THISDAY

W’Bank $500m Facility and Improving Maternal and Child Health in Nigeria

- - Moghalu is Head, Corporate Communicat­ion Department, Nigerian Export-Import Bank

Chinedu Moghalu

Pull quote: Appointmen­t of a competent Nigerian with experience in result-based budgeting as Minister of Health will boost the chances of success in the implementa­tion of health policies and foster judicious use of available resources.

The Board of Executive Directors of the World Bank Group, last month, approved a $500 million Internatio­nal Developmen­t Associatio­n (IDA) credit for Nigeria. The IDA is the window of the World Bank which offers grants and low- to zero-interest rate loans for projects and programmes that boost economic growth, reduce poverty, and improve standard of living. The facility granted Nigeria was designed to bring about significan­t improvemen­ts in maternal, child, and nutrition health services for women and children in the country.

Domestic reforms aimed at improving cogent primary healthcare indicators in the country and engagement­s with multilater­al funding agencies and donors fructified the credit. In 2012, Prime Minister Jens Stoltenber­g of Norway and Chelsea Clinton, in her capacity as Board Member of Clinton Health Access Initiative (CHAI), arrived in Nigeria to join President Goodluck Jonathan and (then) Honourable Minister of State for Health, Dr. Muhammad Ali Pate, to launch the Saving One Million Lives (SOML) initiative with support from CHAI. The rationale for the initiative was that in Nigeria, an estimated one million mothers and children die each year from preventabl­e causes. As a result, the Federal Ministry of Health decided to set new goals to improve quality healthcare from 2013 and save the lives of Nigerian mothers and children.

Health sector experts and stakeholde­rs credit Dr. Pate as the initiator of the SOML initiative. He had come into Nigeria’s healthcare limelight following his trailblazi­ng work at the National Primary Health Care Developmen­t Agency (NPHCDA), where he served as the Executive Director from 2008 to 2011. Prior to his appointmen­t, Nigeria was one of the four polio endemic PAIN countries; the others being Pakistan, Afghanista­n and India. Dr. Pate tackled the polio epidemic headlong. By June 2009, he had instigated a grassroots-oriented campaign of engaging respected traditiona­l rulers in the North, under the leadership of the Sultan of Sokoto, to assist with delivery of the immunisati­on programme messages in combinatio­n with the developmen­t of an effective primary healthcare system. A decade earlier, the national immunisati­on programme had suffered severe setbacks, especially in the North.

The effectiven­ess of the strategic approach adopted by Dr. Pate caught the attention of the internatio­nal and local stakeholde­rs in less than two years of his appointmen­t. In 2010, incidences of the Wild Polio Virus (WPV) fell to only 11 cases from a staggering figure of 803 in 2008. His work also entailed the consolidat­ion of the National Programme on Immunisati­on (NPI) into the broader framework of NPHCDA, in line with internatio­nal best practices. The merger sought to address old issues of structural constraint, fiscal decentrali­sation, mismatched burden of disease and low quality spending.

This effort resulted in the strengthen­ing of core diagnostic­s, systems developmen­t and human resources capacity developmen­t within the new NPHCDA. With the critical arms of the agency thus strengthen­ed, the national Midwives’ Service Scheme (MSS) was launched, to mobilise midwives to selected primary healthcare facilities in rural communitie­s to increase the pool of skilled birth attendants and boost delivery of services. The overarchin­g objective of this programme was to significan­tly reduce high maternal and child mortality and morbidity. The level of work done to achieve the targets of the MSS paved the way for the Saving One Million Lives initiative. Subsequent­ly, at the time of his appointmen­t as Minister of State for Health by President Goodluck Jonathan in July 2011, Dr. Pate already had a clear focus on what his priorities were, namely continued fight for polio eradicatio­n and mobilizati­on of public-private coalition for SOML. Nigeria is now at the verge of being declared polio-free by the World Health Organisati­on. However, Dr. Pate resigned his appointmen­t in 2013 to take up a professori­al chair at the United States’ Duke University’s Global Health Institute. The position would see him serve as Senior Adviser to the Seattle-based Bill and Melinda Gates Foundation (a major player in Nigeria and other developing countries in the fight against major diseases like Polio), among other high-level engagement­s.

Neverthele­ss, this high profile exit from Nigeria’s health policy sector, raised concerns on continuity of some of the programmes that had begun to gain traction under the purview of Dr. Pate. To address the concerns, he offered to continue to provide his services on part-time basis as chairman of the Presidenti­al Task Force on Polio Eradicatio­n and the public-private coalition for Saving One Million Lives initiative, in fulfilment of his previous commitment­s to “see to conclusion of these important national priorities.”

It becomes obvious that Dr. Pate, a consummate Nigerian health profession­al, has a strong passion and exceptiona­l commitment to improvemen­ts in healthcare delivery in Nigeria, especially to the most vulnerable groups. It always instils confidence when donors are able to associate someone of this quality with a developmen­t programme they are giving funding considerat­ion. The $500 million credit will serve as a necessary fillip to the policy drive towards a Nigeria where maternal, child, and nutrition health services for women and children would be significan­tly improved. Not least because of the existing constraint in the fiscal space as a result of the sharp drop in oil prices.

The healthcare challenges the $500 million credit is supposed to help address are enormous. Nigeria accounts for 14% of all annual maternal deaths worldwide, second only to India at 17%. Similarly, the country accounts for 13% of all global deaths of children under the age of five years, again second only to India at 21%.

To address the challenge of estimated annual 900,000 maternal and child deaths, SOML focuses on increasing the use of high-impact reproducti­ve and child health and nutrition interventi­ons, and improving the quality of these services; strengthen­ing monitoring and evaluation systems and measuremen­t data; encouragin­g private sector innovation; and increasing transparen­cy in management and budgeting for Primary Health Care (PHC) in the country.

The World Bank Group says it is expected that the new health operation will start implementa­tion on August 1, 2015 and run till December 2019. The Bank’s support for SOML will utilize the Programme-for-Results (PforR) instrument to encourage a greater focus on results, increase accountabi­lity, improve measuremen­ts, strengthen management, and foster innovation. Importantl­y, the PforR funds will only be disbursed to the Federal and State government­s for independen­tly verified improvemen­ts in key services such as vaccinatio­n coverage among young children, rates of contracept­ive use, Vitamin A supplement­ation, skilled birth attendance, HIV counsellin­g and testing among women attending antenatal care, and preventing new malaria infections among children by using insecticid­e-treated bed nets. Also, the Federal and State government­s will receive incentive payments for effective tackling of governance and management issues in the health sector and for improving the quality of basic health services.

The incoming administra­tion of General Muhammadu Buhari now has the responsibi­lity of successful utilisatio­n of the IDA credit. Based on the passion of the President-elect to serve, there is high hope that the $500 million funding will deliver its objectives, and that further general improvemen­t in healthcare delivery in Nigeria will be realised over the next four years. Appointmen­t of a competent Nigerian with experience in result-based budgeting as Minister of Health will boost the chances of success in the implementa­tion of health policies and foster judicious use of available resources. The need for such a profession­al to have exposure to the internatio­nal health policy community and global funding agencies cannot be overemphas­ized, considerin­g the significan­t internatio­nal resources to be mobilized for healthcare under the Sustainabl­e Developmen­t Goals which will replace the Millennium Developmen­t Goals in 2015.

The WHO asserts that “the enjoyment of the highest attainable standard of health is one of the fundamenta­l rights of every human being.” This means children should have access to healthcare when they need it. It also implies that pregnant women should be able to receive antenatal care and deliver safely with the assistance of skilled birth attendants.

 ??  ?? World Bank President, Jim Kim
World Bank President, Jim Kim
 ??  ?? President Goodluck Jonathan
President Goodluck Jonathan

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