South-East Summit harps on universal health coverage

THE need to achieve Universal Health Coverage (UHC) is currently a global development priority. Yet, developing countries continue to face considerable health systems’ challenges that hinder their progress towards UHC.

In countries like Nigeria, where contextual differences exist across its regions, progress can be made by specifically identifying and characterising the health systems-related impediments to UHC within these regions, and providing guidance on the necessary innovations and strategies to overcome them, in order to achieve progress towards UHC.

Accordingly, the prevailing political, economic, and social realities in Nigeria, the poor health indices, dysfunctional health system, and the significant lag in adoption of innovation and reforms in the southeast, justified the convening of the 2015 Southeast Nigeria Health Summit in September in Enugu. The theme of the summit was ‘Achieving Universal Health Coverage and Healthy Lives’, which is in line with the Federal Government of Nigeria and World Health Organization’s drive to reposition the funding and governance of health systems in developing countries.

Conceptualized as a Health Systems Forum (HSF) Nigeria event and organized by the HSF coordinating team alongside the Health Policy Research Group of the University of Nigeria, Enugu-campus, the summit brought together 812 policy makers, health workers, development agencies, programme managers and implementers, consumers, researchers, civil society groups and the media.

Dr. Chima Onoka, Coordinator of Health Systems Forum Nigeria, explained that the brain-storming summit featured a pre-conference scientific poster session, thematic sessions comprising 12 UHC-related presentations and a 2-hour discussion time. It also included a special session with Commissioners of Health, the Federal Ministry of Health, the National Health Insurance Scheme and UK-funded PATHS2 programme on the spot, to showcase their efforts in advancing UHC in the region.

In a documentary made available to the media, Wednesday, Dr. Onoka, a public Health physician, said the first thematic presentation was titled Structures with(out) systems: Is there a Justification for more health facilities? Dr. John Ihebereme, a Permanent Secretary in Imo State, advocated for greater focus on investing in improving health systems, and where there is an interest in projects (such as health facilities), a compulsory preliminary impact analysis of the project against measurable changes in critical health indicators before money is spent on them.

Based on the experience of Gunduma Health System in Jigawa State, Dr. Mahmoud Magaji reflected on Rational Decisions for Sustainable Health Systems. He showed how the WHO District Health System can be customized based on the Nigerian context and used to promote effective primary healthcare delivery.

Given the limited practical experiences for Establishing and Operating State Primary Health Care Development Boards (SPHCDB), Dr. Chukwuemeka Oluoha who has led the development of the board in Abia State described the importance of identifying reform-minded individuals rather than just political associates to lead the movement, and deliberate, result-oriented stakeholder management of the process. Similarly, Dr. Uka Uduma of the Abia State Health Insurance Scheme highlighted that to overcome Practical Challenges to Establishing State Schemes, stakeholders such as labour unions should be engaged early enough in an open process to engender trust and to ensure implementation success.

Professor Obinna Onwujekwe, while considering the Political and Economic Perspectives of Universal Health Coverage, UHC in the region, noted that most “free health programmes” created opportunities for corruption, and funds for such programmes were better used in establishing State insurances schemes which politicians should lead by first enrolling themselves, their families and employees. To support such reforms, Dr. Ibrahim Kana of the Federal Ministry of Health provided insight into Technical and Financial Opportunities for Achieving UHC through PHC, and meticulously explained how funds could be accessed.

To underscore the need for an effective health workforce in public systems, Dr Daniel Ogbuabor, used research evidence to show that though Number, Mix, Distribution and Motivation influence performance of public sector employees, addressing the disparity in urban rural distribution is key to achieving UHC. Professor Odidika Umeora then shared experiences of Innovative Strategies for Optimizing the Health Workforce in Ebonyi state, where doctors in residency training in tertiary hospitals, undertake part of their normal postings in secondary or primary health care facilities as a way to bridge the skilled health workforce gaps in rural areas.

Progress to UHC also requires effective private sector engagement. Professor Jonathan Azubuike of the Medical and Dental Council of Nigeria emphasized the problems arising from The Divided Health Worker, whose engagement in full-time public employment and simultaneous ownership of private hospitals was contrary to the guidelines of the regulatory council. This practice impedes excellence across sectors, and negatively impacts service delivery.

He challenged State Monitoring Committees, headed by state Directors of Medical Services to rise to the occasion and check the practice. Professor Samuel Ohaegbulam then described how the frustrations at government-run public hospitals drove him to resign and establish the Memfys Hospital for Neurosurgery, in such a way that would showcase Excellence in the Private Sector.

Similarly, Rev. Sister Angela Muobike elucidated how the in a bid to Strive for Effectiveness in a Not-for-profit Private System, the Annunciation hospital developed its low-cost Private Health Insurance scheme for the Poor (Ndo Nwanne), which later metamorphosed into a Health Management Organisation.

To support those in the Private Sector with information for Improving Private Sector Financing, Dr Nkata Chukwu of KPMG, challenged practitioners to review the one-man ownership structure and poor accounting systems that prevails among many private hospitals in the southeast region, if they are to access funds available from private sources.

According to Dr. Chima Onoka, making Universal Health Coverage, UHC, a priority in the states requires the buy in of all stakeholders. The government and private sector must work together to ensure that this lofty goal is achieved in line with international prescriptions and best practices.

The Health Systems Forum Nigeria will continually track the progress that states and institutions will make in line with the summit’s objectives and action points so as to ensure the attainment of sustainable development in health.
•Ilechukwu is a senior journalist and media consultant in Enugu