60th NCH Keynote Address by Health Minister Prof. Isaac Adewole
It is my pleasure and honour to be at this 60th regular session of the National Council on Health (NCH) meeting. This is the third regular session of the NCH meeting in addition to two other emergency NCH meetings that I am privileged to chair since I took over the leadership of the Health Sector. It is important to always remind ourselves that the NCH represents the highest policy making body in the Nigerian health sector, and it is designed to enable members of the Council and stakeholders consider and deliberate on key health issues of national importance.
2. Weak macro fiscal stance, occasioned by low commodity prices over the last few years led to a contraction of the economy. Getting the Country out of recession thus became a focus of this administration. Globally, the health sector is seen as an important driver of economic growth. Studies suggest that there is a correlation between improved health and economic growth, with improvements in health outcomes typically preceding any meaningful gains in economic growth. Investments in the health sector therefore should positively impact on the economic growth of this nation.
3. To restore and improve on the nation’s economic status, this administration has put together a 4-year recovery plan with the broad objectives of restoring growth, investing in our people and building a globally competitive economy. This is why we deemed it very important to tag the theme of this year’s NCH to be “Economic Recovery and Growth Plan (ERGP) and the Health Sector: Matters Arising”.
Appreciation to the Executive Governor of Ogun State
4. Honourable Members, Distinguished Ladies and Gentlemen, let me first appreciate my brother and friend, His Excellency, Senator Ibikunle Amosun, the Executive Governor of Ogun State (The Gateway to Nigeria) and through him, the entire people of Ogun State for accepting to host this important national forum. I thank you Your Excellency. I want to also appreciate His Excellency for making health, one of the 5 point — Cardinal Programmes of his administration and prioritizing the sector since he assumed office. Your Excellency, permit me to note with admiration the infrastructural development in the state and the tremendous economic gains made by your administration. I am also proud of the commitment and dedication of your commissioner for Health and his team for doing a wonderful job in preparing for this meeting despite changes in dates. The team has represented you and people of Ogun state very distinctly. Let me also add that it is on record that the Sons and Daughters of this great state have contributed immensely to the development of the health sector both locally and internationally. It therefore means that the history of the Nigerian health sector can never be complete without mentioning great Sons and Daughters of Ogun State.
Health as an Important Driver of Economic Growth
5. Your Excellency, distinguished ladies and gentlemen, as earlier mentioned, the theme of this NCH is focused on “Economic Recovery and Growth Plan (ERGP) and relating it to the Health Sector”. The ERGP recognises that Nigeria lags behind in indicators for health, education, nutrition and employment because economic growth has been inequitable, with wealth concentrated in very few hands.
6. To grow and develop the economy sustainably, it is imperative that we must invest in the Nigerian people. This means improving access to good and affordable healthcare and education, fostering social inclusion, promoting job creation and protecting the environment. The aim is to enhance opportunities for all Nigerians irrespective of gender, age, socio-economic status and physical ability.
HOW WELL HAVE WE COLLECTIVELY FAIRED?
7. Your Excellency, council members, distinguished ladies and gentlemen, while progress has been slow, the sector has witnessed tremendous progress and we will continue to commit ourselves to our duties until we get to where we all desire to be. Let me therefore share some of our collective progress so far:
Development of the second National Strategic Health Development Plan (NSHDP II)
8. As stakeholders, you will agree with me that we have made progress in the development of the second National Strategic Health Development Plan (2017–2021). We collectively validated the well-articulated national framework in May, 2017 and that marked the end of the first stage of the process. We are currently in the second stage and making efforts to conclude by using the framework to develop specific plans for Federal and States. We also need to double our efforts and conclude the development of the entire plan before the end of this year. I therefore want to urge all Honourable Commissioners to commit themselves and ensure the completion of their state plans and submit it in two weeks.
Our Coordinated Response Efforts to Outbreaks
9. The Federal Ministry of Health through the Nigeria Centre for Disease Control (NCDC) coordinates the response to outbreaks of infectious diseases. To strengthen this function, we now have Rapid Response Teams (RRT) of epidemiologists and clinicians that are on standby for deployment to States in case of any outbreaks. In addition, medicines, personal protective equipment, consumables, laboratory reagents and other medical supplies have been provided to States across the country to ensure preparedness and support response activities during outbreaks. By this, we have become more proactive in preparing for outbreaks.
10. We have also established an Incident Coordination Centre (ICC) to implement daily intelligence gathering and risk analysis of public health events for identification of potential threats. The objective is to be informed on adequate counter-actions so as to forestall negative health consequences.
11. I am happy to share with you the good news that, Nigeria has become one of the 52 countries globally and 15th in Africa to carry out a Joint External Evaluation (JEE) of our International Health Regulations (IHR) capacities. The JEE provided an opportunity for our country to identify quick wins to strengthen our health security through a transparent process.
12. Correspondingly, we have developed disease guidelines for VHFs, Cholera/Acute Watery Diarrhoea and Cerebrospinal Meningitis. A Public Health Risk Assessment of Zika Virus in Nigeria and Interim Recommendations were also developed in anticipation of Zika cases. These guidelines provide details on prevention, management and response to infectious diseases and outbreaks to ensure a harmonized plan of action across the country. It is therefore to our credit that National Public Health Reference Laboratory (NPHRL), Gaduwa, Abuja now conducts relevant tests required to identify and monitor infectious diseases. For instance, the laboratory was used during the Meningitis outbreak on the 1st of June 2017 and the first Laboratory staff meeting held at the lab. Currently, the NPHRL can carry out PCR test of Meningitis, Avian Influenza, Cholera, VHFs and is further building its capacity to test all endemic prone diseases in Nigeria.
We wish to specially appreciate Mr President and Commander-in-Chief, President Muhammadu Buhari for commending the efforts of Federal and State Ministries of Health during the presentation of the 2018 Budget Proposals.
We also extend Mr President’s appreciation to WHO, UNICEF, GFATM, BMGF, USAIDS, USCDC, DFID, UNFPA and other partners for their support.
13. As you may be aware, the Federal Ministry of Health’s NCDC currently hosts the ECOWAS Regional Centre for Disease Control (RCDC) established by the West African Health Organisation (WAHO). In January 2017, Nigeria was selected as the regional hub of the Africa CDC for the West African region and within six months hosted meeting of the Africa Centre for Disease Control (ACDC) and WAHO.
14. Based on this development, states are to take ownership of disease preparedness and response activities, while the federal level will continue to provide support for outbreak response activities. States are also to support their Public Health Departments and State Epidemiology teams with resources required to adequately prepare and respond to outbreaks. The ultimate aim is for each Nigerian to become a Surveillance Officer, and notify designated authorities of disease occurrences whether usual or unusual.
Revitalization of Primary Healthcare Centres in Nigeria
15. Distinguished Ladies and Gentlemen, it is apparent that the roles of the health care systems have been reversed as primary healthcare has ceased to be the first point of call for most Nigerians, despite being best positioned in terms of proximity and service packages. To correct this situation, we have reorganized the National Primary Health Care Development Agency to ensure effective healthcare delivery on its mandate and in doing so, we have outlined four priority areas. These include: PHCs Revitalization, Closing out Polio in Nigeria, Strengthening Routine Immunization and supply chain, and Strengthening governance and accountability.
16. Obviously, the process of effective PHC revitalization is very close to the heart of this administration and we are therefore providing it as a vehicle for the attainment of Universal Health Coverage (UHC). In this regard, we are collaborating with all the States through their Primary Health Care Boards in the selection, renovation and equipping of selected health facilities as part of the on-going PHC Revitalization agenda.
17. Further demonstrating this Administration’s commitment to put the healthcare of Nigerians as a top priority, Mr. President flagged-off the PHC revitalization programme with the commissioning of the Kuchigoro Primary Healthcare Centre. The centre will deliver care to vulnerable population such as women, children under 5 years of age and the elderly. The objective of these efforts is to further reduce financial shocks associated with seeking care, promote equity, expand availability and accessibility of health services.
18. To sustain our PHC revitalization agenda, we will leverage on the National Health Act, which guarantees, a minimum package of services in primary healthcare facilities under the Basic Health Care Provision Fund (BHCPF).
Phase one of the BHCPF will commence in the first quarter of 2018, and will run in 3 start up States — Abia, Niger and Osun. The program has the potential to reach up to 8 million Nigerians. The BHCPF will aim to achieve the following:
· Ensure monies are disbursed, managed and accounted for in a transparent manner;
· Safeguard funds flow from source (at the federal level) to service delivery points;
· Increase service utilization and health worker productivity
· Monitor service delivery, including improvements in service delivery readiness in line with accreditation standards and operating protocols.
· Put in place the systems needed for a mandatory insurance mechanism, such as accreditation, purchasing, provider payment, and verification.
19. It is our firm believe that by implementing the Basic Health Care Provision Fund, we will be addressing underlying system challenges, such as inadequate decentralization of services and weak Primary Healthcare Systems, weak referral linkages between the 3 tiers of the health system in Nigeria, inefficient health financing and persistent financial barriers to accessing healthcare services.
Strategic Intervention in Tertiary Institutions
20. At the tertiary care level, we are reminded daily of the burden faced by Nigerians who require treatment for complex cases such as oncology, renal and cardiology care.
Not a day passes by, that I do not receive a request for financial support to defray the costs of medical treatment sought outside of the country. Data suggests over $1bn is spent annually on medical tourism by Nigerians.
This is unacceptable and needs to be addressed decisively. Consequently, we have entered into strategically alliance with the Nigerian Sovereign Investment Authority (NSIA) to co-invest in centres of excellence to be co-located with selected teaching hospitals across the 6 geopolitical zones and the FCT.
The partnership is symbiotic and aims to be greater than the sum of its parts. It is underpinned by three key principles: (i) Crowding in private sector resources through sustained partnership; (ii) Leveraging private sector implementation skills set within public sector institutions; (iii) Using competition to keep prices low for patients through competitive bidding process for hospital operatorships.
We are confident that the first two centres with a strong focus on cancer care will be ready for public use in the first quarter of 2018.
HIV and AIDS
21. HIV/AIDS remains a persistent threat to the health of Nigeria’s population, straining the already struggling health care system and compromising the past developmental gains
This calls for a concerted and sustained effort by all stakeholders to reduce the transmission of HIV in Nigeria.
Government is addressing this issue in collaboration with its partners through more funding and intervention measures in the areas of HIV testing services, prevention of mother to child transmission, antiretroviral therapy, joint HIV/TB programme and monitoring, supervision and evaluation of these intervention measures. As at the end of June 2017, the number of individuals placed on antiretroviral therapy in the country is 1,050,594 as against 983,980 reported at the end of last year. Government is also implementing other HIV prevention and control programs including the fast-track program in 6 states plus the FCT to reduce the HIV epidemic in the country.
Update on the fight against TB
22. At this juncture, we need to remind ourselves that Nigeria has the highest burden of TB in Africa. It is on record that Nigeria currently detects 1 out of 6 cases of TB annually and this represents only 17% of its estimated annual TB cases, with several cases left undiagnosed and serving as reservoir for continued transmission of TB.
23. In view of the huge gap in TB case finding and the commitment of the present administration towards ending TB in Nigeria, 2017 was declared the year of “Accelerating TB Case Finding”. This declaration was to mobilise political commitment and resources from all levels of Government and Partners for the implementation of strategic TB case finding interventions.
24. Our other efforts to increase TB case finding is by our partnership with KNCV through the USAID-funded Challenge TB project implementing Active Case Finding for TB, called the “Wellness on Wheels (WoW) project”. These mobile TB diagnostic units are meant to bring TB diagnosis to the door steps of clients as a one-stop shop and help ensure early diagnosis and treatment of TB to halt transmission of TB in the community. This project was flagged off in Abeokuta and the trucks will move from state to State to enhance the TB case finding. We wish to thank HE Governor Amosun, our TB Champion for physically flagging off the initiative. He has offered to purchase for keeps, the first truck.
25. To further enhance the TB case finding, we urge the states to ensure that basic TB services, identification and referral are provided at all Primary Health Care centres in their states.
Health Sector Response to Humanitarian Crisis
26. On humanitarian crisis, we have developed the Health Sector Response to Humanitarian Crisis Plan for the Country, with an initial focus on the North East. The Federal Government has also developed a six month Health and Nutrition Emergency Plan and approved and released the sum of Four Billion, Three Hundred and Forty Four Million, Six Hundred and Two Thousand, Eight Hundred and Fifty Naira (N4,344,602,850.00) only for this purpose. The Intervention has indeed:
i. Increased the uptake of high impact interventions in affected communities;
ii. Reasonably improved management of co-morbidities (E.g. Upper Respiratory Tract Infection, Urinary Tract Infection, STDs, HIV infection, TB, Diabetes Mellitus, and Hypertension); and
iii. Increased capacity of health workers to identify, counsel, manage and refer those in need of Mental Health and Psychosocial Support
27. I want to once again thank His Excellency, Mr. President for making this intervention possible and his further approval for its extension for another six months.
The Saving One Million Lives Initiative (SOML)
28. Under the SOML-PforR, there have been obvious and gradual improvements in the ability of States to generate, utilize and analyze data, thereby improving their own internal decision making processes. This is in line with the SOML-PforR objective to encourage each State and the FCT to implement a Performance Management System for improved health outcomes.
29. The SOML-PforR has created a paradigm shift from input-focused approaches to a focus on results. States can no longer hide under national averages. Among several other things, the advent of the SOML-PforR has led to annual population-based and facility surveys, such as the National Health Facility Survey (NHFS). Results from the 2016 NHFS have been disseminated nationwide, and we are currently working with States to extract and internalize State-specific findings and their implications for each State.
30. Expectedly, the next round of disbursements will be based on the performance of each State and calculated using the agreed survey. The Independent Verification Agent (IVA) and the National Programme Management Unit have done the necessary calculations. These will be presented during the SOML-PforR National Steering Committee Meeting, which will hold tomorrow.
Partnership on Human Resources for Health
31. It is important to stress here that, Human Resources for Health (HRH) is the cornerstone and heartbeat of any healthcare delivery system. Without a strong and skilled health workforce, no country can deliver adequate healthcare services to its population.
32. Yet Nigeria continues to grapple with HRH challenges, which include disparities in remuneration packages, low morale, acute shortages and uneven distribution of health workers and inter-cadre conflicts.
33. It is against this backdrop that the Federal Government has commenced partnership with State Governments, the first being the signing of a Memorandum of Understanding (MOU) with Sokoto State Government on how to use the available human resources in the Usmanu Danfodiyo University Teaching Hospital (UDUTH) to extend quality healthcare services to the rural communities in the state.
34. The partnership is on five thematic areas. Metropolitan Posting, Rural Posting, Outreach Services, Accident Cases and establishment of State Medical School/ Teaching Hospital. The partnership would fast track delivering of quality healthcare services to the grass roots. Our doors are always open to partner with States towards the improvement of health services in your states and for Nigeria as a whole
Strengthening Health Research:
35. Health Research has been neglected for some time. We have now taken the issue of Research for Health more seriously as an enabler for an improved health sector performance. I have inaugurated the National Health Research Committee to give us a blue print for the promotion of health research in the country. This is in line with the National Health Policy and National Health Research Policy. Various research activities being carried out by our foremost Research Institutions (NIPRD and NIMR) including those in private and public health institutions have to be harnessed for improved decision-making and policy development/implementation. In recent times, the efforts of our Research Institutes in developing a road map to tackle Antimicrobial Resistance in the country readily comes to mind among other laudable achievements. NIPRD, as part of its achievements, is now an ISO 9001 (2008) Certified for Institute — wide Quality Management System (QMS), while still pursuing its ISO 17025 laboratory Accreditation in partnership with USAID sponsored USP’s promoting the Quality of Medicines Initiative. Also, the Nigerian Institute of Medical Research recently received ISO accreditation of its laboratory at the Institute’s Center for Human Virology and Genomics by the South African National Accreditation System (SANAS) with a unique number M0588. This means that the results from our laboratory in accredited areas are now of international standards and are comparable to results from similarly accredited Institution globally.
36. It is now imperative to identify need driven health research projects for generation of National data on health issues. In this regard the secretariat of the National Health Research Committee will soon organise a major stakeholder’s forum on generation and utilization of health research data. I therefore call on our partners to expand their focus to include support for Research.
37. Your Excellency, distinguished ladies and gentlemen, I will like to conclude my speech by reiterating the commitment of this administration to revamp the Nigerian health system by making the PHC the fulcrum for achieving excellent health services for our people. Therefore, I want to use this medium to implore all development partners to support this initiative and reprioritize their support to our current vision. We do not want duplication of efforts and wastage of resources. I will also want to use this occasion to once again appeal to State governments to invest in health and make it one of their political deliverables in their domain. I believe we can deliver and get to our desired destination of UHC.
38. In closing, I want to once again thank His Excellency and the good people of Ogun State for successfully hosting this important national meeting and also extend my appreciation to all Members of the Council and other delegation, as well as our partners for finding time to attend this year’s NCH meeting. Not forgetting my constituency, I want to thank my brother Dr Osagie Ehanire, the Honourable Minister of State for Health and the entire management and staff of the Federal Ministry of Health led by the Permanent Secretary, Mr. Clement Osarenoma Uwaifo for making this year’s NCH a success. My profound gratitude also goes to the Honourable Commissioner for Health, Ogun State, Dr. Babatunde Ipaye, for his hard work and dedication that made the NCH happen in Ogun State.
39. I thank you all for coming and for the expected useful contributions that would make this meeting a huge success and for your efforts in different fora to improve our country’s healthcare system. Please let us continue with the good work because in no time we shall reap the dividends of our collective efforts. Together we will achieve the best health care services for our Country and bring an end to medical tourism outside Nigeria. Yes we will.
40. I thank you all and wish us fruitful deliberations.
41. God bless the Federal Republic of Nigeria.
Professor Isaac Adewole, FAS, FSPSP, FRCOG, DSc (Hons)
Minister of Health,
9th November, 2017.