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Nigeria’s journey to Universal Health Coverage slow- Ehanire

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*Identify limited funds as a major challenge affected advancement of PHC

By Francesca Iwambe, Abuja

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The minister of health Dr Osagie Ehanire has admitted that Nigeria’s journey to Universal Health Coverage, (UHC) has been slow.

Speaking during the 2022 National Health Dialogue organised by the Centre for Journalism Innovation and Development (CJID) in collaboration with PREMIUM TIMES, Dr Ehanire however noted that remarkable milestones have been achieved.

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Represented by the Director, Primary Health Care System Development, National Primary Healthcare Development Agency, NPHCDA, the minister disclosed that with heightened efforts to revitalize and strengthen PHC system, Nigeria is moving closer to attaining UHC.

Identifying the challenges affecting the advancement of PHC system, the minister listed limited funds, dilapidated infrastructure, weak referral systems, shortage and mal-distribution of healthcare workers as some of the challenges.

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“Several challenges have bedeviled the Nigerian Primary Healthcare System. Some challenges are the shortage and maldistribution of healthcare workers, dilapidated infrastructure, and weak referral systems.

“However, limited financing for the primary healthcare system stands out as a factor that has significantly limited the advancement of our primary healthcare system. National Health Account reports published over the past decade indicate that expenditure on primary healthcare has been sub-optimal, with significant spending on curative healthcare.

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“The inadequacy in funding for the primary healthcare system has negatively impacted the delivery of services such as immunization and maternal and child health services”, he said.

Dr Ehanire who further disclosed that the theme of the dialogue: “Role of State and Non-State Actors in Primary Healthcare Financing” was apt said, everyone has a role to play financing primary healthcare in Nigeria.

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“The private sector, civil society organizations, non-governmental organizations, the media, faith-based organizations, trade unions, professional organizations, academia, community groups and private citizens alike can all contribute to financing primary healthcare in Nigeria.

“To strengthen the primary healthcare system, the Federal Government of Nigeria has continued to make efforts to improve the proportion of resources allocated to the primary healthcare system.

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“The Basic Health Care Provision Fund has been a game changer and resulted in increased financing for the primary healthcare system through the different gateways.

“Efforts from agencies like the National Primary Health Care Development Agency and the National Health Insurance Authority have contributed towards financing Primary Healthcare in Nigeria.

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“Guided by data from the National Health Account Reports, which indicate astronomically high out-pocket expenditure for healthcare, the Government of Nigeria determined that it would provide more resources for health, hoping for a significant reduction in out-of-pocket spending and more funding for priorities such as primary healthcare”, Ehanire added.

The World Health Organisation, WHO in their goodwill message decry shortage of funding for health.

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Quoting the National Health Account, the global health body said, it had estimated that 16.6% of the Current Health Expenditure is from Government (Federal, State, and LGA), 11.8% is from Development Partners while 3.6% is from Insurance.

This it disclosed leaves the remaining 70.5% of health care spending in Nigeria including primary healthcare to households who pay out-of-pocket with catastrophic potentials.

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In addition, it is important to note that 61.4% of health spending in Nigeria is on communicable diseases such as Malaria (36.2%), HIV and other STDs (10.4%), Tuberculosis (5.5%) and vaccine preventable diseases (4.7%).

According to the WHO Representative in Nigeria, Dr. Walter Kazadi Mulombo, considering the above, the task of ensuring that all citizens have access to the quality healthcare they need without falling into poverty is a deliberate political decision and in a large federal nation like Nigeria.

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He said that this would depend on how the governments at the different tiers complement themselves but most importantly collaborate with non-state actors including the private sector.

He added that non-State Actors are integral partners towards ensuring that no one experiences financial hardship and unmet needs.

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“Non-State Actors have therefore been integral partners towards ensuring that no one experiences financial hardship and unmet needs.

“Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

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“Although COVID-19 pandemic revealed global fractures in all systems with far-reaching consequences even in sectors beyond health, it however has provided clear opportunities to demonstrate the importance of health not only as a social service but a key enabler of economic development of any nation, reaffirming that health is wealth. Indeed, COVID proved that meaningful investment of non-state actors such as CACOVID in Nigeria can significantly strengthen the hand of government in accomplishing huge milestones.

The pivotal roles played by local and international non-state actors including foundations like (Dangote, BMGF, CHAI, PharmAccess, Pathfinder, etc) in the establishment and functioning of key health financing mechanisms such as the Basic Healthcare Provision Fund, Global Fund, GAVI, COVAX, etc cannot be over-emphasized. These mechanisms are very instrumental in guaranteeing access to lifesaving PHC services to millions of Nigerians”, he added.

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Health

Monkeypox renamed mpox, WHO announces

monkeypox
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The World Health Organisation has said it will start using a new preferred term, ‘mpox’, as a synonym for monkeypox.

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According to the WHO, the change of name followed a series of consultations with global experts.

In a statement on Monday made available to The PUNCH, the agency said when the outbreak of monkeypox expanded earlier this year, racist and stigmatising language online, in other settings, and in some communities was observed and reported to WHO.

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“Assigning names to new and, very exceptionally, to existing diseases, is the responsibility of WHO under the International Classification of Diseases and the WHO Family of International Health Related Classifications through a consultative process which includes WHO member states.

“WHO, in accordance with the ICD update process, held consultations and further discussions with then WHO’s Director-General Dr Tedros Ghebreyesus, WHO recommends the adoption of the new synonym mpox in English for the disease and mpox will become a preferred term, replacing monkeypox, after a transition period of one year.”

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Yuletide: NCDC warns of possible COVID-19 infection rise

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The Director-General of the Nigeria Centre for Disease Control, Dr Ifedayo Adetifa, has predicted that Nigeria will likely see an increase in COVID-19 cases and a decrease in hospitalisation over the holiday season this year.

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Adetifa claimed that the increase in travel over the holiday season might result in a rise in cases.

He said, “We are prepared to see that there may be a bump in cases just because of the increase in travel and the number of people returning. What we may not expect to see is an increasing number of people who are sick.”

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The NCDC boss said vaccination and previous COVID-19 infections provided some degrees of immunity.

“The population has quite a bit of immunity due to vaccination, previous COVID-19 infection, or repeated COVID-19 infection. So. COVID-19 is not new. The Omicron is not new like it was in November (2021).

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“If you look at our numbers, we haven’t lost people for a while. Even if every single death is a great disaster for people’s families or friends, it’s not anything like the Delta variant when we had a big problem,” he added.

Speaking further, he said the Omicron variant was the dominant strain in the country.

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He said, “Omicron took over as the dominant variant in November and December last year, and it has refused to go anywhere. Other minor variants have emerged, but Omicron remains the most dominant.”

The latest data from the NCDC showed that there were 266,283 confirmed cases of COVID-19 with 3,155 deaths, while the number of discharged cases stood at 259,640 as of November 18.

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NARD raises alarm over migration of doctors

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*Says, 4,000 doctors migrating soon

*Its now a ratio of one doctor to 10,000

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By Francesca Iwambe, Abuja

The Nigerian Association of Resident Doctors, NARD, has raised the alarm over the migration of doctors.

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NARD national president of NARD, Dr Emeka Orji, said on Sunday about 4,000 of its members are planning to disengage their services in the country and migrate abroad for greener pastures.

Dr Orji while expressing worry over the developme noted that it is now a ratio of one doctor to 10,000 patients in the country.

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While lamenting government’s unjust treatment of it members, he said with government’s nonchalant attitudes to members’ salaries, welfare and other deserved packages, the country may be heading to a point where it would have no doctors anymore.

NARD revealed that Nigeria had already lost 2,000 doctors to the outside world in the last two years.

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It tasked the government to halt the drift by doing the needful to avoid what it called disaster in the nation’s health sector.

This, he noted, was far above the World Health Organisation, WHO’s recommended ratio of one doctor to 600 patients.

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Although he admitted that mobility of labour was recognized anywhere in the world, he, however, said there were several reasons why people can decide to leave their countries or migrate to other places, tasking government to find out the reasons and address them.

The NARD president, who was responding to questions on the brain drain among other issues in the nation’s health sector, said: “Mobility of labour is recognized anywhere in the world.

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“There are several reasons why people can decide to leave their counties or migrate to other places even to move from one state to the other in the same country to work ranging from welfare services, remuneration,working condition, security and other social issues.
“And what government should do is to try to find out why and then address it.

“That is what a serious government does, because the truth is that it is really a very serious problem in the health sector as we speak and we believe it is an emergency and that if nothing is done urgently to arrest the drift, we would come to a stage where we won’t have doctors in our hospitals.

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“Over the past two years or so,we have lost over 2,000 doctors to an outside world and on average,we have lost between 100 to 160 doctors every month.

“We are not just talking about the low-level staff here,we are talking about the highly specialized doctors leaving the country.

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“And when you undertake studies to know why they are leaving, 80 percent of them responded that it is because of poor remuneration.

“The salary structure we are using now came into being in 2009. That is over 13 years ago and part of th agreement we had with government then was that it should be reviewed after five years.

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“And that five years was in 2014. Till now, we have been writing for it to be reviewed but we have not made any significant headway on that.

“You know th living conditions in 2009 compared to now with r gards to inflation, dollar exchange rate and all that.

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“As a matter of fact, somebody like me; I’m a senior registrar, but what I was paid in 2009 as a house officer, if you will get the dollar equivalent, you would realize that it was even more than what I’m being paid now.

“So there is nobody that will see that kind of thing and stay back, especially seeing a place where your work is better appreciated, that won’t be tempted to go there.

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“As I’m talking to you now, we have found out that over 4,000 of our members have decided to migrate within the shortest possible time.

“And if that happens, I can assure you that it would be a disaster. It will lead to poor patient management and difficulty in assessing health care.

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“Patients will have long clinic hours such that a patient that should ordinarily see a doctor within one hour can spend the whole day, because if you have one doctor attending to more patients than he should, of course, he won’t give in his best and even the patient would have to wait much longer to be attended to.

“The approved doctor-to-patient ratio by the World Health Organisation, WHO, is one to 600. That is one doctor to 600 patients.

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“But currently in Nigeria, we are doing one doctor to 10,000. You can see the huge gap and it would continue to worsen if government doesn’t don’t do the right thing.”

Dr Orji, who said the leadership of his organisation has been discussing with government on the need to do the right things, regretted that the latter was not expediting actions in addressing the identified grey areas.

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Orji said NARD was taking proactive steps to ensure members were given deserved attention by the government, saying it had met with many stakeholders for intervention.

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