Sav­ing One Mil­lion Lives and Push To­wards UHC

As Nige­ria con­tin­ues to push to­wards Univer­sal Health Cov­er­age, Mar­tins Ifi­jeh ex­am­ines the role of the fed­eral gov­ern­ment’s Sav­ing One Mil­lion Lives in achiev­ing the goal


As Nige­ria con­tin­ues to push to­wards Univer­sal Health Cov­er­age, Mar­tins Ifi­jeh ex­am­ines the role of the fed­eral gov­ern­ment’s Sav­ing One Mil­lion…

It is no longer news Nige­ria is one of the worst places on earth to give birth due to the poor ma­ter­nal and child health indices in the coun­try, but many a time, those who are af­fected do not have a say in which coun­try they should get preg­nant from, or where their in­no­cent chil­dren should be born. They do not have a say in what will be the out­come of their preg­nan­cies. Whether they will give birth safely or lose their lives or that of their ba­bies is an ex­clu­sive pre­serve of the coun­try they live in.

This lack of choice also plays out among other cit­i­zens, es­pe­cially the poor, who are un­able to af­ford or ac­cess ba­sic health­care like treat­ment for malaria, vac­ci­na­tion, man­age­ment of the hu­man im­mune virus, ac­ces­si­bil­ity of fam­ily plan­ning com­modi­ties, among oth­ers; hence lead­ing to high mor­tal­ity rate and the em­bar­rass­ing life ex­pectancy ra­tio for both males and fe­males in the coun­try.

But since the in­au­gu­ra­tion of the Nige­rian Gov­ern­ment’s Sav­ing One Mil­lion Lives Per­for­mance for Re­sults (SOML-PforR) ini­tia­tive, and the grant­ing of $1.5 mil­lion to each of the 36 states of the fed­er­a­tion and the Fed­eral Cap­i­tal Ter­ri­tory (FCT) less than a year ago, has the nar­ra­tive changed? Can this pro­gramme pro­pel Nige­ria into achiev­ing the sin­gle most pri­ori­tised health ad­vo­cacy of the 21st cen­tury glob­ally, which is Univer­sal Health Cov­er­age? Will Nige­ria achieve health­care for all by 2030?

Will this and many more in­vest­ments put into the coun­try’s health­care amount to busi­ness as usual; leav­ing the poor Nige­ri­ans to die from pre­ventable ill­nesses? Is this pro­gramme al­ready sav­ing mil­lions of lives, or is there an­other mes­siah (ini­tia­tive) to be ex­pected.

It is in an­swer­ing these per­ti­nent ques­tions that THISDAY reached the Na­tional Pro­gramme Man­ager, SOML-PforR, Dr. Ibrahim Kana, who be­lieved the pro­gramme was de­signed to pro­vide a par­a­digm shift for the coun­try, with a plan to stop pay­ment for in­puts, as been pre­vi­ously done, and then start pay­ing only for clearly de­fined and ob­jec­tively mea­sur­able re­sults or across the coun­try.

He said the ini­tia­tive is geared to­wards driv­ing the coun­try into UHC for all, adding that the ini­tia­tive has pro­vided an op­por­tu­nity for each state to achieve UHC.

“With SOML-PforR’s fo­cus on im­prov­ing pri­mary health­care, and on in­creas­ing in­sur­ance cov­er­age es­pe­cially for the most vul­ner­a­ble in the so­ci­ety, states can now en­sure that their peo­ple have ac­cess to qual­ity health (in­clud­ing pre­ven­tion, pro­mo­tion, treat­ment, re­ha­bil­i­ta­tion and pal­li­a­tion), while also en­sur­ing that the use of these ser­vices does not ex­pose their peo­ple to fi­nan­cial hard­ship. If each state is able to do this for them­selves, Nige­ria as a whole will achieve UHC.

“We be­lieve this is an ap­proach to struc­tur­ing the flow of re­sources to pay for re­sults. It is the fed­eral gov­ern­ment’s flag­ship in­ter­ven­tion to im­prove ma­ter­nal and child health by chang­ing fed­eral-state re­la­tion­ship to be­com­ing a re­sults-based part­ner­ship. This pro­gramme re­lies on ex­tant po­lices and sys­tems, and is de­signed for the fed­eral gov­ern­ment to in­flu­ence the states through: col­lec­tion of ro­bust data on ser­vice de­liv­ery at com­mu­nity and health fa­cil­ity level and feed­ing it back to states; re­ward­ing and recog­nis­ing states for bet­ter per­for­mance; and pro­vi­sion of tech­ni­cal as­sis­tance.”

Kana said SOML-PforR was pred­i­cated on quan­ti­ta­tive indi­ca­tor, which is the sum of in­crease in vac­ci­na­tion cov­er­age, con­tra­cep­tive preva­lence rate, vi­ta­min A cov­er­age, skilled birth at­ten­dance, in­sec­ti­cide treated nets us­age by chil­dren un­der five, and the test­ing of preg­nant women for HIV, adding that the other area is the im­prove­ment in qual­ity of care.

He said the SOML-PforR means that the Pri­mary Health­care Cen­tres (PHCs) across the coun­try will be func­tional, as cit­i­zens will get qual­ity health­care as at when due, not­ing that hospi­tal staff will by this pro­gramme get ad­e­quate train­ing and mo­ti­va­tion.

“This also means chil­dren will no longer suf­fer or die from vac­cine pre­ventable dis­eases. There will be less episodes of malaria, while moth­ers will be able to de­ter­mine how many chil­dren they want to have, space them, and pre­vent them from dy­ing from sim­ple com­pli­ca­tions.

But how ef­fec­tive has the pro­gramme been since its com­mence­ment? Kana said SOMLP­forR pub­lishes re­sults on all se­lected key health in­di­ca­tors, as they are al­ready see­ing state gov­ern­ments be­com­ing more ac­count­able to their peo­ple.

“No sin­gle past pro­gramme has been as ef­fec­tive in forc­ing de­ci­sion mak­ers to col­lect, an­a­lyse and re­view data and use ev­i­dence to in­form/guide their de­ci­sions and ac­tions as SOML-PforR has done in the short time since it com­menced op­er­a­tion.

There has been a marked im­prove­ment in trans­parency by gov­ern­ment at all lev­els due to the SOML-PforR’s re­quire­ment that due process and fi­nan­cial reg­u­la­tions/sys­tems are strictly ad­hered to.

“SOML-PforR mea­sures progress in each state through these ro­bust sur­veys: Na­tional Nu­tri­tion and Health Sur­vey as well as the Na­tional Health Fa­cil­ity Sur­vey.

Each state com­petes with it­self and both zonal and na­tional cham­pi­ons are re­warded in or­der to cre­ate com­pe­ti­tion be­tween the states and zones.

The re­sult of these sur­veys are then pub­lished on na­tional dal­lies as well as on the SOMLP­forR web­site.”

He said fol­low­ing an anal­y­sis of state’s re­sults from the 2016 MICS com­pared against the 2015 Na­tional Nu­tri­tion and Health Sur­vey, 12 states in the coun­try have per­formed high, not­ing that the star states have qual­i­fied for the fed­eral gov­ern­ment’s earned per­for­mance re­wards.

He said on a gen­eral note, all states were mak­ing progress on dif­fer­ent as­pects of the pro­gramme to vary­ing de­grees.

How has the states utilised the $1.5 mil­lion granted to them? Kana ex­plained that states were par­tic­i­pat­ing ac­tively, while the Nige­ria Gov­er­nor’s Fo­rum was in full sup­port, adding that sev­eral in­ter­na­tional part­ners have also keyed into the pro­gramme as a novel way of fi­nanc­ing health­care in the most trans­par­ent man­ner

For in­cen­tives to states who ju­di­ciously spend the grant, he said states have been given flex­i­bil­ity in what they spend the funds on as long as due process is fol­lowed, as this was done to avoid in­ter­fer­ing with their abil­ity to de­liver the ex­pected re­sults. “Ju­di­cious use of the funds is ex­pected to re­sult in im­proved health out­comes that can be mea­sured. States will re­ceive direct fi­nan­cial in­cen­tives for such im­prove­ments.

“On ac­count­abil­ity, what we do is that each state and the FCT has opened an SOML-PforR Op­er­a­tional Naira ac­count at the CBN, which is part of the TSA, but the funds within are ring-fenced, and can only be ac­cessed di­rectly by the SMOH; Ac­cess to the fund is only pos­si­ble via the REMITA plat­form; all dis­burse­ments are made di­rectly to ben­e­fi­cia­ries; all trans­ac­tions are con­ducted via elec­tronic transfers only; ap­prov­ing of­fi­cers are not sig­na­to­ries, and the state gov­er­nor for­wards the names; all ex­pen­di­ture must be from ap­proved ex­pen­di­ture plans (ap­proved at Fed­eral level by HMH, ap­proved at State level by HCH and FMOH).

“Reg­u­lar au­dit­ing is also con­ducted for com­pli­ance with fi­nan­cial reg­u­la­tions to en­sure fund util­i­sa­tion in line with ap­proved work-plans; we also make sure all pro­gramme ex­pen­di­ture is tracked and a sum­mary re­port pro­duced by the state pro­gramme man­age­ment unit; and the Au­di­tor Gen­eral of the Fed­er­a­tion re­serves the right to au­dit the pro­gramme fi­nan­cial state­ments in any of the states.”

He also added that other mea­sures put in place in­clude au­dits by state au­di­tor gen­er­als, re­port­ing of pub­lished and con­sol­i­dated bud­get ex­e­cu­tion re­port for all in­come and ex­pen­di­ture on PHCs, and a signed agree­ment be­tween the World Bank and the fed­eral gov­ern­ment for anti-graft agen­cies (EFCC, ICPC, etc.) to cross check and ver­ify all ex­pen­di­tures un­der SOML-PforR.

He said among other things the pro­gramme has ac­tively helped to sup­port part­ner­ship be­tween the fed­eral and state gov­ern­ments by en­cour­ag­ing joint plan­ning and shared ac­count­abil­ity for re­sults.

With the world tilt­ing to­wards univer­sal health cov­er­age for bet­ter health­care glob­ally, time will tell if this pro­gramme will push Nige­ria into achiev­ing this goal by year 2030.

Will SOML im­prove health cov­er­age in Nige­ria?


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