Recent Policy Intervention and Achievements
It is generally agreed that by May 1999, Nigeria had no healthcare system to write home about. This is because the health sector had decayed to unprecedented levels. Laudable public health policies had been abandoned, institutions had decayed and staff demoralisation was very high. Routine immunization was at an all time low, primary and secondary health care facilities were totally dislocated or non-functional; equipment were either outdated or broken down all over the country, emergency services were non-functional, many hospitals had no ambulances, and referral systems between various health facilities were simply ineffective. Public expenditure on health was not even a quarter of the internationally recommended minimum.
All the rather poor data presented earlier had their roots in the mis-governance, corruption, carelessness, insensitivity and poor planning of previous, especially military governments. It was the return to democratic rule in May 1999 that set the foundation for a gradual regeneration and reform of the health care sector and commitment to addressing the issues of maternal and infant mortality. The system was so bad that at the beginning of 2000, Nigeria was ranked 187th among 191 member countries of the World Health Organisation. But the problems were so many, the decay so intense and the contradictions so deep that the government could not but try to address all sectors and problems at the same time. This in itself stretched resources and made fundamental impact very difficult.
The Reform Agenda of Olusegun Obasanjo Administration identified the health sector for special treatment as a “PRIORITY SECTOR” (along with education, works, agriculture, power, water and security) and initiated the following programmes/policies:
- Increased budgetary Allocation: Beginning with the 2004 budget, the health sector alone (excluding related ministries like water and agriculture) received 8% of allocation. The main focus was to design and implement a “viable national health system that could deliver effective, good-quality and affordable services to all Nigerians.”
- Policy Reform: The objective was to reform and prioritise attention to those areas that affected the ordinary citizen. In doing this, policies were designed to target diseases such as malaria, tuberculoses, HIV/AIDS, and reproductive health-related illnesses. The new approach was encapsulated in the Health Sector Reform Program (HSRP) of the Federal Ministry of Health that was designed to “guide the orderly restoration and improvement of the national health system to improve the quality of lives and lengthen life expectance….” This Program was endorsed by the National Council on Health and the Federal Executive Council.
- Increasing public education/awareness: The Nigerian government invested in health education to promote general awareness on health rights, promote disease prevention and improve public knowledge on obligations on health services. This was complemented with the creation of a National Health Insurance Scheme as well as a blood transfusion service designed to concretize accessibility to healthcare delivery and safer services.
- Local manufacturing of essential drugs: The Government took seriously, the manufacturing of essential drugs and reagents including anti-retroviral drugs for the management of HIV/AIDS related illnesses and also designed programmes to ensure strong antenatal, postnatal and family planning services to reduce maternal and infant mortality especially in the inner cities and rural areas.
- Private sector involvement: A special aspect of the reform was to encourage the private sector, including foreign investors to invest heavily in all aspects of health care delivery including the construction and operation of private hospitals and clinics, HIV/AIDS awareness at the workplace, improved maternity and paternity leave for workers, and other related services including counselling.
- Supervision and monitoring: Government emphasised supervision, coordination, and monitoring of healthcare delivery by agencies and institutions to ensure effective and efficient deployment of resources, implementation and deliverables especially safety, high quality standards and security for all Nigerians. The establishment of NAFDAC was to achieve part of these objectives.
- Institutional collaboration: The reform agenda sought to identify, encourage and facilitate cooperation and collaboration between different healthcare delivery units and related agencies as well as actors while building mutually rewarding partnerships within and beyond Nigeria. The Government accorded more recognition for Traditional Medicine especially in the areas of ”research and development, policy and legal development and regulation.” The National Institute for Pharmaceutical Research and Development was encouraged to collaborate and coordinate issues of intellectual property rights of traditional medicine practitioners, appropriate guidelines and standards for safety. With the assistance of the Africa Regional Office of the WHO, draft Bills on Traditional Medicine Policy, and Establishment of the Traditional Medicine Practitioner’s Council of Nigeria were being prepared. At the moment, a lot of work is being done under the strict guidelines and monitoring of the Nigeria Natural Medicine Development Agency.