Scoring the Health Manifestos of the Three Leading Parties for the 2023 Nigerian Presidential Elections
To assess the manifestos of the three front running political parties in the 2023 presidential elections, I used a modified version of the model used by New York based Common Wealth Fund, a private foundation that is used in assessing the performance of health care systems with the aim of achieving better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, young children, and elderly adults.
We used 27 indicators that measure performance in four domains important to policymakers, providers, patients, and the public: Care Process, Access, Equity, and Health Care Outcomes.
· Care Process: This was primarily covered by three subdomains which closely looked at the standardised interventions in care delivery.
o Patient Engagement: The role of the patient is no longer as a passive recipient of care. These days patients are expected to engage in their own health, care, and treatment. It involves the implementation of initiatives that encourage patient involvement in being more active in health care.
o Coordinated Care: This involves deliberately organizing patient care activities and sharing information among all the participants concerned with a patient’s care to achieve safer and more effective care. This means that the patient’s needs, and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient.
o Preventive Care: Implementation of programmes to reduce the toll diseases have on the population.
· Access: Access to health care means having “the timely use of personal health services to achieve the best health outcomes” (IOM, 1993) and consists of four components (Healthy People 2020):
o Coverage: Facilitating easy entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status.
o Services: Provision of a usual source of care is associated with adults receiving recommended screening and prevention services.
o Timeliness: The ability to provide health care when the need is recognized.
o Workforce: Provision of capable, qualified, culturally competent health professionals.
· Equity: According to the WHO, equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification. Socioeconomic metrics which are likely to impact the quality of the health of individuals have been selected. These metrics, also known as social determinants of health are the conditions in which people are born, grow, live, work and age. The factors used include
o Access to improved source of water: which are sources that, by nature of their construction, adequately protects the water from outside contamination, in particular from faecal matter, providing some protection form disease transmitted via the faecal-oral route.
o Access to improved sanitation facility: which are facilities that usually ensure separation of human excreta from human contact, providing some protection form disease transmitted via the faecal-oral route.
o Female Education: There are many studies that link the education of girls and women with reduced child and maternal deaths, improved child health, and lower fertility.
o Poverty: Researchers have forged a solid, convincing link between low socioeconomic status and bad health, and demonstrating that there is a clear and established relationship between poverty, socioeconomic status, and health outcomes.
o Access to mass media: Mass media campaigns can directly and indirectly produce positive changes or prevent negative changes in health-related behaviours across large populations.
· Health Outcomes: These are an interrelated set of attributes that describe the consequences of disease for an individual. These include impairments, symptoms, functioning, participation in activities and social roles, and health-related quality of life. To measure health outcomes amongst the different states we used the following metrics:
o Life Expectancy: is a statistical measure of the average time a person is expected to live, based on the year of their birth, their current age and other demographic factors including sex. Life expectancy increases with age as the individual survives the higher mortality rates associated with childhood. Nigeria has the fourth lowest life expectancy rate in the world at 54 years.
o Neonatal Mortality Rate: is the statistical measure of neonatal deaths, which is defined as a death during the first 28 days of life (0–27 days). Nigeria continues to have one of the highest neonatal death rates in the world.
o Child Mortality Rate: also known as under-5 mortality or child death, refers to the death of infants and children under the age of five or between the age of one month to four years depending on the definition. Nigeria is the highest contributor to child mortality deaths in the world.
o Maternal Mortality Rate: The Maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). Nigeria has one of the highest maternal mortality rates in the world and in 2021 was responsible of 34% of all global maternal deaths.
APC
Care Process
· Patient Engagement: There is a brief one sentence on how patients will be engaged in the delivery of health services. Score: 1/5
· Coordinated Care: This was well touched on in the manifesto with plans to move patients through the different levels of care — primary, secondary and tertiary. Score: 4/5
· Preventive Care: A section of the manifesto was dedicated to the provision of preventive health services as well having the country prepared for the nest public health emergency. Score: 3/5
Care Process Score: 53% (8/15)
Access
· Coverage: Made mention to expanding the mandatory national health insurance scheme to cover 40% of the population within 2 years but no mention on how to tackle the barriers that have prevented an uptake. Also, the implementation of the community based insurance schemes is a good idea even though it already currently exists. Score: 3/5
· Services: Mention was made of ensuring that patients are within a 30 minutes walk or 3 km distance of a primary health centre with will ensure that more people have access the services they need, however given how expensive this undertaking will be given the geographical and population size of the country, no detail was given on the costs or proposed timeline to achieve this. Score: 3/5
· Timeliness: While the establishments of more primary centres will help in improving access to health, very little detail is given on how to adequately deal with the increased demand of service ensuring that people get the care as when needed. Score: 1/5
· Workforce: There are details on reviewing medical curriculum, upskilling, improving pay as well as providing favorable benefits to health professionals to increase retention. They are unlikely to stem the tide of those leaving the shores for greener pastures, but it is a start. Score: 3/5
Access Score: 50% (10/20)
Equity
· Access to improved source of water: There was mention of a national portable water supply campaign but no details of how it will be implemented. Score: 2/5
· Access to improved sanitation facility: No mention was made on improving the availability of improved sanitation facilities. Score: 0/5
· Female Education: While there was a commitment to improving female education by working with the state governments and the provision of scholarships for to encourage more women in the STEM fields. Score: 4/5
· Poverty: There are plans to build on and expand the social welfare programmes implemented by the Buhari administration even though those programmes themselves have had limited success in tackling poverty. Score: 3/5
· Access to mass media: There was no mention on improving access to mass media. Score: 0/5
Equity Score: 36% (9/25)
Health Outcomes
· Life Expectancy: No specific mention on how to improve life expectancy. Score: 0/5
· Neonatal Mortality Rate: No specific mention on how to improve neonatal mortality rate. Score: 0/5
· Child Mortality Rate: Other than proposed vaccination programmes, no specific mention on how to improve child mortality rate. Score: 2/5
· Maternal Mortality Rate: No specific mention on how to improve maternal mortality rate. Score: 0/5
Health Outcomes Score: 10% (2/20)
Overall Average Score: 37.3%
LP
Care Process
· Patient Engagement: There is no mention on how patients will be engaged in the delivery of health services. Score: 0/5
· Coordinated Care: There was no proper elucidation on how to coordinate care primary, secondary and tertiary, however the plans but commitment to implementation of the National Health Act and the revamping of the National Primary Healthcare Agency is a good start. Score: 3/5
· Preventive Care: No specific mention on the implementation of preventive health services. Score: 0/5
Care Process Score: 20% (3/15)
Access
· Coverage: Made mention to expanding the mandatory national health insurance scheme to cover 133 million people but no mention on how to tackle the barriers that have prevented an uptake or how it plans to achieve this. Score: 3/5
· Services: While the implementation of the National Health Act and Abuja Declaration on Infectious Diseases will improve funding needed for tackling infectious diseases, there is no mention on how this will be implemented. Score: 2/5
· Timeliness: Stepwise scaling of the Abuja Declaration as stated in the manifesto will help with dealing with timeliness in the provision of services but again no details were given about how it will be achieved. Score: 2/5
· Workforce: Mapping of the Nigeria’s healthcare system occupational categories to generate relevant data on human capacity and resources for healthcare training to identify weaknesses and then tapping the diaspora to assist in filling the gaps are a great idea. However, more is needed on how this will be implemented Score: 4/5
Access Score: 55% (11/20)
Equity
· Access to improved source of water: There was no mention of provision of improved source of water. Score: 0/5
· Access to improved sanitation facility: There was a brief mention of implementing a sewage masterplan and no details on implementation. Score: 1/5
· Female Education: While they are some nice ideas on tackling education, they were no specific mention was made on improving access to female education. Score: 1/5
· Poverty: There is some understanding of the impact of poverty on health as well as some explanation on how they plan to solve the problem but very little specificity. Score: 3/5
· Access to mass media: There was no mention on improving access to mass media. Score: 0/5
Equity Score: 20% (5/25)
Health Outcomes
· Life Expectancy: While there was a graph on life expectancy but no specific plans on how to improve it. Score: 1/5
· Neonatal Mortality Rate: While there was a graph on neonatal mortality but no specific plans on how to improve it. Score: 1/5
· Child Mortality Rate: Though there was a mention of its No Child Left Behind Policy to tackle child mortality, there was no real detail on how this will be done. Score: 2/5
· Maternal Mortality Rate: Though there was a mention of its No Child Left Behind Policy to tackle maternal mortality rate, there was no real detail on how this will be done. Score: 2/5
Health Outcomes Score: 30% (6/20)
Overall Average Score: 31.3%
PDP
Care Process
· Patient Engagement: There is no mention on how patients will be engaged in the delivery of health services. Score: 0/5
· Coordinated Care: Will seek to work with the States in the delivery of health services in a streamlined process. Score: 3/5
· Preventive Care: Will seek to strengthen community-based preventive health initiatives as well as carry campaigns on healthy living and proactively deal with health epidemics but does not explain how this will be achieved. Score: 3/5
Care Process Score: 40% (6/15)
Access
· Coverage: Will seek to expand the national health insurance scheme to cover 80% of the population but no mention on how to tackle the barriers that have prevented an uptake or how it plans to achieve this. Score: 3/5
· Services: Makes a commitment to expand the availability of primary health services as well as encourage states to provide special health services as well as take the health services to the people via Mobile health care delivery schemes, there is no mention on how this will be implemented. Score: 3/5
· Timeliness: The expansion and streamlining of health services coordinated via the states should help in the timeliness of service delivery but again no details were given about how it will be achieved. Score: 2/5
· Workforce: Increase funding, more training, improved clinical governance and tapping the diaspora to provide specialist services are a great idea. However, more is needed on how all these will be implemented Score: 4/5
Access Score: 60% (12/20)
Equity
· Access to improved source of water: There are brief mentions a lack of access to improved source of water and increasing that access but nothing more than that. Score: 1/5
· Access to improved sanitation facility: There was are brief mentions of the lack of proper sanitation facilities and no details on implementation on improving them. Score: 1/5
· Female Education: There was an acknowledgement of the disparity in female education when compared to males and mention was made on making the educational system more inclusive but with very little details. Score: 2/5
· Poverty: There were quite an interesting number of policies and ideas within the document on poverty alleviation within the manifesto. Score: 4/5
· Access to mass media: There were mentions in the manifesto on harnessing old and new media in pushing out policy information and using the media to implement behavioral changes but not in detail. Score: 2/5
Equity Score: 32% (8/25)
Health Outcomes
· Life Expectancy: While there were mentions of the low life expectancy on in the manifesto but no specific plans on how to improve it. Score: 1/5
· Neonatal Mortality Rate: The programmes to increase the number of skill attendants will help in improving the neonatal mortality rate but more is needed. Score: 2/5
· Child Mortality Rate: There is a brief mention on immunization but other details were provided in the manifesto. Score: 1/5
· Maternal Mortality Rate: Makes mention of developing targeted programmes to improve maternal health, specifically in the areas of antenatal care, identification of high-risk pregnancies and provision of skilled birth attendants. No mention of the service delivery though. Score: 3/5
Health Outcomes Score: 35% (7/20)
Overall Average Score: 41.8%
Conclusion
All three campaigns score poorly and do not show a great understanding of what it takes to deliver an efficient health system. However that said, the PDP had the best score, while that of the Labour Party score the least.
