Protocols.
Thank you for providing this platform for us to
communicate with Nigerians about our activities over the past several months,
under the leadership of President Bola Ahmed Tinubu, GCFR.
On behalf of the Honourable Minister of State for
Health, the Permanent Secretary, along with the Director Generals, CEOs of
agencies and regulatory bodies, and the CMDs of our hospitals, I am pleased to
present this report.
People’s Voices.
Initially, when we started we embarked on a
deliberative process to understand the expectations of Nigerians through the
People’s Voices Survey. We examined the experiences and expectations of
Nigerians, the burden of diseases and how it is evolving, what is working well
and what is failing, the state of health infrastructure, human resources,
financing, and the overall state of health of Nigeria.
We consulted with the States, development partners,
civil society, and the private sector to articulate an agenda that aligns with
the President’s overall reform agenda (The Renewed Hope Agenda). This agenda in
health aims to save lives, reduce physical and financial pain, promote health,
and ensure it is accessible to all Nigerians.
Since announcing the health agenda, we have been actively implementing it. Over the last several months, we have made considerable progress implementing the four pillars, which I will report on regarding our accomplishments, not just our future aspirations, to build human capital, improve health and well-being of our people to drive future prosperity in our country.
(Right) Coordinating Minister of Health & Social Welfare, Muhammad Ali Pate
(Centre) Minister of Information & National Orientation, Mohammed Idris Malagi
(Left) Minister of Budget and Economic Planning, Sen. Abubakar Atiku Bagu
First Pillar:
Improve the Governance of the Health Sector. While not as tangible,
improving governance is crucial for advancing the health and welfare sector. It
requires collaboration between the federal government, states, development
partners, private sector and civil society.
We signed a strategic
compact with all the 36 States of the Federation and FCT, endorsed by Mr.
President, during the unveiling of the Health Sector Renewal Investment
Initiative (SWAp) in December 2023. For the first time, our development
partners signed a Compact governing our joint operations with them. This also
included the private sector and civil society. At that event, our partners pledged $3 billion, reflecting their confidence in Mr.
President’s agenda. Of this pledge, we have signed $932 million grant with GFATM, $200 million with a philanthropic
foundation and expecting additional $60
million in grants, $150 million announced by the Gavi Alliance, in
addition to US$1 billion facility governed by MOU signed with Afreximbank to unlock the healthcare value chains.
Additional resources are being mobilized.
We have begun to strengthen the regulatory framework
within the sector. There are 16 professional regulatory bodies and other
regulators of pharmaceuticals, such as NAFDAC, pharmaceutical council, medical
laboratories, medical and dental council, nursing and midwifery council, and
other aspects of the ministry’s stewardship role that we have repositioned and
reinvigorated their leadership. We have also engaged constructively with health
professional associations and unions to foster healthy work environment.
We have embarked on an ambitious digital
transformation agenda to be on the path of electronic records, quality data for
decision making and stronger data governance.
Additionally, we have set up a committee on
standards for tertiary healthcare, which has been absent for eight years. This
committee is tasked with defining the standards for tertiary facilities, in
line with the National Health Act. The details of these standards are now
accessible online.
We have also engaged multiple times with civil society, traditional leaders, religious leaders, and the media across the country, as a way to improve our orientation towards service to the Nigerian people, not narrow interests.
(1st right) Attorney General of the Federation and Minister of Justice, Prince Lateef Olasunkanmi Fagbemi
(2nd right) Coordinating Minister of Health & Social Welfare, Muhammad Ali Pate
(1st left) Minister of Budget and Economic Planning, Sen. Abubakar Atiku Bagudu,
(2nd left) Minister of Information and National Orientation, Mohammed Idris Malagi
Second Pillar: Population Health Outcomes: Now, concerning the substantive second pillar—improving the population health outcomes of Nigerians—it is important to note that the federal government is only one part of this effort. Other sectors of the government also contribute significantly at the Federal level, as well as State Governments and intergovernmental entities.
At the federal Ministry of Health, we oversee 30
teaching hospitals, 22 federal medical centers, and 21 specialty hospitals,
along with 5 core agencies, 16 regulatory bodies, 10 departments, and 3 special
units.
At the primary health care level, through the National
Primary Health Care
Development Agency, in collaboration
with the States, we outlined a plan to revive
8300 primary health care centers across the
nation to make them fully functional and to
expand and upgrade to 17,000 Primary Health Care Centers over the next 3-years.
The expansion is to refurbish these centers, equip
them, making them fully functional to deliver essential services such as
immunization, reproductive, maternal, newborn, and child health services,
treatment of non-communicable diseases, and to facilitate referrals to
secondary facilities. However, this ambitious plan requires the states to
complement the efforts of the federal government.
We reviewed audits on the previous utilization of
such financial resources and identified major gaps in several states. These
issues were addressed through the National Economic Council and the Governors’
Forum. Our state governors have been instrumental in aligning with the
President’s vision for increasing investments in the health sector. The
transparency of disbursing the Primary Health Care Provision (BHCPF) funds was
enhanced by conducting it publicly and establishing a hotline for Nigerians to
report any misuse of resources. Oversight bodies such as the ICPC and EFCC are
also encouraged to monitor to ensure that the implementation at the state level
aligns with the intended objectives, particularly in terms of infrastructure
and equipment and that the resources not misused.
In September, we
announced the commitment to retrain 120,000 frontline health workers. This is part of a three-year
agenda, and His Excellency, Mr. President, was recognized by the African Union
as the African champion for human resources for health and community health
delivery.
To fulfill this promise, we have reviewed and
updated the training guidelines and curriculum for these frontline health
workers. The revised guidelines have been printed, and the resources for
training have been secured. The trainers
have been trained in almost all States. Within the next one or two weeks, the
training itself will commence across all states of the Federation. Over the next three years, at least 120,000 frontline health workers serving
rural populations will be equipped with the necessary skills, supported by the
infrastructure and equipment we will provide.
At least 1,400
Primary Health Care Centers are now equipped to provide skilled birth
attendance, funded through the NPHCDA and the NHIA, covering the 8,300 facilities. More
than 2,400 health workers, including nurses, doctors, and midwives, have
been recruited to provide services to Nigerians, many of whom are women in
rural areas delivering essential services.
In the area of vaccination, over 5 million
Nigerian children have been vaccinated against
diphtheria using pentavalent vaccine. More than 10 million Nigerian children
received the tetanus and diphtheria vaccines.
We are working hard to stop the circulating variant polio viruses showing
up in Kano, Katsina, Sokoto, Zamfara and Kebbi States. We have delivered
measles vaccines to more than 5 million children to protect them against
measles, and 4.95 million girls 9-14 years in 15 States have received HPV vaccines
to protect them against cervical cancer, representing 80% target, among the
highest in the world. 6 million more are planned to receive the vaccines in the
next phase for 21 states starting from May 27, 2024.
We are witnessing substantial upgrade in healthcare
infrastructure, a testament to the President’s leadership. Plans are underway for the groundbreaking ceremony of 10 healthcare infrastructure projects, through
the NSIA, across the six geopolitical zones,
including diagnostic centers and oncology centers. These developments are
part of a broader initiative involving public-private partnerships. We are
moving forward with a major PPP to get to the full business case stage for
expanding infrastructure and equipping 6 teaching hospitals.
Addressing the critical issue of the health
workforce, we have doubled the intake capacity of our educational institutions.
Enrollment quotas for medical schools, nursing schools, and other health professional
training institutions have increased significantly
from 28,000 to 64,000 annually. Now the hard work of getting educational
institutions to enhance infrastructure, teaching materials to ensure quality is
not eroded by expanding the quantity. This is necessary given the shortage of
health workforce.
We have also approved a managed migration policy for
health and are looking at how best to address the excessive workload of medical
providers, especially the medical doctors. In
the last 7 months, more than 100 young medical graduates secured residency positions in the US and we
issued the certificates of need for them to
be trained and return home, and changed the policy to include domestic as
well as internationally trained medical graduates. We are working with Ministry
of Labor as well as Salaries Incomes and Wages Commission to address long-standing
legacy issues of compensation and allowances, which will take time and more
patience from health workers.
All the above are on the supply side, but on the
demand side, to expand affordability and financial protection, we are
repositioning NHIA to expand insurance coverage for all Nigerians, especially
the poor and vulnerable, not excluding civil servants who need deepened
coverage. 1.8 million Nigerians are covered
through the Vulnerable Groups Fund at
NHIA. Reforms of the NHIA soon to be announced will address areas,
including expanding private health insurance for informal sector, and
strengthening the HMOs in tandem with SSHIAs at the States, repositioning NHIA
as an effective and efficient regulator of the health insurance markets.
Unlocking the
Healthcare Value Chain - The third pillar of our agenda is to unlock the
healthcare value chain. The President has emphasized the importance of
domesticating production capabilities, to retain economic value, and create
jobs for our youth. In October, Mr. President approved the Presidential
Initiative to Unlock the Healthcare Value Chain. Since then, we have made
steady progress in policy changes to facilitate this goal.
We are witnessing substantial upgrade in healthcare
infrastructure, a testament to the President’s leadership. Plans are underway for the groundbreaking ceremony of 10 healthcare infrastructure projects, through
the NSIA, across the six geopolitical zones,
including diagnostic centers and oncology centers. These developments are
part of a broader initiative involving public-private partnerships. We are
moving forward with a major PPP to get to the full business case stage for
expanding infrastructure and equipping 6 teaching hospitals.
Addressing the critical issue of the health
workforce, we have doubled the intake capacity of our educational institutions.
Enrollment quotas for medical schools, nursing schools, and other health professional
training institutions have increased significantly
from 28,000 to 64,000 annually. Now the hard work of getting educational
institutions to enhance infrastructure, teaching materials to ensure quality is
not eroded by expanding the quantity. This is necessary given the shortage of
health workforce.
We have also approved a managed migration policy for
health and are looking at how best to address the excessive workload of medical
providers, especially the medical doctors. In
the last 7 months, more than 100 young medical graduates secured residency positions in the US and we
issued the certificates of need for them to
be trained and return home, and changed the policy to include domestic as
well as internationally trained medical graduates. We are working with Ministry
of Labor as well as Salaries Incomes and Wages Commission to address long-standing
legacy issues of compensation and allowances, which will take time and more
patience from health workers.
All the above are on the supply side, but on the
demand side, to expand affordability and financial protection, we are
repositioning NHIA to expand insurance coverage for all Nigerians, especially
the poor and vulnerable, not excluding civil servants who need deepened
coverage. 1.8 million Nigerians are covered
through the Vulnerable Groups Fund at
NHIA. Reforms of the NHIA soon to be announced will address areas,
including expanding private health insurance for informal sector, and
strengthening the HMOs in tandem with SSHIAs at the States, repositioning NHIA
as an effective and efficient regulator of the health insurance markets.
Unlocking the
Healthcare Value Chain - The third pillar of our agenda is to unlock the
healthcare value chain. The President has emphasized the importance of
domesticating production capabilities, to retain economic value, and create
jobs for our youth. In October, Mr. President approved the Presidential
Initiative to Unlock the Healthcare Value Chain. Since then, we have made
steady progress in policy changes to facilitate this goal.
The forthcoming executive order, prepared in
collaboration with the Attorney General, will pave the way for local
manufacturing, job creation, and economic value retention within Nigeria. This
initiative will shape the pharmaceutical market to support local
industries.
The President’s effective promotion of Nigeria as a
business-friendly environment has already attracted several international investors and foreign direct
investments. Notably, a Brazilian entity has committed
US$240 million to establish a generic manufacturing plant in Nigeria.
Additionally, three entities are set to produce test kits, with one already
operational in Lagos and two more on the way. This marks a significant shift
from the past 25 years, where such kits were imported. The policy changes initiated
by the President are now fostering domestic production and more are on the
horizon.
Fourth pillar
of our agenda focuses on health security. The new Director-General of the
Center for Disease Control (NCDC) is playing a pivotal role in this area. The
NCDC’s success lies in its ability to prevent diseases from becoming
widespread, as evidenced by the containment of the Lassa outbreak and the rapid
response to meningitis with the introduction of the pentavalent meningitis
vaccine. The President has also approved additional resources for the NCDC to
have contingent financing available, allowing for prompt action during health
crises. The One Health Steering Committee comprising health, environment,
agriculture and water ministries to coordinate the approach to preventing
outbreaks is in full effect. We have submitted Nigeria’s application to the
Pandemic Fund for increased financing.
Malaria remains a pressing issue in Nigeria.
Recently, we initiated a major effort to reassess our approach to malaria, with
the goal of accelerating progress towards its elimination, including better
case management, affordable medicines, optimized delivery of tools, careful
introduction of vaccines when available, community engagement and data systems.
Research and knowledge-building are crucial
components of all our endeavors. We
established NHRC and NHREC to strengthen ethics and governance in research and
clinical trials. These committees are to ensure that all research conducted is
not only intelligent but also ethical, protecting public interests, and
adhering to proper standards.
At the regional level, the leadership and agenda set forth have led the Africa CDC to establish their regional headquarters for the Africa Center for Disease Control here in Abuja. The President has generously offered a building for this purpose, and you may have noticed the ACDC’s presence here. We have signed a Memorandum of Understanding (MOU) to formalize this arrangement.
Closing Remarks
There is a lot more to say, but let me end by
appreciating the President’s leadership, close collaboration with all my Cabinet
Colleagues, Chief Executives, and Civil Servants in the Ministry, Development
Partners, Private Sector, Civil society, and all Nigerians for their trust in the
Nigeria Health Sectoral Renewal Investment Initiative.
Thank you!
