The Director, Health Planning, Research and Services of the Federal Ministry of Health, Dr. Anthony Usoro, said the handicap of the local government areas informed the intervention of the Federal Government in primary healthcare. Usoro said: “We have the Primary Healthcare Development Agency, which was established because we were not having results peripherally. The states and local governments were not functioning optimally or they were hardly functioning. The leadership in those areas of jurisdictions has other priorities. So, that’s why we set up the NPHDA. We are actually going to do what we are not supposed to do because health is on the concurrent list in the constitution. “Ideally, we should cater for tertiary healthcare services by providing leadership. The states have to cater for secondary healthcare services and the local government areas take care of primary healthcare services. But now, we have to do a lot of things for them, including programmes, sensitisation, among others because of this huge gap.”

The non-release of funds for capital projects since the begining of the year has not helped matters in the health sector. “In 2015, we have not received any capital allocation. What the Federal Ministry of Health has received is only running costs. We have not received any capital allocation for this year, and we are already in September,” Usoro said. Development partners, such as the World Health Organisation (WHO) and the International Atomic Energy Agency, have had to come in to offer assistance. Recently, the U.S. government initiated the establishment of a warehouse for drugs in Lagos. It had earlier worked on one in Abuja. The Director, Food and Drugs Services of the Ministry of Health, Gloria Modupe Chukwuma, said the development partners have helped a lot.

“Most of our funding is from global funds which provide resources for the battle against HIV, TB and Malaria. Then, the other partners, like the UNFPA and the USAID are big financiers for us. We also have the  DFID and the Bill & Melinda Gates Foundation. These are the major financial backers. They use implementing partners to work, they don’t implement. But, we don’t handle cash. When you hear that we have a $1 million funding, it is not in cash. These are services and products from all these donors. It’s the worth of the services, products, capacity building and everything that have been given to Nigeria.  Those organisations don’t give cash and even when they want to use cash, they will run it through their own mechanisms,” Chukwuma said.

Significantly, the sector has also had to cope with too many labour unrests. If doctors are not on strike, nurses are. When nurses and doctors are at work, other health workers down tools. Unfortunately, it is the people who bear the brunt. The Director of Hospital Services,  Dr. Patience Osinubi, blamed the recurrent industrial disharmony in the sector on rivaly. “Many of them revolve around rivalry between the different professional cadres. However, much after the Yayale Ahmed Committee, a bit of that has been settled with the issuance of a white paper. Though signed by the President but the people await the outcome of the white paper. The major problem we now have is that the government in previous negotiations, acceded to the fact that it would pay some allowances without due regard to the economic situation of the country.

Now, the cock has come to roost because they (health sector workers) latch on to  the fact and say,  you signed an agreement to pay us this amount of allowances (not salaries) at this rate and you promised us last year that you are going to pay this year, or, you promised in 2013 that you would pay the following  year. But, we are not visitors in the country and we know what the economy has been. Unfortunately, these groups are not ready to listen. Several attempts have been made – Whenever we have any form of industrial action, the ministry sends a team over and we try to speak to them, negotiate, cajole, explain, promise, reach a compromise,  all to ensure that the only reason why they are in that hospital – the patients are not affected.

In some instances, we have succeeded; we have some recalcitrant health workers, who just say ‘if we don’t get the money, we don’t get back to work’. Now, that’s where the government has to come in because there are rules in Nigeria already in existence, such as the Essential Services Act which prevents anybody doing essential services from going on industrial action- they are listed- the police, the fire service and  the Army. Have you seen any of those attempting to go on strike even if they don’t pay them for one year? And fortunately for us, hospital services, health is listed among the essential services. What we need is the political will to enforce that Act.”

Usoro agrees with her, saying: “I will blame political leadership because there are certain things one should avoid. For instance, if an employee disappears for nine months and now comes back after he finished negotiating with the employer and he said ‘you have to pay me that nine months I didn’t work’, if the employer pays, there is a problem because it disrupts every other sector forever. Everybody will wake up and do the same thing. The extant regulation don’t allow it, if you want to go on strike, go on strike, you know the consequences.  Political leadership in order to solve problems quickly gives in to blackmail from anybody. Nurses can wake up tomorrow and say that they want to be paid the same salaries as the doctors and they listen to them and say,’ okay, you can go back to work.

We’ll pay you.’ After working three months, they say ‘no, you have not paid us, we are going back on strike.’ Those are our major problems. I think that the drastic measure is that the public hospitals can actually be privatised. That will solve a lot of problems. They can’t do that in private hospitals, they will be fired immediately. That is our major challenge which is even affecting the Internally Generated Revenue (IGR) base of the hospitals because they are complaining to us. There should be a way out – enforce the extant regulations – you cannot pay someone for not working. It doesn’t make sense. When you have a serious cancer, you have to remove it for the person to survive.”

The Nigeria Centre for Disease Control (NCDC) is understaffed. The centre, headed by Dr Abdulsalami Nasidi has about 300 members of staff. This is not even up to half of what it needs to truly offer its best. Nasidi said: “We need more than 1000 to really become strong. For now, we are employing additional 350 – in all areas, doctors, nurses, public health specialists and so on. They’ve finished the interviews, it is done. It is just to issue letters now. We made request for 650. So, I think the remaining 300 will be employed very soon again.” Funding is also a challenge for this centre. Its budgetary provisions are nothing to write home about. “Funding through the budget line is not sufficient because most of our activities are impromptu. So, the budgetary allocation is just for routine activities, but we write proposals and collaborate with partners. They don’t give us cash these days, but at least, they fund some of our activities.

Then, we also work with World Bank and other partners to develop what we call National Emergency Response Plan which we already have, but we want to put more life into it now. If we have counterpart funding like a World Bank grant, we should be able to operate easier,” Nasidi explained. Despite its challenges, the centre has been designated as the regional hub. Between September 28 and 30, representatives of West African countries are due in Nigeria to concretise the arrangement. This means it needs assistance to equip itself for the task ahead. “That is what we are doing now,” Nasidi said, adding: “We are equipping the Nigeria Centre for Disease Control for it to have the capacity to be able to do this job. So, we are now saying before you go to ECOWAS Centre for Disease Control, your Nigeria Centre for Disease Control should be on its feet completely. So, equipment for the laboratories, equipment for the office, fibre glass networking- everything has been done.  We have than on ground now. So, all we need to do is to activate this place in two, three weeks and then if we have any additional thing, because we don’t have all the money to put all we want now, we shall now be adding them one by one. That is what we are going to grow.”

Source:The nation online