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Universal health coverage for all Nigerians is attainable by 2020. If Buhari listens to Gowon.
Wisdom from Gowon to Buhari; Policy continuity is better for Nigeria
The national strategic health development plan, NSHDP, was published in 2010 to, along with other economic policies, help catapult Nigeria to one of the top 20 economies in the world. It is an exceedingly good policy document although the implementation was shabby during Jonathan era. Party politics aside, it is difficult to see how the Buhari Presidency can come up with a substantially better policy document on health. A great deal of thought went into the document. Unfortunately, the President has kicked the policy to the long grass, to the detriment of the health of the people. Nigerians are waiting for a "revised health policy".
But a former head of state of Nigeria has advised President Buhari to maintain continuity of policies. This is the advice from the wisdom of a former president to current president. Whether the advice will be heeded for the benefit of Nigerians and for the glory of Buhari is another matter. However if the advice were heeded, Buhari would leave an everlasting legacy for prosperity.
The NSHDP reviewed the reasons why Nigeria health system is one of the very worst in the world. Aside from poor funding, three causal themes predicated on the errors of previous reforms were identified. First, centralization of decision making and policy implementation whereby officials at the capital are making decisions that could be made by health village committees. Secondly, the health system is fragmented with too many parastatals and agency operating in silos of vertical health programs. Thirdly, the need for a multiplicity of insurance schemes rather than rely on national health insurance scheme.
The solutions to these problems are contained in the policy document although half-heartedly implemented by Dr Jonathan, the preceding President.
First, devolve policy implementation to the people. Give the calculated budget of about US$30 to Village Health Committees, on pro rata basis. With a population of 180 million, there will be 1606 Health Village Committees in Nigeria. Give these people's committees strategic health targets. Each year, publish a league table of Health Village Committees and their attainment of the targets. The health system of Nigeria will continue to deteriorate because of centralization. The origin of centralization of health policy formulation and implementation can be traced back to the colonial era. But now, health policy implementation in Great Britain has been decentralised to Local Commissioning Groups who now disburse about 60% of the health budget.
Secondly, abolish all vertical health programmes in the country, Take a cue from Cuba and use primary health care to achieve all health targets. This is what Cuba used to eradicate mother and child transmission of HIV that USA and Canada are struggling to achieve. Once vertical health programmes are abolished, give the Health Village Committees the responsibility to achieve what the vertical programmes were set up to achieve.
Finally, each state government should pass a law to mandate every Nigerian; poor or rich, king or servant, rural farmer or urban executive, to belong to a community health insurance scheme. The 2014 Presidential Health Summit recommended that insurance schemes should be made legally compulsory. The President, Dr Jonathan accepted and declared that a voluntary health insurance scheme is never effective. The research evidence is uncontrovertible that a voluntary health insurance scheme achieves little, especially in developing countries. Once registered with Community Health Insurance Scheme, a number should be issued to the enrollees. Without this Community Health Insurance Number, CHIN, nobody should be able to use any public service in Nigeria. You cannot obtain a driving license or an international passport. You cannot buy a car or set up a business. Only your CHIN, will enable you to do these.
By 2020, there will be 1606 community health insurance Funds in Nigeria serving a population of 180 million people. Every Nigerian will have health insurance. Health care treatment will be free for all at the point of use! Life expectancy will begin to improve, a healthy nation will be born ready to fight for one of the top 20 places in world economies.
In 2030, Buhari will not be remembered for the fight against corruption but as the father of universal health care in Nigeria. What a legacy?