EN ROUTE 2030, ASSESSING THE IMPEDIMENTS OF ACHIEVING GOAL 3 OF THE SDGs IN NIGERIA
I am firmly of the belief that achieving any or all of the Sustainable Development Goals in Nigeria is not just an uphill task, it is an impossible one. My cynicism and pessimism are not unfounded and not unpatriotic, although, I would very much love to be proved wrong by the end of 2030 when the goals ought to have been achieved.
Goal 3 of the SDGs is about ensuring a healthy populace and promoting well-being of everyone. Be that as it may, it is instrumental to the achievement of goal 1 because solving basic health and food problems of the desperately poor is a big boon to ending extreme poverty or at best reducing it.
The morning always shows the day. Nigeria has only been paying lip service to the SDGs. True there is an office (of the Senior Special Adviser to the President on SDGs) that is to all intents and purposes advisory. Beyond this, there is little to show for the country’s commitment to achieving Goal 3. There is simply no personal and institutional commitment to achieving both domestic and internationally set targets.
A number of connected factors guarantee that achieving Goal 3 is a tall order for Nigeria.
Poor track record
Abuja, Nigeria’s capital was the venue when African states agreed on a 15% annual budgetary allocation to health. This was in 2001. Today in 2019, Nigeria’s budgetary allocation to health has never exceeded 7%. Meanwhile less ‘gigantic’ states like Liberia, Madagascar, Malawi, Rwanda, Togo, and Zambia have all achieved this target.
Nigeria is one of the countries that could not meet most of the targets of the Millennium Development Goals which precede the Sustainable Development Goals. The country is still lagging in many of the metrics.
On the domestic stage, Nigeria’s parliament passed the National Health Act and the National Health Insurance Scheme ostensibly to promote health administration in the country. The NHIS was established in 2005 while the National Health Act became law in 2014. Fourteen years later, the NHIS has still not led to universal health coverage nor has the national government been able to adhere strictly to the provisions of the National Health Act.
Uncoordinated approach
It is clear as crystals that there is no coordination in government institutions to reach these important targets. Policy inconsistencies do not only happen when ruling parties change, but it also happens when a single party holds forth. The Abuja target was never reached between 2002 and 2015 when the PDP was in office. It would be overly optimistic to expect the APC government, in office since 2015, to work itself up over a 2001 agreement.
Even at the sub-national level, in states where the same party has been in office since 1999 e.g. Lagos, Bayelsa, Delta, Akwa Ibom, Cross River, Jigawa, and Taraba, there is hardly any improvement that can be remarked upon after twenty years.
With the poor mileage of the NHIS, states are now adopting the SHIS to drive health coverage. While this is not a very bad idea it lacks coordination with the national NHIS and is quite inconsiderate of existing economic realities in the country. As it stands only employed citizens of the states can afford the premiums of the SHIS. Both the NHIS and the SHIS are not well known by the citizens. I daresay over 80% of Nigerians still pay out-of-pocket when they use the country’s health facilities.
Poor budgeting and poor implementation
While the federal government is the biggest culprit of poor budgeting, the state governments do not fare better. It is clear that the federal government has a poor appetite for massive intervention in the health sector, the states are even less ambitious to show progress.
It is not often public knowledge, how well every budget is executed on an annual basis. This is because there is hardly any review of the previous year’s budget before the new one is presented and approved. Thus it is difficult to say that even the meagre health allocation is well implemented. Usually, the allocations are expenditure-heavy with a bias for recurrent spending and less on capital projects or even research and development.
More progress has been made in eradicating or ameliorating the scourge of diseases through the concerted efforts of international aid organisations and apropos NGOs than through government action alone. According to the World Health Organization, Nigeria is rated 187th out of 191 countries in terms of health care delivery.
A senior government official said many years back that money allocated is not money released. A quip he made to buttress the point that budgetary allocations do not necessarily result in implementation — a situation that persists to date.
Weak institutions
This is an albatross of developing economies. Usually, the strength or success of an institution is a function of the grit of the helmsman at that period. Nigeria has not been able to channel individual drive to collective and consistent glory for its institutions. What we have seen over the years are superstars who strut their stuff and when their time on the stage is done leave no stardust in their wake.
We have not been very lucky with leadership, nor have we had followership that is hungry for results. It has always been a matter of body language. If the boss is an achiever, the organisation performs but only so long as that woman or man sits in that chair a la Dora Akunyili at NAFDAC, Prof Olikoye Ransome-Kuti at the Health ministry. It is not a particularly long list.
We need a succession of extraordinary gentlemen and ladies to bring vitality to our institutions. People who will match policy with results on the ground. People who know their patch.
The assemblymen and women in the states are also culpable. This is to say nothing of the health committees of the Senate and House of Representatives in Abuja. They have all failed in their duties to raise the bar of discourse and the quality of health sector hence: poor doctor-citizen ratio; poor remuneration for health professionals; poor training of medical professionals; reprehensible working conditions; terrible primary health care especially in rural areas and the Niger Delta; insufficient hospitals; non-existent research and development ad nauseam.
Lack of commitment
Closely tied to the above is a total lack of will in the ranks of the political elite to set things straight. We can no longer blame an absence of the right laws as responsible for the backwardness of the sector. The National Health Act, the NHIS, the expired MDGs and the current SDGs, as well as the Abuja target, are enough, with some degree of intelligent domestication, to establish a revolution in the Nigerian health firmament but an atmosphere of selfishness or deceit prevents this.
In the eighth national assembly, Nigeria’s lawmakers were so shameless that they knocked out a bill that stipulated that public office holders should not travel abroad for medical purposes. They killed the bill because it would hamper some of their fundamental human rights! This is the same reason our schools do not work. There is no will to fight for the ordinary citizen who cannot afford a local flight ticket not to talk of paying medical bills in dollars. It is now a frequent occurrence for sick Nigerians to take to the internet to ask for donations to embark on avoidable medical expeditions. It is estimated that Nigerians spend N359.2 billion on medical tourism annually.
The politicians only know how to talk. They lack the moral rectitude, empathy or even the capacity to get stuff done. Many of them are not in office for the common good, they are there to serve the self. They have had twenty years of the ongoing republic to prove this assertion wrong with tangible results that mean a better life for the populace.
Poor enlightenment
This is the terrible ignorance that the citizens live in. To serve their own purposes or simply due to neglect of duty, there is almost complete silence on the advantages of programmes like the NHIS. It is akin to the silence of insurance companies in the country not encouraging car owners to get comprehensive cover or not educating them on how to make claims on their third party cover. What we do not know is killing us.
The people need to know what they are entitled to for them to be able to demand it. It is therefore convenient to keep quiet or even confuse the public on matters of public health — a detestable culture.
What we need to do
The first and most important thing to be done if Nigeria is going to shoot for Goal 3 is for the president, the health ministers and commissioners of health and the legislature to immediately communicate their collective and unreserved commitment to public health. This will be considered valid by the next action which is to ensure 100% implementation of their health budgets (no matter how paltry) in the coming year.
This will give confidence to many Nigerians. Another level of commitment will be required from all political parties to ensure that the administration of health is sacrosanct and not susceptible to political whims. This will ensure that no matter which party is in office, the goals will remain the same. Let us make health apolitical.
Closely following this will then be a framework created with the input of government, health professionals, aid organisations and health NGOs on how to achieve the 13 targets of Goal 3. I am certain that with all hands on deck, a responsible and workable framework will be produced and with unflagging commitment and diligence, Nigeria can fast track the goal of Ensuring Healthy Lives and Promote Well-Being for All at All Ages by 2030.
Perhaps, there is or there are other ways, but I believe this is one way to go.
