All four manifestos have common policies and varying differences, reflective of recommendations made to strengthen deliveries on the expectations for the health sector. After the elections conclude and a winner is declared, one of these manifestos will be the blueprint for the health sector for the next four or eight years.
Across the globe, elections into public offices come with promises and commitments. These promises are to invoke confidence in candidates and their parties by the voting population. Nigeria is no exception and it is disappointing when these promises are not fulfilled.
A 2019 article on voter apathy in Africa notes that while 98.2 per cent and 79.5 per cent of the registered voters in Rwanda and Kenya eventually voted in their last elections, just 35.66 per cent of registered voters voted in Nigeria. A reason for this low turnout is that politicians tend to renege on the promises made during campaigns, as well as commitments outlined in their manifestos.
In the build-up to the 2023 elections, Nigeria’s political climate has become more energized; seen in citizen’s interest in the presidential aspirants and their manifestos. A PUNCH article described these growing interests as a consequence of anger at the state of the nation. Citizens must not only devise means of holding their leaders accountable, they equally need to contribute to the kind of leadership they want. This can be achieved by studying the manifestos presented to the public and presenting the proposed policies in ways that can inform public opinion and provide reminders to those seeking public offices on what they should deliver when elected.
A LOOK AT NIGERIA’S HEALTH SECTOR
At the onset of the COVID-19 pandemic, the lack of trust in Nigeria’s health system became apparent as the nation struggled to contain and adequately respond to the health emergency. The elite, who usually fly out of the country for medical attention, were unable to as lockdown measures had been enforced. Many of them had to rely on the health system they had neglected and some became victims of avoidable deaths.
Although the panic around the disease seems to have worn off, Nigerians must be reminded of where the country’s health sector is and why the government must do things differently to keep citizens safe and healthy.
Nigeria is yet to go above a score of 0.5/1 on the Human Development Index, when similar developing countries like Indonesia and Libya rank at 0.705 and 0.718 respectively, and Ghana with 0.632. On the health index score, Nigeria is listed among the last ten countries out of 167 countries, scoring 49.1 points out of 100, compared to Iran’s 74.8 points, Indonesia’s 72.7 points, and 64.6 points for Kenya. Infant mortality rate in Nigeria is among the highest in the world, currently at 70.6 per 1000 live births, compared to 18.9 for Indonesia, 10.9 for Iran, and 27.9 for Kenya. Life expectancy in Nigeria is 55.75 years, below sub-Saharan Africa’s average of 60.85 years
Similar statistics characterize Nigeria’s maternal mortality rate, morbidity and mortality incidents from several diseases, including cancer, diabetes, tuberculosis, stroke, etc. Despite these poor health outcomes, there have been several successful political administrations in the areas of health policies and programmes in Nigeria. These include the 2014 National Health Act, National Strategic Health Development Plan, Primary Healthcare Under One Roof, Basic Health Care Provision Fund (BHCPF), National Health Insurance Authority Act, National Drug Policy, Expansion of Molecular Laboratories to contain health emergencies, and the Central Bank of Nigeria’s support to local pharmaceutical companies.
In the Lancet Commission on Investing in Health, experts say that the many health policies and programmes in Nigeria have barely translated into positive health outcomes for citizens. They believe that this is so because of low investments in health, corruption and accountability issues, dearth of pro-poor health financing, and lack of political will to prioritize and decisively optimize the health sector.
It is based on the foregoing that Nigerians are concerned about what the 2023 elections and the future holds for them in terms of healthcare. To provide insight into addressing these concerns, the proposed health policies of the four leading presidential aspirants should be considered.
ALL PROGRESSIVES CONGRESS (APC)
The ruling APC has been in power since 2015 and has a former Governor of Lagos state, Bola Tinubu, as its presidential flag bearer. Its manifesto, ‘Renewed Hope’ has Universal Health Coverage (UHC) as its priority; the party promises to make healthcare available to all and prevent citizens from incurring financial hardship while they seek medical attention. To achieve this, the APC has promised to ensure that healthcare is treated as a fundamental human right and a matter of national security.
The manifesto builds its aspirations for the health sector on some components of the health systems, governance and leadership, human resources, health financing, and service delivery. It promises to maintain the current legislative environment of the health sector, as it will partner with state and local governments to achieve most of its aspirations. It recognizes the need to address fragmentation in health sector leadership, stimulate more community ownership, and ensure that primary healthcare stands up to its mandate as the bedrock of healthcare. The party proposes mobile clinics, so no Nigerian lives more than thirty minutes away from a primary healthcare facility.
The APC pledges to achieve one functional general hospital across Nigeria’s 774 local government areas, one highly functional tertiary hospital in each state, and a world-class specialist hospital in each geopolitical zone. By functional, the party means equipping and staffing these facilities to reduce our reliance on foreign healthcare systems and reposition Nigeria as a medical destination for foreigners.
The party’s plans for human resources in health are robust; ranging from improved curricula contents to contain leadership and financial/corporate management courses, performance-based salary increases, home-ownership plans, health insurance and tertiary education scholarship for family members of health workers. The ruling party also aims to domicile mental health care in primary health centres, with primary health workers equipped to address such concerns. Its human resource aspiration is also targeted at discouraging brain drain in the health sector.
The APC recognizes health inequities and is promising to address this with community-based health insurance schemes; it seeks to achieve 40 per cent health insurance coverage—currently under 5 per cent across the country. The APC intends to finance this from money saved from the removal of fuel subsidies and consumption taxes on alcohol and tobacco products. It pledges to spend one per cent of pooled health insurance funds on health-related research, including domestic production of essential medicines and vaccines. The party has promised to continue with the BHCPF but will introduce special funding for the healthcare of persons classified as vulnerable groups.
Finally, the APC has promised to look into other pressing health sector concerns such as fighting corruption in the civil service that undermines health service delivery, addressing water and sanitation issues, scaling up health promotion and preventative healthcare practices at the grassroots, and preparing the country’s health system to be resilient against public health emergencies.
PEOPLE’S DEMOCRATIC PARTY (PDP)
Since its exit in 2015, the longest-serving ruling party in Nigeria’s history is the PDP (1999 – 2015) has been aspiring to return to presidential power. Its flag bearer is Atiku Abubakar, a former Vice President. The PDP’s manifesto titled, ‘My Covenant with Nigerians’, contains a 5-point development agenda—unity, security, economy, restructuring, and education. However, health is mentioned as a part of achieving human capital development.
The PDP recognizes the centrality of UHC and seeks to ensure that affordable quality healthcare is available for Nigerians. The party’s manifesto notes the gender and spatial gaps present in healthcare and promises to address them by investing in health infrastructure, rural and mobile clinics, maternal and child health, mental health, and preparedness against epidemics and pandemics. It seeks to leverage the private sector and pursue a well-devolved health sector, maximally allocating responsibilities to state and local governments.
For the PDP, the health sector has an untapped market potential and by successfully exploring such potential through investments from the private sector and ICT, Nigeria can produce its essential medicines, achieve reversal of brain-drain of medical doctors and put a stop to medical tourism.
Other ambitions include the expansion of frontline human resources for health, digitization of procurement procedures, a lasting solution to water supply and sanitation issues, and investments in health promotion and preventative healthcare. The party also promises to reform the Federal Ministry of Health, pursue anti-corruption in civil service, and shield the healthcare institution away from political interference.
THE LABOUR PARTY (LP)
A former Governor of Anambra state, Peter Obi, is the flag bearer of the Labour Party. Although LP has been in Nigeria’s political space since 2002, it will for the first time be a top contender for the Presidency heading to the polls in 2023. Health is clearly listed among the seven priorities in the manifesto of the LP, and it is underpinned by the health-related targets contained in the SDGs. The manifesto is titled, ‘Our Pact with Nigerians’ and key concerns for the LP include health insurance, human resources, health financing, and health-related research.
The manifesto recognizes the 2014 National Health Act and laments poor implementation of the policy. It has promised to implement the Act to the letter, as well as dramatically scale up budgetary allocation to the health sector while revamping the National Primary Healthcare Development Agency through whom devolved funding for primary healthcare will be pursued. The party promises to chase innovative healthcare financing through public-private partnership initiatives, special taxes, and duty waivers, as well as grant incentives that will inspire the domestic production of drugs, vaccines, and other medical consumables.
For the LP, pooled funds for healthcare will be invested in pro-poor health insurance for Nigeria’s 133 million multidimensionally poor, including pregnant women, children, older adults, informal sector workers, and persons living with disabilities.
The LP believes medical tourism can be reversed by supporting Federal Teaching Hospitals in niche areas where they can enjoy comparative advantages. Also, boosting and funding health-related research, with dedication to evaluate research findings for use was mentioned. This will be joined by establishing integrated health training institutions that will pull together different healthcare disciplines.
NEW NIGERIA PEOPLES PARTY (NNPP)
The NNPP has been in existence since 2001, two years after Nigeria’s return to democracy after military rule. However, it is one of Nigeria’s top contenders for the presidency after a former Governor of Kano State, Rabiu Kwankwaso emerged as its flag bearer. The party’s manifesto is tagged, ‘My Pledges to You’.
Healthcare is a major focus for the NNPP; morbidity and mortality incidents were highlighted alongside poor attention to drug and substance abuse and the government’s lack of committed investments in health infrastructure and human resources. The goals for the NNPP are underpinned by the philosophy of ‘health is wealth’, and thus, it is committed to reforming the health sector on the counts of accountability, service quality, and professionalism.
The manifesto of the NNPP notes the importance of partnering with state and local governments to invest in health, especially in maternal and child health services. It promises to spread quality health services to underserved communities through mobile clinics and aims to revamp tertiary hospitals. NNPP is concerned about accident and emergency (A & E) cases, as it promises to review A & E protocols to scale up urgent and quality responses to emergencies.
To expand human resources for health in communities, it seeks to commit to community medical education, while ensuring that health workers concentrate on their clinical responsibilities with no involvement in trade disputes. The NNPP is of the view that to reduce medical tourism, it must invest in health infrastructure like building facilities, expand the reach of primary healthcare, install equipment like PET-CT scanners, and optimize health information systems, local production of medical consumables, and expand and equip human resources.
While the NNPP acknowledges the need to improve budgetary allocation to health, it argues that accountability is needed to get value for money. It goes on the say that the disease control agency in Nigeria must be strengthened and steps must be in place to prepare for the next public health emergencies and disease outbreaks. Health-related research is a priority as the party promises to aggressively monitor health research in Nigeria and convert research findings into actionable policies, projects, and programmes. The party proposes a review of the National Drug Policy, and efficient monitoring of medical consumables procurement chains. The Drug Revolving Fund will be supported through efficient funding and digitized monitoring mechanisms, and the overall health sector will be made to be ICT-compliant.
The NNPP seeks to sanitize the informal health provision space by regulating traditional health services while linking them up to formal health providers. It promises to pay close attention to global health indicators and to align with ‘One Health’ by paying attention to animal health.
Other concerning health-related areas for the NNPP include reforming the National Health Insurance Scheme and making health insurance mandatory for children, investing in biomedical engineering, addressing malnutrition, water and sanitation issues, encouraging physical and health education, and ensuring the cooperation of diverse health resource persons in Nigeria.
WHAT CAN NIGERIANS EXPECT?
Albeit ambitious, these promises are not out of reach if the political will is there to follow through. All four manifestos have common policies and varying differences, reflective of recommendations made to strengthen deliveries on the expectations for the health sector post-May 2023. This includes the adoption of UHC, improved budgetary allocation to health, three-tier health investments/human resource optimization, and the expansion of primary healthcare reach, quality, and water/sanitation, innovative and pro-poor health financing, health research investment/use and addressing corruption.
The parties have different stances on A&E responses, the informal health space and traditional and orthodox health practices, private sector involvement; partnering with communities, civil society organizations and academia. The manifestos also have varying positions on training curricula for health institutions, implementing existing health policies, aligning with Sustainable Development Goals health targets, and pursuing ‘One Health’.
After the 25 February elections conclude and a winner is declared, one of these four manifestos will be the blueprint for the health sector for the next four or eight years, pending re-election after the first four-year term. It is also likely that the winner at the poll might collapse the brilliant ideas from other manifestos into his, affording him the opportunity of running with a comprehensive blueprint.
Ahead of the elections, the Health Policy Research Group of the University of Nigeria, Nsukka, and the Health Sector Reform Coalition, Abuja, recommends the expansion of BHCPF to all PHC facilities in Nigeria, the full implementation of minimum standards for PHC centers, the use of strategic purchasing in budgets and the use of research findings for policy making. The health coalition also recommends a mainstream health agenda in all sectors, engaging qualified mental/social service professionals in PHC, addressing corruption, manpower challenges and inter-professional rivalry.⎈
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