Deepening Accountability, Leadership in the Nigeria’s Health Sector

Over the years, Nigeria’s healthcare system has been characterised by low coverage of basic health interventions, driven primarily by limited supply of quality Primary Healthcare (PHC) services and low demand for these services. This low-level health system equilibrium translates into approximately 900,000 children and mothers dying annually, largely from vaccine-preventable diseases such as pneumonia, malnutrition, malaria, among others.

Given Nigeria’s suboptimal health systems performance, a lot of attention has been placed on increasing equity in access and utilisation of basic health services. Despite significant investments in the health system to improve health outcomes, a commensurate increase in coverage of key reproductive, maternal and child health indicators have not been recorded.

This paradigm suggests that a ‘black box phenomenon’ exists, which may be underpinned by critical governance, management, quality improvement and leadership capacity gaps that detract health system and service delivery performance.

In several states in the country, although interventions to align with the Primary Healthcare Under One Roof (PHCUOR) and other policies are underway, there is dearth in capability that needs to be built to manage a rapidly growing and changing State Primary Health Care Develop- ment Agency (SPHCDA) with increasingly complex roles and responsibilities.

These new roles are expected to be delivered by existing staff who do not have the skills, capabilities, and mindset to operate under the new mandate. Some of these limitations already manifest as poor budgeting, poorly executed contracts, suboptimal and fragmented supply chain system and limited financial management capacity within the PHC system.

Previous attempts at addressing critical governance and management capacity gaps have employed traditional training methods, which usually results in a small incremental and reversible change. This however necessitates the need for a bold, disruptive and dynamic approach that is needed to cause a transformative systemic change in an evolving health system.

Following recent engagement with SPHCDAs, State Ministries of Health (SMOHs), private sector corporates, academic institutions and partners across the country, the Healthcare Leadership Academy (HLA) -which is a collaboration of the Private Sector Health Alliance of Nigeria (PHN), Health Strategy and delivery Foundation (HSDF) saw the need to develop the Leadership Enhancement and Accountability for the Public Sector (LEAPS) Programme.

LEAPS programme The LEAPS is a bespoke fellowship programme designed to enhance the leadership acumen and execution capacity of senior healthcare administrators and policymakers operating at a state or regional level in a bid to disrupt the current poor health system performance.

The 18-months fellowship programme is targeted at high performing managers (midlevel and senior) in the public sector (SPHCDA and ministries of health) with a focus on building the capacity of managers, policymakers, and administrators in areas such as management, effective commissioning of care, payment systems, performance management, health-care financing, and quality assurance and improvement.

Each LEAPS cohort consists of committed participants nominated by Federal or State Governments, with representation that includes Executive Secretaries, Directors and Managers of State Primary Health Care Development Agencies, Directors at State Ministries of Health and, Executives of Professional Provider Associations amongst others.

This maiden edition, participants of the LEAPS program were senior healthcare administrators & policymakers drawn from State Ministry of Health, State Primary Healthcare Development Agency and State Ministry of Budget & Planning from Lagos, Imo, Cross River, Delta, Niger, Nasarrawa and Kaduna.

Federal government, health expert view The Minister of Health, Prof Isaac Adewole revealed that the LEAPS programme was a welcome development that seeks to enable healthcare leaders and policy makers expand into their roles, transform organisational structures and create an enduring impact on health sector strengthening

Adewole, who was represented by the Permanent Secretary, Federal Ministry of Health, Dr. Amina Bello Shamaki, said that there was need to develop the right capacity in human resource development given its overall impact in the health sector.

According to him, “the local and state governments should be in tandem with the positioning and training of PHC professionals for the States’ Primary Healthcare Development Agencies (SPHCDA). The federal government is already giving the leadership in primary healthcare. We are trying to change the pyramid. The foundation of healthcare should be at the primary level through the save one million lives. It is a loan from the World Bank but we are giving it as loan to the states. States are giving the funding intervention based on the results they achieved. We started with $1.5 million. The states get funding based on the outcomes of certain healthcare indices.”

On his part, the CEO, Health Strategy, Delivery Foundation and HLA Advisory Board Member, Dr. Kelechi Ohiri, hinted that the LEAPS programme was an attempt to address the complex challenges that face Nigeria’s healthcare system in a bid to advancing towards achieving health-related Sustainable Development Goals SDGs).

Ohiri maintained that the primary role of LEAPS was to build leadership among the private and public sector mobile resources and address the gaps in the sector.

“The journey of a thousand miles begins with a step. LEAPS targets policy makers driving reforms in their states. In doing so, we selected the first group of states across the geopolitical zones so we can capture different states with different issues and complexities,” he added. Lending his view, the CEO, Private Sector Health Alliance of Nigeria (PHN),Dr. Muntaqa Umar-Sadiq, disclosed that the alliance led by Alhaji Aliko Dangote, Mr. AigbojeAigImoukhuede ,Mr. Jim Ovia, Mrs. Sola David Borha, and other corporate leaders have come together to leverage private sector management techniques and capabilities to support states to accelerate improvement in health outcomes.

Sadiq noted that the HLA was a partnership between PHN and HSDF to create a platform strategy to strengthen the capacity of policy makers and private finance particularly around leadership, financial management, quality improvement and overall health outcomes.