Wednesday 26 January 2022


My niche, conflict transformation, informs the perspective from which I see events around me. I was consistent as regards the prism through which I perceived the summit held in Abuja on the 16th of December, 2021. The theme of the parley was 'Universal health coverage (UHC): Putting health & the health sector on the political front burner'. Chief (Mrs) Moji Makanjuola, MFR, Chair, UHC 2023 Forum, was the convener. Since her sojourn at the Nigeria Television Authority (NTA), anchoring 'Health Reports' and other programmes, ('Bridges' post retirement), I knew she was up to something formidable like the UHC 2023 Forum.

My take is that if inclusiveness is the watchword as regards UHC, then vulnerable groups, which include women, children, the aged, persons living with disabilities (PLWDs) would be captured. When the critical mass of the citizenry is healthy, then they can function at maximum capacity in the society. When citizens can function maximally, then the level of productivity in all sectors of the society is enhanced. When productivity is enhanced, then the volume of the 'cake' baked at all levels is pleasing -  scarcity, hunger and dis-affection may then be effectively tackled. This could lead to greater harmony and indeed less conflict in the society. Hopefully, then, no one would be left behind...or at least, majority of the populace would have been enclosed in the safety net of UHC...

                                                           The banner for the Summit

Did I digress earlier? Apologies. Back to the summit. The following are the Summit themes:

*Putting health and  health security on the political front burner: What we have learned, what can we do differently?
-Taking advantage of the election period to advance health policy thrusts: What has international experience taught us?
-A critical appraisal of Nigeria's health challenges & promising policy options.
-Towards articulating a health agenda & obtaining commitments for enhanced prioritisation of health in Nigeria

*Subsidising health cost in Nigeria: Successes, gaps & the next frontier.
-Implementation of the BHCPF: How far have we gone? What else should we do?
-Expanding health insurance coverage to the poor through equity fund: Accomplishments & impediments.
-Using donor funds to subsidise health cost: The Christian Aid experience.
-Subsidisation for financial protection: What do we want from the political class?

*Forging consensus & building a coalition towards putting health on the political front burner.
-The role of donors, the media & civil society in putting health and health security on the political front burner.

Some of the participants are:

*Senator Bukola Saraki - President, 8th Senate, Nigeria
*Rep. Gov. Abdullahi Sule - Governor, Nasarawa state
*Rob Yates - Director, Global Health Programme/ED Centre for Universal Health, Chatam House
*Prof. Aliko Ahmed - Associate Fellow, Global Health Programme,Chattam House
*Sen. Dr. Ibrahim Oloriegbe - Chair, Senate Committee on Health
*Mrs. Moji Makanjuola - Chair, UHC 2023 Forum/Summit Convener
*Rep. Gov. Okowa - Governor, Delta state
*Dr. Olumide Okunola - World Bank/IFC
*Prof. Nasir Sambo - ES, NHIS
*Dr. Amina Dorayi - Country Director, Pathfinder
*Dr. Sam Agbo - FCDO
*Dr. Yusuf Yusufari - Bill & Melinda Gates Foundation
*Dr. Dayo Oluyemi-Kusa - Independent Conflict Transformation Strategist, Abuja
*Prof. Alli Mohammed
*Otun Adewale - Well-being Foundation
*Ms. Ene Ede - VAPP Coordinator, FCT
*Anu Rotimi - Rep. CSOs
Some of the highlights of the animated discussion are:

UHC can be used to address poverty. Nigeria is low to medium UHC. There should evolve a clear pathway for UHC. We need to end maternal and new born deaths via UHC. Primary Health Care (PHC) is critical to UHC. Less than 2% of the population covered under the NHIS in Nigeria. Any child born in Nigeria has approximately 36% productivity. Vulnerable groups fund & NHIS Authority Bill are being discussed. There should be effective linkage between primary, secondary and tertiary  health systems. Democratic nation-states have citizens with longer life span. Your vote affects how long you and members of your family live. Politics is a normative and subjective enterprise that affects health security. Free and fair elections have a positive effect on life expectancy.

Civil society needs to generate political commitment for UHC. Expertise on how to launch and sustain UHC reforms required. We need to share experiences from successful models. More public events, fora, etc. like UHC 2023 Forum need to spring up to call attention to the need for UHC. The political strategy to enhance UHC should also include round tables, briefings, media engagement, etc. We should use Chattam House rules in meetings, so that individuals can express themselves freely. We need to talk to incumbent governments and the opposition also. We should use the power of ideas to influence the idea of power. In Nigeria, population has out-paced economic growth. Public spending is constrained by insufficient funds. In a recession or pandemic, countries are forced to spend more on health. We need to block the health benefit black hole. The proposed 'Sugar Tax' should be given to he health sector. 

In my intervention, I called attention to the fact that health security is only a part of the whole gamut of human security, which is beyond perimeter fencing. We keep brandishing the concept of 'political will', but I know that we cannot have political will without 'political pressure' to do the needful as regards UHC. As a Political Scientist, I am particularly interested in the political economy of health care. Also as a Conflict Transformation Strategist, I strongly believe that some conflicts can be prevented in the society if we have inclusive UHC...

The NHIS boss reiterated the fact that the overall objective of the BHCPF is to ensure the provision of a basic minimum package of health services (BMPHS) to all Nigerians. But there are a number of challenges: Poor PHC facilities, advocacy, political will as regards the equity fund, financial management, Epidemiology, accreditation, digital technology, data/demographics, quality assurance, monitoring & evaluation, information/education/communication (IEC), enrollment, etc. UHC entails population/service/insurance coverage.

What then is to be done?

*There should be prompt release of BHCPF for sustainability.
*Advocacy to support SSHIAs beyond BHCPF wanted.
*Mandatory health insurance (HI).
*Increase in percentage disbursement to BHCPF.
*Massive creation of awareness about NHIS to the public.

What then are the policy options?

*We should strategically use the political season to call attention to the importance of UHC while soliciting the buy in of  politicians.
*UHC could be actualised via the NHIS.
*Digital technology is crucial.
*The political class has a crucial role to play. Investment in health should be increased. A minimum of 15% of the annual budget should go to the health sector.
*Civil society should continue to advocate for UHC.
*We should leverage socio-cultural nuances while calling attention to the importance of UHC. The role of traditional leaders as regards advocacy is crucial.
*A lobby group should constantly liaise with the National Assembly, Governors' Forum, etc.
*The cooperation of the mass media should be solicited for UHC advocacy.

Next steps

*The recommendations should be converted into a road map for the UHC Forum.
*An engagement strategy should be formulated.
*A draft template (Manifesto) should be written. This should include what we want to see in the health sector as regards UHC...

Impressive! The UHC 2023 Forum is definitely off to a terrific start. The tempo needs to be sustained. On my part, I am committed to advocacy for conflict prevention via UHC. Bravo to Mrs. Moji Makanjuola and her fabulous team...

Related Links

*How to build Africa's health care defense system by Akinwunmi Adesina


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