More FP/RI champions in the health Bureaucracy join PAS Advocates

More senior government officials from Kano, Kaduna, Niger, Lagos, Enugu,  and Taraba states recapitulate their commitments to serve as champions on Routine Immunization and Family Planning under the partnership for advocacy in child and family health at scale.

The champions made this commitment during the completion of a strategic management and leadership capacity building for government officials in the health (family planning and routine immunization) in collaboration with AMREF international university, Nairobi Kenya  9th -13th December 2019.

The champions building capacity was in fulfillment of the investment primary outcome on champions capacity building within the health bureaucracy that aims to respond to FP funding in Nigeria. It also corresponds with the IPO 11:3;2 that aims to increase the number of duty bearers in the executive and legislature self-identifying as champions of child and family health.

The New Champions

These new champions were targeted government officials currently involved in programs implementation in the area of Family Planning and Routine Immunization at the National level and in Kaduna, Kano, Niger, Lagos, Enugu and Taraba states.

SN Official State Position
1 Dr Tijjani Hussaini Kano State Executive Secretary, Kano State Primary Health Care Board
2 Mrs Atika Bakari Taraba State FP focal person, Taraba State Primary Health Care Board
3 Dr Wada Imam Bello Kano State Director Public Health
4 Mrs Okanlawon Juliana Idowu Lagos State Senior FP Officer, FP Master Trainer/ RH Unit SMoH
5 Pharm. Emily Olalere National level Director Pharmacy Practice, Pharmacy Council of Nigeria
6 Dr Hauwa Kolo Niger State Director Community Health Services, NSPHCDA
7 Dr Ibrahim Idris Niger State Director Public Health
8 Dr Okaga Saidat Lagos State Director Child Survival Strategy
9 Dr Safiya Isa Inusa Kaduna State FP Unit
10 Pharm. Ahmed Ibrahim Babashehu National Level Director Planning, Pharmacy Council of Nigeria
11 Dr Okafor Christopher Sunday Enugu State Coordinator FP
12 Dr Muhammed Ado Zakari Kano State Director Hospital Services

Outcomes

These cohorts of twelve senior and middle cadre officials working in the areas of family planning and routine immunization has also made the following commitments:

  • Reconstitute my team with the core competencies for effective performance on FP and RI issues
  • Strategic planning of programs and deployment of the logical framework for FP and RI programs.
  • Improve team building in the departments.
  • Address Family Planning commodities stock-outs.
  • Cascade down the training to FP providers in the states.
  • Support performance management and design appraisal systems.
  • Promote advocacy on FP and RI
  • Assignment of specific targets to FP coordinators and PHCs in the states.
  • Implement the Belbin model for impact
  • Cascade the training to members of the team.

Next Steps

The champions developed a work plan that will be implemented in 2020 to support the commitments made as new champions of FP and RI under the PACFaH@Scale project. They requested the following support to enable them implement the 2020 work plan.

  • Provision of support for step down/cascading of the pieces of training.
  • Provision of some of the resources required for the activities.
  • Mentor-ship and supportive supervision
  • Support for organizing half-yearly follow up meetings.
  • Support for development and deployment of appropriate strategies
  • Increase capacity building for the Executives.
  • Support the goals through advocacy, communications and social mobilization to the Executives.
  • Support by continued partnership.

The work plan will be reviewed by the technical department of PAS for implementation in the first quarter of 2020.

Click here to read the complete report

Taraba launches TSTS policy for Essential healthcare services

The Official Launch of Taraba State TSTS Poly and SOPs by the Permanent Secretary Taraba State Ministry of Health

Persistent evidence-based advocacy pays as the Taraba state government launches the domesticated Task Shifting Task Sharing policy for essential healthcare services in the state. The policy was launched on Thursday 12th December 2019 at the state’s Ministry of Health in Jalingo.

The domestication and launching followed over a year of advocacy visits by the dRPC-PAS sub grantee in the state, the Women and Child Health Empowerment Foundation (WACHEF), under the Partnership for Advocacy in child and family health At Scale (PACFaH@Scale), to the state ministry of health, where consultations with a wide range of stakeholders led to the composition of a TWG that developed the TSTS document. The process was rounded up with a validation meeting on the policy document and the accompanying Standard Operating Procedures (SOP).

The Challenge

  • Shortage of adequate manpower for Human Resource for Health in Taraba state
  • Poor  access to pregnant women in hard-to-reach areas in Taraba
  • Absence of clearly outlined tasks that can be performed by different cadres of frontline health care workers
  • Absence of legal framework for empowering community health workers (CHOs and CHEWs) to provide quality maternal and newborn care services, especially at PHCs

With this launch, the human resource for health in Taraba state will get a boost as other categories of health workers will not be empowered to provide services to the teeming population in the state and these identified challenges will be mitigated.

The Launching

The launching of  the document brought various stakeholders in the health sector of Taraba state. Amongst them are, the Permanent Secretary, TMoH, officials of the state primary health development agency, TSPHCDA, Rector and staff of the College of Science and Technology, Taraba State Health Systems Management Board, Nigerian Medical Association, NMA, Nurses and Midwives Association, NANNM, CSO, Development Partners, and the Media.

Next Steps

With the domestication and launching of the TSTS document in the state, stakeholders have made the following their next line of action as they continue to move forward in the implementation of the document.

  • Plan more advocacies to ensure implementation of the domesticated and launched policy
  • Cover the training gabs within the ranks of a lower cadre of health workers
  • Train Community Health Workers (CHEWs) on emergency life-saving skills and LACK
  • Train CPs and PPMVs on the provision of other services
  • Supervision and monitoring of lower cadre health workers in the state

Nurses Association conducts and disseminates RI people’s scorecard in Kaduna state

As part of efforts to strengthen the implementation of RI finance strategies at the state levels, the National Association of Nurses and Midwives (NANNM), Kaduna State chapter, developed a routine immunization (RI) people’s scorecard and presented its finding at a dissemination meeting in the state.

The objective of the dissemination meeting was to present the findings of the RI people’s scorecard developed using set of indicators to identify areas of weaknesses of RI financing in the state. The RI scorecard will then be used to plan for advocacies towards overcoming the identified weaknesses. The dissemination meeting was conducted on the 7th of December 2019 in Kaduna.

Overview of the Dissemination meeting

Before the dissemination meeting, the RI scorecard commenced with a training organized by the dRPC-PACFaH@Scale, on the 27th September 2019 in Abuja. The training was to prepare the participants on RI scorecard indicator development for use during the RI people’s scorecard in Kaduna state. After that, a one day planning meeting was organized in collaboration with other stakeholders, and officials of the Kaduna state primary healthcare development agency, to develop a checklist that will be used in developing the scorecard; as well as to identify the primary healthcare centers (PHCs) to be visited for the assessment, identify a date for training the data assessor, a date for the field work exercise, and another date for the scorecard dissemination. Earlier, on the 3rd of December, the validation of the data analysis was conducted where officials from the state primary healthcare development agency, State Ministry of Health and other agencies attended. The data for the assessment was collected from some selected PHCs in six local government areas the state, namely; Zaria, Soba, Kaduna North, Kajuru, Jema’a,  and Jaba .  These local councils were chosen from the three geo-political zones of the State (North, Central & South).

Main Findings in the scorecard

The people’s scorecard found out the following:

  • Vaccines coverage in the state is 74%.
  • The national target for Penta 3 is 85%, 74% coverage can said to be on track
  • Vaccines and supplies stood at 83%
  • The availability of RI bundle vaccines in adequate quantities.
  • CSO engagement in RI activities in the state stood at 58%
  • CSOs participate in conducting visits to health facilities and proffering solutions to identified issues

The final Outcome of the scorecard:

The overall assessment shows that Kaduna state scored 77% in the peoples RI Scorecard.

Recommendations

The recommendations made are:

  • Government should do more in the areas of vaccine distribution to PHCs
  • Government should also engaged more with CSOs and the communities were this

PHCs are located

Next Steps

  • Printing of the copies of the RI people’s scorecard to be used for advocacy to government officials.
  • Sharing the RI scorecards to policy makers and implementers.

For Full report click here

Women Groups, other stakeholders meet to review post-GAVI implementation plan strategies

Women groups in Nigeria, and other stakeholders, met in Abuja for a 1-day dialogue to discuss the post-GAVI implementation plan as part of strategies to find sustainable ways of increasing domestic resource mobilization for funding routine immunization in Nigeria.
Organized by the National Council of Women Societies (NCWS), a subgrantee of dRPC’s Partnership of Advocacy in child and family health at Scale (PACFaH@Scale), the dialogue, also discussed ways  CSOs will ensure accountability in RI finance strategies at National and state levels in Nigeria.
Several women’s groups from Niger, Kano, Lagos, Taraba, Anambra, Enugu, and Kaduna states attended the dialogue, with representatives from the Federal Ministry of Health (FMOH), Budget Office of the Federation (BOF), Federal Ministry of Finance (FMF), and Center for Disease Control (CDC), as government stakeholders. Other GAVI transition stakeholders such as the BMGF, WHO, World Bank and AFENET also attended.
Dr. Garba Bello Bakunawa from the National Primary Healthcare Development Agency (NPHCDA) led the discussions on the implementation status of GAVI transition, potential domestic funding post-GAVI and development of a RI scorecard.
Then, the  Nigeria Strategy for Immunization and PHC System Strengthening (NSIPSS),which was  premised on the need to have a robust and ambitious plan to improve and sustain immunisation coverage and maintain quality PHC service delivery post-GAVI in light of the multiple transitions faced by the country between 2018 and 2028, was also discussed. As the most important and binding document between GAVI and the Nigerian government, participants want the document to be made public so that civil society can hold the government of Nigeria accountable over its promises. Women groups can also use the document to engage with government agencies during advocacies.
The other issue discussed was increasing domestic resource funding post GAVI, which the participants highlighted as a necessary step to sustain the funding of routine immunization in Nigeria.
Outcomes of the dialogue are: At the end of the 1-day dialogue, the following outcomes were achieved:

  • Participants had a better understanding of the GAVI implementation status: as the goal of the NSIPSS is the attainment of 84% average national immunization coverage with all scheduled routine antigens by 2028.
  • Participants agreed on key systems approach to address the gaps, taking immunization, not as a stand-alone programme, but as an integral part of a strong PHC system in the NSIPPS document.

The following key areas of focus are:

Leadership, Management ,and Coordination:
To strengthen the primary healthcare centers (PHC) management through PHCUOR, and technical support program by the NPHCDA to the states to improve the PHCOUR implementation and Task-shifting program within NPHCDA. This will improve the organizational capacity of the NPHCDA to manage the Immunisation programme. Establishment of SERICC in 18 low performing states and the recruitment of SERICC Technical Assistants. The country developed and signed the joint accountability framework with GAVI to institute an accountability framework for RI. The key challenge here is insufficient funding. This task is achieved but further strengthening is needed.

Service delivery:
Implementation of the optimized and Integrated RI sessions (OIRIS) in 18 priority states, rreduction of Missed Opportunities for Vaccination (MOV) in urban PHC facilities, secondary and tertiary facilities, and Introduction of new vaccines (MenA, MCV2) is on-going. Rota to be done by 2020, and reduction of missed opportunities for vaccination (MOV) by instituting daily fixed doses across high- volume PHCs, secondary and tertiary facilities of the 18 low performing states.

Demand creation:
The Multi-level coalition for RI advocacy which entailed the NPHCDA leadership and partners have continued to advocate to stakeholders (National Assembly, State governors, etc) and it is the only goal achieved in demand generation. The other goals like Engagement of state health educators and transition of structures and capacities, broader partnerships and engagement with the private sector and development of a national communication plan, Data for action, States specific approach are yet to be achieved.

Supply chain:
Supply chain system redesign like the 3-hubs, push plus, and National Supply Chain Integration Project (NSCIP), Data for the supply chain to improve visibility and accountability, accountability measures including vaccines physical stock count, state-specific forecasting, mandatory vaccine utilization report. This task is a work in progress albeit with a variable level of success across the 36 states and the FCT.

Data management:
Majority of the goals here are yet to be achieved like the, strengthening of data quality audit, assurance and assessment mechanisms, conduction of annual surveys to provide timely and reliable information for decision making, Strengthening Operations research mechanisms, introduction of electronic vaccine registry to capture individual immunization record, and Passage of enabling laws and policies are all not available due to poor funding and delay from GAVI approving the electronic data collection proposal. This task is a work in progress

Financial management:
Strengthening of financial management by Setting-up of the vaccine financing and accountability WG, leading to improved visibility and tracking of vaccine financing is currently not available. Also, key initiatives such as automation of the financial management processes have not been rolled out due to lack of funds. Increase in government funding for vaccine procurement by Inclusion of over 40% of vaccine procurement needs in the Service wide votes. Release of the funds is expected in coming days.
Other outcomes are:
Increased awareness on how to domestically source for funding post-GAVI
Improved knowledge and skill on RI scorecard development
Better understanding on the various roles CSOs can play in ensuring accountability in their states by tracking the Budget allocation, release and tracking of expenditure; and eventually use the information derived for further advocacy and engagement with the state governments.

Recommendations:
At the end of the 1-day dialogue, participants recommended for the government agencies, donor organizations, the private sector, etc to ensure the implementation of the NSIPSS goals and bring about strategies to mitigate the challenges or accelerate the implementation of 84% average National immunization coverage.
They want the federal government of Nigeria to explore other innovative means of domestic finance mobilization for RI through increasing its tax base revenue, imposing health-specific levies on telecom companies, PPPs with the organized private sector and improving accountability and transparency through effective utilization of its earnings.
The participants also called on the CSO to continue to advocate for demand generation of routine immunization services and to study the budget cycle to enable them hold the governments at all levels accountable
Next Steps:  The participants called for on the federal government to take the following measures regarding the NSIPSS document:
•      Review, prioritize and phase strategies outlined in the NSIPSS, incorporating findings from the Joint Appraisal.
•      Develop annual operational plans for prioritized immunization and PHC interventions, with clear accountability measures
•      Engage government and partners to source for adequate resources to address identified challenges
•      Continuously monitor and evaluate progress and impact of implemented strategies
•      The NPHCDA and other Government agencies should collaborate and work with NCWS-PAS to accelerate vaccine coverage and demand generation in the country.

The dialogue is a critical output towards the achievement of IPO 1, supporting the implementation of Nigeria’s RI financing strategy. For the full report click here

AANI anchors TWG on FP in Lagos State

FP Annual Operation Plan meeting at Lagos state with participants from AANI, CHAI, FP zonal coordinators, MoH, State Primary Healthcare Board, Budget & Planning and other partners 

As part of efforts to improve allocation and timely releases of family planning funds in Lagos State, dRPC-PACFaH@Scale sub grantee, the Alumni of the National Institute for Policy and Strategic Studies (AANI), is appointed by the Lagos state ministry of health to anchor the quarterly Technical Working Group on Family Planning in the State.
The TWG was set up by the state government to drive policy on FP, meet quarterly to discuss issues affecting family planning, and to proffer solutions to the challenges facing FP policies or funding in the state. The group will also assess the performance of the various PHCs and the quality of FP services at all the PHCs in the state. The TWG is also tasked with assessing the performance of the AOP developed for the year in the state.
Announcing the appointment, the Director, Reproductive Health, Lagos State Ministry of Health, Dr Victoria Omera disclosed that the appointment of AANI-PACFaH@Scale to anchor the quarterly TWG meetings was in recognition of its commitment to improving policy implementation of FP in the state.
Dr. Omera added that Lagos State government has achieved a lot in terms of maternal and child health in Nigeria according to the 2018 Demographic and Health Survey that shows that the state has one of the very high percentages of women (80%) delivering by skilled birth attendants, the highest percentage (29%) of women using modern family planning, and the lowest % of children under 5 with no vaccinations (1.7%) in the country. She, then, enjoyed AANI to continue to lead the group to come with up with implementable suggestions to the SMoH so as to improve maternal and child health in the state
Earlier, leader of the AANI-PAS the delegation, Dr (Gen) Shina Ogunbiyi thanked the Lagos state government for appointing AANI-PAS to anchor the quarterly FP meetings and assured that critical issues bordering on FP policies and funding will be discussed and solutions proffered.

Key Stakeholders

Key stakeholders in the TWG are officials of the Lagos State Ministry of Health, Director RH, LSMoH, Directors of all PHCs in the state. Others are, Coordinators of FP, Officers In charge of PHCs, Directors of Local government Health Authorities, A representative of Traditional council in the state and development and donor partners such as NURHI, CHAI, etc

Impact of Anchoring the TWG

With AANI-PAS as anchoring the TWG on FP in Lagos state, the following impact is expected to be achieved:
• Monitoring government interactions on FP in the state
• Monitoring government performance on FP in the state
• Developing scorecard on FP
• Using information and knowledge on FP to conduct advocacies on improved funding and timely releases

This appointment is strategic as it supports dRPC-PAS Primary Investment Outcome 5 which targets the improvement of allocation and timely release of funds through the domestication of federal government policies and the introduction of the state’s specific programs.

THIRD ANNUAL SUMMIT OF THE LEGISLATIVE NETWORK ON UNIVERSAL HEALTH COVERAGE (LNU) HELD ON 13TH – 15TH NOVEMBER, 2019.

A COMMUNIQUE OF ACTIONS

We, the members of the Legislative Network on Universal Health Coverage, held our Third Annual Summit from 13th – 15th November, 2019 at Transcorp Hilton Hotel, Abuja, under the chairmanship of Distinguished Senator Ahmed Lawan, Senate President, Federal Republic of Nigeria.

We recognize and commend the efforts of the Ministries, Departments and Agencies (MDA) at all levels and acknowledge the support that the Development Partners (World Bank, WHO, E.U. UNFPA, UNICEF, UKAid, CIDA, BMGF, R4D, WAAPH, Palladium, Malaria Consortium), Civil Society Organizations and other stakeholders are providing towards increasing Universal Health Coverage, and delivery of technical support.

We have equally OBSERVED some critical issues affecting achievement of UHC in Nigeria, such as:

  • The absence of Health Agenda to guide Legislative Actions towards achieving Universal Health Coverage across the country.
  • Some aspects of the guidelines for managing the BHCPF are not in consonance with provisions of the NHAct
  • The current level of resources (human, equipment, infrastructure) militate against achievement of UHC in the country.
  • Payment for care at the point of use (whether through explicit policies on user fees or informal payments) causes financial hardship for those that do seek health care.
  • Poor compliance to Appropriation Act
  • Weak oversights

In view of the above, we RESOLVE to:

  1. Ensuring finalization and implementation of legislative health agenda at national and state levels towards achieving Universal Health Coverage.
  2. Working with governments, the private sector, development partners, and civil society organizations towards ensuring that every Nigerian is able to access a full-range of health services at all levels.
  3. Encouraging all financial risks associated with seeking care are mitigated.

To achieve this, we COMMIT to doing the following:

LEGISLATION:

  • National Assembly amending relevant sections of the National Health Act
  • Ensuring speedy review, passage and assent of National Health Insurance Commission Bill
  • Ensuring passage of State Health Insurance (SHIS) Bills in states without a health insurance scheme

OVERSIGHT

  • Ensuring full implementation of legislative health agenda at national and state levels
  • Ensuring revision of the present BHCPF guidelines to be in consonance with the NHAct
  • Providing oversight of operations of the NHIS
  • Providing oversight of operations of tertiary health institutions
  • Ensuring the BHCPF guidelines reflect the provisions of the Act
  • Monitoring and evaluating implementation and impact of BHCPF
  • Ensuring that government and the private sector are accountable

APPROPRIATION

  • Ensuring increased appropriation to the BHCPF
  • Working towards increasing Health Budget
  • Ensure innovative funding mechanisms to increase funds availability to health
  • Ensuring that state health insurance budget is on first line charge

Use of data-driven, evidence-based Advocacy will improve health funding-Legislators, Advocates

Legislators and Advocates at a health summit in Nigeria have adjudged the use of data-driven, evidence-informed advocacy models at a formal gathering as the most an effective way of influencing legislators to increase health sector funding in Nigeria.

In a post-survey conducted by the development Research and projects Center (dRPC), under the Partnership for Advocacy in child and family health at Scale project (PACFaH@Scale or PAS), during the 3rd summit by the Legislative Network for Universal Health Coverage (LNU), an initiative of Nigerian Lawmakers in the health committees at the National and States levels, held in Abuja from 13th-15th of November 2019, legislators believe that they are likely to increase health sector budgets if they are sensitized at formal gatherings to understand the impact of adequate health sector funding on their constituents and their prospective electoral values.

The 3rd LNU summit is an annual think tank gathering that brings about all lawmakers in the committees on health at the National Assembly, including Speakers at the national level and state levels, Clerks of the National and States Assemblies, as well as members of the health committees at the 36 state house of Assembly in Nigeria. Civil society organizations, donor agencies, heads of various health-related MDAs from across the 36 states and the FCT, and other government officials are members of the summit and they gather each year to deliberate and share experiences, synthesize lessons to guide the implementation of the BHCPF policy towards the achievement of UHC across Nigeria.

Overview

The summit started on the 13th day of November with a presentation on the status of health in Nigeria by the FMoH Departments and Agencies, followed by a plenary session. In day two, the morning session featured an address on finding solutions to healthcare financing for the achievement of UHC by the Senior Executive class 41 of NIPSS, the address was made possible by the efforts of dRPC-PAS. The evening session also powered by the dRPC-PAS was on ways of building and harnessing the human capital development necessary for the achievement of UHC. The 3rd day of the summit featured a technical session on health financing in Nigeria and the implementation status of the BHCPF policy by the FMoH representatives and development partners. The workshop was adjourned following the issuance of a communiqués and development of a 4-year National Legislative Health Agenda and Strategic Framework.

dRPC-PAS administered questionnaires to all the 200 participants to collect information that will form the basis for future engagement and advocacy to the legislators at the states and national level.

The Evaluation Findings

Evaluation Findings:

Analysis of responses generated through the questionnaires revealed the following:

Out of the 200 administered questionnaires, 117 were returned completed, making the response rate to be 59%.

Socio-demographic distribution of the respondents showed:

Sex: 86 Males (74%) and 31 females (26%)
Age: Respondents ≥ 60 years were 26 (22%), 59-40 years were 71 (61%) and 39-20 years were 20 (17%) and none of the respondents were ≤ 19 years.
Educational level: 66 (56%) respondents have master’s degree or its equivalent, 35 (30%) have a first degree, while 15 (13%) respondents possess Ph.D., 1 respondent with the technical level of education and none with secondary school certificate as their highest.
Profession: 52 (44%) of the respondents were Government officials, while 16 (14%) were politicians, 15 (13%) were legislators, 8 (7%) have media as a profession, 12 (10%) respondents identified as development workers (6 local and 6 international), 5 (4%) respondents identified as independents, 2 (2%) educators, 1 respondent equivalent to 1% identified as a diplomat , 2 (2%) academics, and 1 (1%) analyst.

Findings

• 85% of the respondents agreed that advocacy is effective in influencing increased health financing. The above response also supports the following findings in this survey:
• 48% of the respondents adjudge the use of data-driven, evidence-informed advocacy models at formal gatherings like the recently held summit as the most effective way of influencing legislators to increase health sector funding. Also, 21%of the respondents believe legislators are likely to increase health sector budgets, if they are sensitized at formal gatherings to understand the impact of adequate health sector funding on their constituents and their prospective electoral values
• Similarly, 47% believe the executives could be influenced to increase the health sector budget through evidence-based advocacy engagements with sensitization on the burden of diseases and other health conditions in Nigeria.
• Both sexes agreed the use of evidence on diseases burden in Nigeria is the best advocacy tool for the executives. Also, a cross-analysis of the data showed more females (5%) believe the use of data on budget performance reviews and the analysis could is a better advocacy tool than the rest.
• Both sexes have a consensus on the use of data-driven, evidence-informed advocacy strategy as the most effective means of advocating the legislators to increase funding to the health sector
• 68% of the respondents believed that the most important health stakeholders with the capacity to influence Legislators’ view on healthcare financing was at the summit. The above findings underscore the number and magnitude of the health sector influencers in attendance at the summit to guide and support the participants on how best to cascade the lessons of the conference in their various states. More so, the response above supports the belief held by more than half (52% and 58%) of the respondents on the greater roles NGOs play in conducting budget performance review and to generate evidence for advocacy and attend budget public hearings to strengthen accountability and inclusive participation respectively.
• Approximately 2 out of three (74%) of the respondents believed the data presented at the the workshop will be an effective tool to influence legislators present at the workshop to increase the FG 2020 health budget
• More than 2/3rd of the respondents, 78%, of the respondents believed health budgets have a direct effect on the economy. The higher the health sector budgetary allocation, the higher the health status of the citizenry and in effect, the more productive the populations are bound to be. Also, on that note, 70% and 55% of the respondents believe NGOs have a greater role to play in mobilizing and educating the public on budgetary allocations, and tracking budgetary releases to MDAs respectively
• 81% of the respondents networked with others at the summit to foster peer-review learning on best practices and challenges
• Poor accountability and transparency coupled with the obligation of all MDAs to remit all unspent funds from the health sector back to the federation account at the end of the year despite passing the budget late, were adjudged (56% and 32% respectively) by the respondents as the leading reasons why the FG was unable to increase the % allocation to the health sector in the 2020 budget above the amount allocated in 2019
• 40% of the respondents believe untimely releases to the health sector are caused by Delays in the preparation, presentation, deliberation, and passage of budgets complicated by bureaucratic bottle necks affecting the budget calendar; 18% believe it is as a result of low Government revenues and unrealistic fiscal planning, 13% believe it is due to inadequate political will from the government, while 11% believe it is from competing government priorities and demands and 15% were not sure why. With the new efforts made by the executives and NASS to have the 2020 budget passed before December 2019, it could be the end of the short budget calendar drawback.
• 7% of the respondents encourage the use of data on budget performance reviews and analysis for advocacy to the executives and 5% suggested that FG should strengthen accountability and transparency mechanisms in the health sector to improve resources mobilization and utilization, while 4% believe the government should explore other innovative healthcare financing mechanism with more private sector involvement
• And, 9% of the respondents believe supporting and strengthening the oversight responsibility of the legislature could convince them to increase funding to the health-sector, while 6% of the respondents believe the legislators could be convinced to increase health sector funding through sustained public enlightenment and campaigns by CSO on health sector budget analysis and health indices

Outcome(s)

• Consensus built on Strategic Framework for the National Legislative Health Agenda focusing on efficiency and effectiveness
• Year 2020 activity work plan framework for NASS and state legislator
Communiqué of action (link to communiqué)
• Increased knowledge and advocacy skills for PAS-CSOs in attendance
• Attainment of the strategic position of leverage by dRPC-PAS in building champions within the executives and the legislature

Conclusion

It is apparent from the workshop and survey that the use of evidence-informed, data-driven advocacy model at formal gatherings remain the most effective advocacy tool to engage and convince duty bearers at all levels to increase health sector budgetary allocation and releases. This further buttress why dRPC-PAS adopted the use of evidence gathered through research for advocacies to relevant government MDAs as the best advocacy model

Recommendations

The quality assurance tool needs to be updated and validated, so vital research information like the data from this the conference could be refined and published in journals
LISDEL to make more efforts in bringing federal executives on board as participants in subsequent workshops to foster synergistic actions
Use of evidence gathered from this survey to better inform subsequent engagement between dRPC-PAS and other legislative stakeholders

Next Steps:

• Attend post-workshop review meeting with LISDEL and other partners
• Synthesize lessons learned from the survey to improve the quality and outcomes of advocacy visits conducted by PAS-CSOs

For the full report, please click here

PHOTO GALLERY OF 3RD ANNUAL SUMMIT OF LEGISLATIVE NETWORK FOR UHC AT TRANSCORP HILTION, FCT ABUJA

Financing Universal Health Coverage in Africa: Nigeria’s comparative experience

The Partnership for Advocacy in Child & Family Health at Scale, PACFaH@Scale (PAS), is a social accountability project which aims to strengthen the capacity of Nigerian Civil Society Organisations at the national and state levels. The project aims to hold decision-makers (in the executive and legislature) to account to comply with commitments in child and family health, policies (laws); financial obligations and to bring down regulatory and administrative barriers to effective and efficient service delivery. PAS is anchored by the development Research and Projects Centre (dRPC) and implemented by a coalition of 23 indigenous health NGOs and professional associations. The project is also supported by 2 government partners working to develop champions with the executive and legislature.

Premium Times National Health Dialogue Communique

A communique issued at the end of a two-day conference with the theme “Universal Health Coverage: The Role of State and Non-state Actors in the Healthcare Funding and Support” organised by Premium Times, Premium Times Centre for Investigative Journalism, PACFaH@Scale, development Research & Projects Centre, Project PinkBlue, International Society of Media in Public Health, Nigeria Sovereign Investment Authority and Nigeria Governors Forum. 

Preamble

In line with the United Nations’ Sustainable Development Goal (SDG) 3, which emphasises the need for Universal Health Coverage (UHC) and healthcare funding in Nigeria. PREMIUM TIMES and its partners organised this year’s National Health Dialogue with the theme: “Universal Health Coverage: The Role of State and Non-State Actors in Healthcare Funding and Support”. The dialogue, which is second in the series, attracted experts, policymakers, media, and civil society organisations.

The Vice President of Nigeria, Professor Yemi Osinbajo, represented by his Chief Personal Physician, Dr. Nicholas Audiferren, declared the event open.  Keynote and opening speeches were delivered Dr. Waziri Dogo-Muhammad, Former Executive Secretary National Health Insurance Scheme; Alhaji (Dr) Abubakar Shehu Abubakar III, the Emir of Gombe; and Dr Chiedo Nwankwo of the Paul H. Nitze School of Advanced International Studies, John Hopkins University, USA. Various experts also spoke at different sessions and panels in the course of the two-days.

At the end of the two-day Dialogue, participants made the following observations and recommendations:

OBSERVATIONS

  1. Participants describe the dialogue as needful and commendable opportunity for a multi-stakeholder conversation on the Nigerian healthcare system. They commended Premium Times and its partners for convoking the event.
  2. Absence of sufficient funding/ weak funding model: The Nigerian government has consistently under budgeted for the Health sector. The 2018 budget, for example, allocated only 3.8% of budgetary allocation to health. The 1% consolidated fund for Basic Health Care Provision Fund (BHCPF) lacks 100% releases with so many gaps as to who benefits from health insurance.
  3. There is failure of the NHIS to capture citizens in the informal sector
  4. Population overgrowth: Nigeria is estimated to be 200 million and projected to double that figure in 25 years. Family planning programs which are the best way to control population growth is frustrated by poor funding.
  5. Absence of data: The Health sector suffers a fate that troubles almost all sectors of the economy, lack of data. Initiatives and programmes are not data-driven and thus almost bound to fail. Lack of sufficient data leads to a lack of adequate information and as such, poor quality health delivery to the people.
  6. High leadership turnover: Leadership changes in Nigeria almost automatically means truncation of initiatives and programmes, no matter how laudable
  7. Corruption: Corruption does not spare the healthcare system, as seen in many scandals in the sector over the years.
  8. Poor policy implementation: Policies are poorly understood and poorly implemented to the detriment of expected outcomes and results.
  9. Strikes: The sector is poorly funded and health workers often have to resort to incessant strikes to get the attention of stakeholders.
  10. Weak or non-existent collaboration among the tiers of government and intra/inter ministry and agency: The federal, state and local governments often haggle over whose responsibility healthcare is and the agencies overseeing the health sector work independently of each other often leading to poor, inconsistent policy design and implementation.
  11. Poor knowledge about health insurance schemes, benefits and operations by citizens.

RECOMMENDATIONS

  1. Increased budgetary allocation to healthcare with intent of attaining Universal Health Coverage by 2030.
  2. Decentralization of the National Health Insurance Scheme to improve its functionality and bridge inequality in access to healthcare.
  3. Additional funding for the Implementation of the Basic Healthcare Provision Fund (BHCPF).1% consolidated funding for the BHCPF should be supported by international partners and the private sector.
  4. Increased capacity building of PHCDA workers and HMOs in identifying simple cancer signs and symptoms in other to attend to patients.
  5. Free cancer screening and subsidized rates for cancer drugs and treatment such that even the poor can afford without any financial implication.
  6. Create advocacy around causes of cancer and the Basic Health Care fund provisions to the cancer patients
  7. Tax should be placed on tobacco, champagne bearing in mind that in no time, revenue generated from oil will become very low to sustain the implementation of UHC in the country.
  8. CSOs must work towards ensuring that universal basic health care is made a top priority in the political agenda of parties during elections, which later will be enforced when they come into power.
  9. Strong advocacy for state-level implementation of the NHIS backed by constitutional provisions.
  10. Political commitment from the president and governors is important to the success of the universal health coverage. Both federal and state government must interact with clear understanding of the insurance scheme and what role each has to perform for maximum results to be achieved.
  11. Engagement of traditional rulers as advocates of the scheme will impact on participation.
  12. Non-state actors should be engaged as stakeholders to critique and contribute to policy design and implementation of the scheme.
  13. The media must employ ensure storytelling technique backed by sufficient evidence to showcase, advocate and for accountability. Data collection and harmonisation must be done such that both the supply and demand sides benefit from it.
  14. Nigeria and Africa must make a case for health in politics, especially during election period as was done in Ghana and the public must actively participate in holding the ruling government in power on delivering on its promises.
  15. Autonomy should be given to primary health centres as this will help them to meet daily expenses that are likely to hamper effective service delivery.

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