Buhari on Healthcare

Awareness

The Maternal death rate of Nigeria is higher than the average for Sub-Saharan Africa so in one respect by formulating policy on maternal healthcare the CPC has acknowledged the problem. But in another respect they could have gone further to link such a high maternal mortality rate to the prevalence of under-age brides in certain parts of the country. The manifesto also acknowledges the importance of infant healthcare and regular and reliable drug supply. Also by mentioning the need for health insurance there is a nod to the issue of funding the healthcare system.

Beyond this the Buhari/Bakare manifesto could have gone further and highlighted the human resource problems facing the healthcare sector, the need for infrastructure and how the issues of health tie in with other issues such as education, sanitation etc.

Ambititon

The plan to extend free healthcare to pregnant women, children under the age of 18, the elderly over the age of 70 and people suffering from infectious diseases such as TB and HIV/AIDS has to be seen as very ambitious. In essence he (Buhari) is extending free healthcare to the majority of people who will need it in Nigeria (if the policy was extended to include malaria in the infectious diseases then he would be granting free healthcare to virtually all who need it). It will be an enormous task to train and equip enough people to do it and to ensure that the institutions built will be adequately funded and staffed.

Detail

Two of the policies in this section are well outlined. To be fair they are very blanket policies of free healthcare to a number of people and introducing a better drug management system. However, there is no information as to when they are likely to be implemented, how they will be funded and how they will be monitored. The policy to reform and strengthen the health insurance scheme is very vague, there is no indication which direction the reform will take and there is definitely no measureable goal against which its achievement can be measured.

My View

Firstly a promise to provide almost universal free healthcare doesn’t sit well with the principles of liberalism and free market economics that is stated in the mission section of the document. Secondly I think that rather than scaling up state involvement in healthcare, we should be scaling it down. The same way the state is committed to universal basic education; it should be committed to universal basic healthcare and nothing more. The state should ensure that everyone has access to a minimal but evenly distributed level of healthcare and after that the private sector should be allowed to do the rest. The issues of maternal/infant mortality and infectious diseases can be better tackled in cheaper ways such as through better education, better sanitation and better primary healthcare to detect issues before they go too far. Also any real discussion of maternal health in Nigeria cannot be had without a discussion of child brides particularly in Northern Nigeria, were state legislatures have been reluctant to pass laws restricting marriage to minors. As with this Manifesto’s section on education, if you believe that the problem with healthcare in Nigeria is not with the system but rather with the performance of the system then this is a very ambitious and good plan. But as with education, I do not believe this.

Scores (out of 5)

Awareness: 3.0

Ambition: 4.0

Detail: 1.5

My View: 2.25

Ribadu on health

Awareness
In terms of awareness, Mallam Ribadu acknowledges the need for primary healthcare and investments in human resources, and more long-term the need to invest in secondary and tertiary infrastructure. There is also a nod to the university teaching hospitals.
There are however other problems or health issues that aren't addressed. There is no acknowledgement of the scale of investment needed (an issue in itself). It makes no mention of sanitation and education, easily addressable issues that will have monumental effects on the health of the nation.

Ambition
In terms of ambition, his plan aims to meet the Millennium Development Goals (MDGs) vis a vis reducing infant and maternal mortality and combating infectious disease. This on the face of it may not seem ambitious, as the goals are meant to be achieved by 2015 ( coincidentally the end of the next presidential term), however, as it has been suggested by Action Aid international Nigeria, the achievements of the health MDGs need sustained effort to be achieved in Nigeria and so in this regard the pan should be seen as ambitious. The plan to build 6 top of the range secondary and tertiary institutions across the geo-political zones is very ambitious. It will require money, expertise and political capital of epic proportions to be initiated and such commitments will surely need to outlive the presidency to reach the 'world-class' levels it aspires to.

Detail
This section of the manifesto is somewhat dry on detail, it says it will improve healthcare through improvement of human resources and improving efficiency and there is of course the promise of 6 new specialist hospitals. Beyond that however, there isn't much to go on, it talks of using incentives to attract more people to the workforce but leaves it at that. There is no plan set out for how to achieve the MDGs other than their attainment is a goal. There are no other measurable targets set for any of the ambitions, neither is there a time scale set nor are details of the funding of these projects given.

My View
I think health in Nigeria is a complex issue, the scale of health problems is undeniable: life expectancy is less than 50 years, infant mortality was 100/1000 live births in 2003. I think that tackling healthcare should be a job for both the public and private sectors. The government should focus on training and utilising primary healthcare professionals and publicly funded programmes for the time being should be limited to primary healthcare. Investment in secondary/tertiary healthcare should be left largely to the private sector for now. The government should also focus on non-sector specific things that will improve health such as education, sanitation, reducing smoking, promoting healthy active life-styles etc. These will have massive effects and will probably cost less.
A start must be made somewhere and the achievement of the MDGs by 2015 has to be part of any healthcare plan for Nigeria

Scores (out of 5)
Awareness: 3.25
Ambition: 3.0
Detail: 2.0
My view: 3.0