Is this the breaking of a new dawn in Nigeria’s health sector?

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Last Friday’s news flash that President Muhammadu Buhari had appointed new heads to five public health institutions took the Nigerian health sector by surprise, with social media bursting with what could be likened to a collective shout of excitement.

The news came without any political musings or rumblings or rumours in the background. The five public health institutions who will now have new leadership are the Nigerian Centre for Disease Control (NCDC), the National Agency for the Control of AIDS (NACA), the National Primary Health Care Development Agency (NPHCDA), the Nigerian Institute of Medical Research (NIMR), and the National Health Insurance Scheme (NHIS). Apart from the National Agency for Food and Drug Administration and Control (NAFDAC), which still has a leader in an acting capacity, these are some of the most important agencies in the Nigerian health sector.

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Tweet by Bashir Ahmaad, Personal Assistant to President Muhammadu Buhari on New Media, announcing the new appointees.

The reality of having five institutions in the Nigerian health sector change leadership in one fell swoop will almost inevitably lead to a rise in the expectations of many Nigerians, health sector professionals, and no doubt the international donor community. These five institutions play key roles in the delivery of critical public health services to Nigerians and the five people chosen to lead them seemed to literally “come out of left field.” We reached out to some leaders in the Nigerian health sector to get a feel of what they think about the new appointments.

Charles Usie, Country Manager of International NGO, Christian Aid, expressed excitement at the appointments. “This is a really big achievement for the current government,” he said, adding that, “the real winners will be the millions of poor and marginalised Nigerians whose chances to enjoy improved quality services from these five agencies has increased and hope restored.” He noted that, “When the right people are allowed to serve in the right offices, small incremental changes aggregate into transformational changes.”

Edwin Ikhuoria, Nigeria Country Representative of ONE Campaign, an International Health Advocacy Group, said that he expects the new leadership to work hard to tackle the current situation in the health sector. “The first challenge before the new leadership is to appreciate the enormity of the health challenges and to prioritise how resources must be allocated and utilised to deliver the best outcomes”.

To help put these and many other Nigerians’ expectations into perspective we have summarised the roles these five institutions play in the country’s public health sector below:

The Nigerian Institute for Medical Research (NIMR) oversees all aspects of research done in Nigeria in the health sector. Its mission statement includes conducting research, helping to disseminate research findings and creating an enabling environment for health research and training. Compared to the Medical Research Council in the Gambia, KEMRI Wellcome Trust Research Programme in Kilifi Kenya and the Medical Research Council in South Africa, NIMR has fallen significantly behind in the delivering the research outputs that will respond to the biggest public health challenges of our time. Successful leadership of NIMR would mean a return of a vibrant research culture in Nigeria.

The National Agency for the Control of AIDS coordinates the response and sustains advocacy for HIV/AIDS/STDs programmes in Nigeria and develops plans for the expanded HIV/AIDS response to inform the government’s policy decisions. It is also tasked with monitoring and evaluating the implementation of the national plan for the control of HIV/AIDS in Nigeria. NACA has supervised the increase in those Anti-Retroviral Treatment (ART) to 750,000 Nigerians but this still represents only 17% of HIV positive Nigerians on treatment, based on the latest prevalence survey. Inserting new energy into the national programme is a major task for the incoming leadership. Success will be dependent on resolving the conflicts with the FMoH’s HIV/AIDS division as NACA itself is under the Presidency. Is it time to change this?

The Nigerian Centre for Disease Control is charged primarily with preventing and controlling communicable diseases in Nigeria and coordinating the public health response to and preparedness for disease outbreaks. It is also the agency tasked with limiting the rise of non-communicable diseases and managing the health impact of disasters. The NCDC is the newest of all the health agencies, and with new leadership, one of the first challenges will be to complete the passage of the enabling bill of the agency, which will define its mandate, and clarify its relationship to all the disease specific departments within the Federal Ministry of Health.

The National Primary Health Care Development Agency (NPHCDA) leads on policy formulation for the country’s primary health care system, which is meant to guide the delivery basic health care services to all Nigerians. Primary health care is the bedrock of the public health system, the foundation upon which the rest of the health system for the public must rely on if the majority of Nigerians are to be reached. The Minister of Health has made primary health care the arrowhead of his administration, bringing the role of NPHCDA into intense focus. What this means for the incoming leadership is aligning the Ministers ambitions, with the reality of the federal structure in Nigeria, where primary health care is largely a state government function.

The National Health Insurance Scheme (NHIS) has as one of its objectives the mandate “To ensure that every Nigerian has access to good health services.” It is supposed to do this by putting in place services that protect families from the financial hardship of massive medical bills, limit the rise of the cost of health care, and maintain high standards of health care delivery. The NHIS’s huge challenge is figuring out how to get Nigerians to have confidence that subscribing to the financial cover provided by health insurance, will lead to appropriate medical cover when needed. It has promised that by 2017 it will reach 51 million Nigerians with insurance, although it is not clear how many Nigerians the Scheme currently covers the subject of intense scrutiny on social media recently. Increased transparency and accountability is probably the most important short term challenge for the new leadership of the agency.

Ikhuoria pointed out that for all the five institutions, “The National Health Act, which has provided a framework for managing the sector, should be seen as the overarching framework for delivering better accountability for health service providers and recipients.

Former Commissioner of Health in Ogun State, Dr. Ola Soyinka, said, “A key priority will be to begin implementation of the National Health Act. I also believe not enough priority is being given to the quantity and quality of human resources for health in the country — we have a crisis on our hands. Perhaps most important is the issue of health financing and the role of the NHIS in getting us to our Universal Health Coverage target, particularly by stimulating the resuscitation of primary health care in the country and assisting states to set up sustainable social protection models especially for the poor and other vulnerable groups. Collectively the health MDAs have a Herculean task that requires bold thinking, determined action and a sense of urgency.

Usie said President Buhari’s five choices for the sector have a common thread that connects them. “(They) have demonstrated two competencies that will contribute significantly in repositioning the healthcare system in Nigeria,” he said. “Firstly, they all have proven record of excellence and personal accomplishments, which implies that they are self-motivated, disciplined and good stewards of resources. Secondly, they are leaders who have led other leaders to the attainment of life-saving health solutions, no short cuts and quick fixes, but years of sweat and blood in dedicated, selfless learning, coaching and delivery of results.”

He looked ahead to the change he felt would come from their joint effort. “There is no doubt left in our minds that their performance together under the Ministry of Health will cause an avalanche of change and transformation with our healthcare system in Nigeria.”

Expectation is very high among Nigerians and the Nigeria Health Watch team congratulates each of the new leaders and asks them to work resolutely to maximize the opportunity granted them to change the trajectory of the Nigerian health sector and to make an impact in the lives of Nigerians. We hope they will reach out to one another in this quest, to collaborate, to innovate, as they lead. We hope they will reach out to Nigerians, to inform, to educate, and to seek to understand… as they lead.

Granted there will be challenges ahead. Yet, Nigerians are hopeful for the breaking of a new dawn.

Dr. Chikwe Ihekweazu was until his appointment the Curator of Nigeria Health Watch. We wish him, and the other new appointed leaders, every success in their new roles. Here at Nigeria Health Watch, we remain committed and will continue to do the work that we do: amplifying some of the great work happening in the health sector, challenging the bad, holding our leaders to account and creating a space for positive ideas and action.

Originally published at nigeriahealthwatch.com on August 2, 2016.

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We use informed advocacy and communication to influence health policy and seek better health and access to healthcare in Nigeria. nigeriahealthwatch.com

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