…charts pathway for self-reliance, sustainable financing
The Federal Government has revealed that the largest percentage of funding in the nation’s health sector is driven domestically, with 90 per cent, leaving less than 10 per cent to external funding from donors.
This came as the country sets modalities in motion to chart a new course towards self-reliance and sustainable financing to meet the essential health needs of Nigerians in order to reduce dependence on external financing.
The Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate who spoke at the ongoing HIV/AIDS, Tuberculosis and Malaria (ATM) Generative Workshop on Monday in Abuja, said the health accounts since 2005 have consistently shown that total external funding for Nigeria’s health sector is less than 10% of the total health spend, with 90% being domestic — about a third from public sources and two-thirds from private out-of-pocket expenditure.
He, however, said there was a need for Nigeria to take ownership in financing her health system, to develop efficiency in the sector, increase domestic investment and shift towards local manufacturing of pharmaceutical products and medical supplies.
Pate expressed excitement that some of the presentations at the workshop organised by the ministry in collaboration with the ATM Technical Working Group (TWG) to design a transition pathway to self-reliance on financing essential health services in Nigeria, were already optimising the integration agenda, and the service delivery models, logistics and supply chains.
He said: “For more than two decades, we have benefited from the generosity and support of various external partners in the fight against HIV, malaria, and other conditions.
“Those partnerships have been very instrumental in supporting our nation’s response to the recent disease burden, expanding access to special services, and strengthening the capacity of our health system.
“I am especially grateful to the United States Government for its generosity, the Global Fund and others who have contributed. Many bilateral partners have supported us.
“However, the recent suspension of the World Health Organisation cuts that we have seen put us all in the urgency of reinforcing sustainable country-led systems, strengthening our local institutions, taking full programme management, and sharing long-term impact.
“Fundamentally, in the last 25 years, what we did for sustainability, those programmes, the way the global health architecture was constructed, was fundamentally unsustainable to the level of issues that we have, and that’s what we have seen.
“When we look at external finances, we are completely dependent on the support of the Organisation for Economic Co-operation and Development Government and others.
“And for us, as a country, to think that we can build a healthy nation, a healthy population, and benefit from other people’s money is full of logic.
“So while we can’t live for what we have today overnight and flip a switch because we are accustomed to programme design, institutional structures, that we are not able to afford just on our own, even when we are still facing limited resources.”
Pate, who appreciated the United States and Global Fund and other donors for the support over the last two decades, noted that the cut in funding was an eye-opener on the need for Nigeria to take ownership.
“Thanks to these changes, and I think most of the time it goes to mental changes, because they have opened us up to say, look, you have to own this issue. You have to really make the tough decisions so over time, you can exit, so that you are not perpetually hooked on those kinds of goodies that used to come for the last 20 years.”
While urging state governments to take greater responsibility for the health of their citizens, the minister charged them to increase their allocations to critical aspects of health services, especially HIV, TB, malaria, family planning and reproductive health.
“We cannot rely on external funders to invest in the health and well-being of our own people. We must invest more of our resources to take care of our people. We want the state governors to also deploy some of the revenues that they are getting from the improved fiscal situation in the country.
“With the increased resources going to the states, we’re asking state governments also to increase the resources they allocate to HIV, TB, malaria, family planning and reproductive health, so that collectively as a national health system, we meet the needs of Nigerians. That is what we’re working on, so far it’s been very good.
“Even if we’re limited in terms of resources, the will, the political will is there from the highest levels to ensure that we do our best to develop a system that meets the needs of its people.
“At a minimum, we need the states to buy or provide the commodities, train the health workers within your states to work in facilities, as a way to contribute to this overall effort.”
The Director General of the National Agency for the Control of AIDS (NACA), Dr. Temitope Ilori, explained that the workshop was focused on how Nigeria can take ownership of its health response including HIV, TB, malaria, maternal and child health, by using government structures, mobilizing domestic resources, and ensuring there’s no disruption in services.
To this end, the workshop would identify the immediate gaps and also the intermediate and long-term sustainability plan to ensure the country is not solely dependent on external aid.
According to her, the workshop would also “ensure that we guide government policies using our own existing government structures, and also facilitating domestic resources to ensure that in Nigeria, nobody is left behind, that there’s no disruption in services, that we continue to operate, and more importantly, to have a sustainable model different from what has been existing before.
“We have the political will, we know the government is responsive, we are not only reactive, but we are also responsive and responsible. The administration of President Bola Tinubu is a listening administration, and they have actually facilitated resources to ensure that there are no gaps. So we believe that because of that political will in our presidency, and of course the Minister, that we have the necessary resources to actually sustain the programmes.”
The President, Resilient Health Systems, Dr. Soji Adeyi, who maintained that external funding was a relatively small percentage of current health expenditure in Nigeria, noted that the bulk of the expenditure was from out-of-pocket expenditure.
“In Nigeria, it’s no more than 7.5% whereas in some countries, all African countries, we’re seeing 60% in Malawi, 37% in the DRC. However, that external financing accounted for large parts of these non-programmes. Of course, in our country, a large part of expenditure comes from private out-of-pocket.
Adeyi, who noted Nigeria was confronted with cultural, policy and technocratic challenges in the long-running dependence on external financing for certain commodities and certain programmes, said there was an urgent need to reorient Nigerian institutions and individuals with the goals of self-reliance.
He urged the government to focus on legislation and policy, regulations and institutions, financing and planning, in order to deliver on the health expectations of the citizens, who he noted, spend heavily on health.”
Lead Specialist, Procurement and Supply Chain Management at Resilient Health Systems, Mr. Emmanuel Nfor, called for a shift from programmes to patient and client, adding that the needs of the clients should drive all over the entire ecosystem.
“If citizens cater for over 70 per cent out-of-pocket expenditure, shouldn’t they have a say in their health needs?” he asked.
