The Honourable Minister of Health, Dr. Osagie Ehanire has sought for the support of the Health Partners Coordinating Committee (HPCC) for the newly developed Integrated National Health Sector Covid-19 Response Plan derived from Pillar 4, Priority Area 1 of the NSHDP 11. The plan is to ensure defined responsibilities and harmonization of efforts across the Federal and States and non-interruption of non COVID-19 routine health services. This came to fore when the Honourable Minister held a virtual meeting with the Health Partners Coordinating Committee (HPCC) on Friday, 26th June, 2020.
Dr. Ehanire sought for the HPCC to recall that Nigeria had earlier demonstrated commitment towards improving its health sector outputs and outcomes and achieving Universal Health Coverage (UHC) with the signing of the National Health Act, 2014 that gave birth to the Basic Health care Provision Fund (BHCPF). He said, “The effective implementation of the BHCPF which requires partnership and robust collaboration with all the relevant stakeholders particularly the development partners is key to the realization of set goals towards the UHC”. The Minister emphasized that maintaining strong collaboration with donors/partners and private sector will ensure alignment and achieving a balanced allocation of funds for financial sustainability.
The Honourable Minister explained that the BHCPF launched in January 2019 by President Buhari was suspended afterwards following observations by the Health Committees of the National Assembly (NASS) in a document entitled, ‘Design and Implementation of the BHCPF- A Review,’ in November, 2019 on grounds that some portions of the earlier developed 2018 operational manual for the implementation of the fund were not in compliance with the National Health Act and as such it’s further implementation would amount to deliberate flouting of the law.
The followings, Dr. Osagie said were the issues raised by the National Assembly on the BHCPF:
1. Lack of clarity on “take off” of the implementation of BHCPF
• States were being asked to deposit a uniform counterpart funding of N100 million not known to law;
2. Poor system thinking and tendency not to go outside “the box”
• Section 11 of NH Act expected to be implemented as part of the whole whereas it will be great to implement it with sections 12 & 13;
• Putting money into PHCs without established minimum standards of quality is not what it intends;
• Provisional accreditation given to PHCs per ward is dangerous in a country where almost all temporary measures become permanent;
• Allocating 2.5% of BHCPF to DHS is not the best use of funds;
• Sub-national health experts not involved in the evolution of the guideline as much as the law expects and community needs to be more involved and engaged;
3. Concern of partners for their investments and theory of change to be safeguarded
• Partners concerned that money in BHCPF is efficiently utilized. Everything should be done to do that but not at the expense of implementing the law;
• Therefore, an accountability mechanism must be put in place to ensure various gateways are accountable;
• Since this is a system strengthening intervention that should continue ad infinitum, funds from donors should not constitute a distortion to the BHCPF.
4. Preference for unwieldy and complex bureaucracy
• Creating a National Steering Committee and Secretariat are perceived as creating extra bureaucracy which may make the implementation of BHCPF quite unwieldy.
5. Desire to indulge/exclude governments at sub-national levels in spite of the law
• Eligibility required by law for any State to spend money from the pot is development of costed plan and payment of not less than 25% of the cost of the project;
• It is not clear what criteria were used to determine the sums allocated to the States as well as why percentages are paid.
6. Poor preparedness of the States for this very important health reforms.
Consequently a committee set up by the Office of the Honourable Minister of Health to review the 2018 Operational Manual and correct the errors. It submitted a guideline entitled, ‘Guidelines for the Administration Disbursement and Monitoring of the BHCPF’ which was subsequently harmonized with the 2018 Operations Manual with the 2020 Draft Guideline in existence, with respect to issues raised by the NASS Health Committees.
In a related note, on the signing of the Nigeria Country Compact Agreement with Development Partners scheduled for the HPCC meeting, the Minister said, “The compact is not in any way legally binding, but just a mutual understanding that we will work together to implement our National Strategy towards achieving UHC and attainment of SDG3.”
Speaking further, he said, “To track implementation of the National Health Plan, the M&E plan of the NSHDP 11 has provided for a Joint Annual Review (JAR). On this, the NSHDP 11 JAR governance structure was inaugurated during the previous HPCC meeting’.
The Minister expressed appreciation to all for their continued support to the health sector while expressing his desire for more partnership and collaboration in concerted efforts to reposition the sector to be more efficient.Distributed by APO Group on behalf of Federal Ministry of Health, Nigeria.