DEVELOPING STATE HEALTH
PRIORITIES TO REFLECT
NATIONAL HEALTH GOALS
~ Dr Tarry Asoka (Health Adviser)
South-South Zonal Workshop on Putting
Health High on the Political Agenda
Organized by Health Reform
Foundation of Nigeria (HERFON)
January 27, 2011, EEMJM Hotel, Uyo,
Akwa Ibom State
Introduction
• Political Economy – Nigeria is a ‘federal country’;
36 States, Federal Capital Territory (FCT), 774 LGAs
• States have considerable resources and autonomy
(revenues > annual budgets of countries in SSA)
• Federal Government, all States, FCT and all LGAs –
have collective responsibility for health care to the
entire population
• But lack of cooperation among 3 tiers – acting
against effective and efficient delivery of health
care in the country.
Institutional Context
• State and Local governments - protective of their
independence in decision making
• They tend to favour large, visible, and capital intensive
projects
• Federal Ministry of Health & its Agencies - largely
influenced by a desire to retain control over the flow
of funds from the national budget, & political and
financial opportunities that these provide
• Situation compounded by lack of coordination of
policies; characterised by parallel implementation
systems, which result in duplication of service delivery
interventions and overlap even within each tier.
But things are looking different
There is now a national framework for coordinated
actions towards achieving the national health
objectives:
• composite National Strategic Health Development
Plan (NSHDP) 2010 – 2015
• drawn from the individual strategic health plans of
the 36 States, the Federal Capital Territory (FCT)
• the NSHDP represents Nigeria’s One National
Health Plan, with One Results Framework, and
One Monitoring and Evaluation (M&E) System
Mutual Accountability by all
Stakeholders
• Signing of the declaration of this plan by all the 36
State Governors and FCT Minister
• All States & FCT - agree to be individually and
collectively held responsible and accountable for
achievement of outcomes as outlined in the National
Results Framework
• President & Minister of Health - signed the Nigeria
Country Compact with International Development
Partners
• NSHDP now considered a ‘social compact’ between
political leadership (irrespective of party affiliation)
and the citizens of the respective States.
How Important is this?
You need to be aware of this arrangement
(the NSHDP) because your performance in
the health sector will be assessed on the
basis of how well you have met the targets
in your State, as stated in the National
Results Framework.
NSHDP (2010 – 2015): Situation
Nigeria’s health system performance ranked 187th out of
191 member States by WHO in 2000
PHC - bedrock of the national health system, remains
prostrate due to gross under funding,
mismanagement & lack of capacity at LGA level
Poor Health Indicators - immunization coverage of 23%;
6% of under-fives sleeping under ITNs; only a third of
children with fever appropriately treated at home; at
less than half of deliveries attended to by skilled
health personnel
Wide regional variations – Zones, States, Rural/Urban
NSHDP (2010 – 2015): Response
• Given that recent improvement in Nigeria’s
macroeconomic performance not translated into
discernable improvement in the quality of life of
Nigerians;
• And given that, to meet challenges of achieving
improved health status particularly for its poorest
& most vulnerable population, the health system
must be strengthened;
• The Federal Ministry of Health (FMOH)
understands that this can best be done within the
context of a costed National Strategic Health
Development Plan (NSHDP)
NSHDP (2010 – 2015): Process
• Generic Framework developed to serve as guide to
Federal, States & LGAs in the selection of
evidenced-based priority interventions
• Major steps in development of NSHDP Framework
included: conduct of 10 background studies;
inauguration of a steering committee and technical
working group comprising all stakeholders
• Using NSHDP Framework costed Federal & State
Strategic Health Plans were developed
• Federal level, 36 States & FCT health plans were
then collated and harmonized into the one NSHDP
The National Health Plan
Vision: To reduce the morbidity and mortality rates due to
communicable diseases to the barest minimum; reverse the
increasing prevalence of non-communicable diseases; meet
global targets on the elimination and eradication of
diseases; and significantly increase the life expectancy and
quality of life of Nigerians
Mission Statement: To develop and implement appropriate
policies and programmes as well as undertake other
necessary actions that will strengthen the National Health
System to be able to deliver effective, quality and affordable
health
The overarching goal of the NSHDP: To significantly improve
the health status of Nigerians through the development of a
strengthened and sustainable health care delivery system
Key Issues to be addressed by NSHDP
Weakness of government’s provision of primary health
care services
Organization and management difficulties that affect
the entire health system
Lack of clarity in the division of responsibilities across
different levels of government
Weak linkages across the different levels of government
and stakeholders
Inadequate governance and accountability at all levels
of the health system
Opportunity offered by a dynamic private sector that
can fill part of the gap left by the weak PHC system
Priorities for Revitalized National
Health System
Focus on two broad agenda:
1. Delivery of an essential package of care –
available and accessible to all Nigerians
2. Improving the performance of the health system
– through a holistic approach at Federal, State
and LGA levels targeted at 8 evidenced-based
priority areas: leadership and governance, service
delivery, human resources for health, health
financing, health information system, community
participation and ownership, partnerships for
health, and research for health
Essential Package of Care
(A)Family & Community Oriented Services
- Insecticide Treated Mosquito Nets for children
under 5 and pregnant women; Access to improved
water source, Infant & Young Child Feeding etc
(B) Population Oriented / Outreach Services
- Immunisation; Ante-natal care, Family Planning etc
(C) Individual / Clinical Oriented Services
- Artemisinin-based Combination Therapy for
children, Normal delivery by skilled attendant &
Emergency Obstetric Care, etc
8 Priority Areas
(1) LEADERSHIP & GOVERNANCE
- Streamline & empower Ministries of Health at the
Federal & State levels + LGA Health Departments
- Reposition their organisational & management
systems to provide strategic & tactical leadership
- Enhance mutual accountability & transparency in
the use of health development resources
(2) HEALTH SERVICE DELIVERY
- Deliver the essential package of care to all
- Improve the functionality, quality of care and
utilization of services
Priority Areas II
(3) HUMAN RESOURCES FOR HEALTH
- Get the right number of health personnel, in the
right place, doing the right job, at the right pay and
motivated to stay on based on the right incentives
(4) HEALTH FINANCING
- Increase budgetary allocation to meet the needs of
the health system
- Provide financial risk protection, especially for the
poor & vulnerable through social health insurance,
vouchers, and exemptions etc.
Priority Areas III
(5) NATIONAL HEALTH INFORMATION SYSTEM
- Provide resources: materials, money and men
(women) to obtain information for planning and
monitoring progress
(6) COMMUNITY PARTICIPATION & OWNERSHIP
- Engage communities in needs identification,
planning and implementation of health
programmes
- Empower citizens to undertake actions to improve
their health situations
Priority Area IV
(7) PARTNERSHIP FOR HEALTH
- Partner with the private sector, non-governmental
organisations, communities and development
partners (donors) as well as other social and
economic sectors to deliver health services
(8) RESEARCH FOR HEALTH
- Use simple methods to get some information to
know how well health programmes are being
received by the people
Progress so far – 2010 NSHDP
Joint Annual Review
Global awareness of the existence of the NSHDP, but
poor understanding of it works
Data for 2010 on key health outcome indictors based
on national results framework not available
Progress on health system performance is variable
Main recommendations
1. Government at all levels to concentrate efforts on
delivering essential package of care
2. rapidly scale-up mechanisms to protect people
from financial difficulties when accessing services
NSHDP (2010 – 2015): Emerging Issues
1. The need to constantly be engaged with
the political process
2. The need to strengthen the
implementation capacity at the State
level
3. The need to improve the monitoring
and evaluation of the plan
Conclusion
The arena where real actions are required to turn
around the dismal health indicators of the country
is at the State level.
And with the current zeal being shown by citizens to
participate more actively in the political process, it
may no longer be business as usual.
In the not too distant future, citizens would be
holding political office holders to account for their
stewardship.
But they too require some level of enlightenment
that can equip them for the task ahead.