I strongly believe that your vast background in public health, combined with your passion and patriotism, can serve as the much-needed tool missing in steering our healthcare system toward greater triumphs.
The immensity of the task ahead cannot be denied; however, the potential is there for a better outcome. There is a need to reflect on past administrations achievements and drawbacks to guide your ambitions.
Sir, as the caretaker of our nation’s health, your focus must be on how to accelerate the goal of universal health coverage for every Nigerian and reduce the proportion of out-of-pocket payments by Nigerian citizens. These would go a long way toward ensuring equitable healthcare access for all.
Although I am a young doctor and a very junior colleague to you, my passion for public health has made it necessary for me to offer a few suggestions that I strongly believe would help our nation improve our failing healthcare indices.
1. Universal Health Coverage: This cannot be overemphasized enough, as there is a dire need to exert more efforts into improving healthcare access, cost, quality, and standards, as well as prioritizing patient care and health outcomes. We need to shift more focus to primary health care and ensure we have functional primary health centers to achieve this. In the 1988 document titled “The National Health Policy and Strategy to Achieve Health for All Nigerians,” Prof. Olikoye Ransome-Kuti wrote in the foreword a particular paragraph that has stuck with me for a very long time: “I believe that a national health system based on primary health care is definitely the arena in which a number of fundamental changes are going to take place in the coming years. These will include attitudinal, health behavioural, technological and managerial changes.” These fundamental changes have been either absent or poorly executed over the years.
2. National Health Insurance Coverage: The statistics and field experience speak volumes. According to the WHO’s statistics from 2019, out-of-pocket healthcare expenditure for a developing country like ours sits at a miserable 71%. A survey carried out by NOI Polls in 2021 shows that 8 out of 10 Nigerians do not have health insurance coverage. Insurance is a hard sell, especially in a country like ours where trust is a scarce commodity, and that’s why we must show the people the benefits of enrollment. The new vulnerable group fund, set up to ensure coverage for 83 million indigent Nigerians and financed through the Basic Healthcare Provision Fund and health insurance levy, amongst others, should be made to work as it should to convince people into further enrollment.
3. Synergy with all state health commissioners to ensure that the healthcare vision at the national level is being reflected at the state level and that no state is left behind as we march toward universal health coverage.
4. Improving our health-seeking behavior: Health indices are largely affected by health-seeking behaviors, and we are really poor at that. Partnerships with the media should be considered, especially in today’s digital age where social media health educators like ‘Aproko Doctor and Bearded Shina’ have noticeably had a very impactful effect in shaping the health-seeking behaviors of many Nigerians. Health education jingles on radio and television would also prove to be impactful if properly executed.
5. Partnership with traditional medical and alternative medicine practitioners, together with a strict and massive clampdown on unlicensed health facilities, would help against quackery and unnecessary loss of lives, especially among women and children. An example of this is the ‘Abiye project’ launched by Governor Mimiko during his tenure in Ondo State. There are lessons to be learnt from this.
6. Improvement in our data collection and interpretation, health research and development to help us monitor our health indicators, thereby serving as a guide for any actionable steps we would be taking.
7. Community participation and ownership: This is a very necessary tool in achieving successful policy implementation and monitoring.
8. Healthcare funding: It is sad that decades after the ‘Abuja declaration’, we still struggle to pinch closer to 10% budgetary allocation and even with the abysmal allocation, implementation always never crosses the 50% mark. There is a huge need to increase the health budget to a minimum of 10% in the next budget cycle and a conscious and concerted effort made to finally achieve and sustain the 15% benchmark.
9. Governance and stewardship go a long way and I’ll like to implore you to lead by example. Let your subordinates and everyone in the healthcare system from top to bottom know that it’s not going to be business as usual.
Sir, in addition to all these, I’ll like to add my personal request. The Ministry of Health should work together with the National Assembly to pass a bill seeking to include teachings on First Aid and necessary First responder knowledge in our Secondary schools and as GST courses in higher institutions. There is already a bill passed by the last senate sponsored by the current Minister of State for Education which would make teachings on Cervical and breast cancer in secondary schools mandatory. The precedence is there, so I believe it’s achievable.
Finally, I would like to wish you the best of luck as you assume your new role and I believe you’ve got an excellent partner in Dr Tunji Alausa. May you both be guided by wisdom and make decisions that would have a positive and lasting impact on the health landscape of our Nation.
Dr. Adigun Mubarak (MBBS Lagos)