18 States perform poorly in Health services between 2019, 2021 – Report

Despite the provisions of the Basic Health Care Provision Fund in the country, a new report has shown that 18 Nigerian states perform poorly on health systems indicators and are unable to provide adequate primary healthcare services.

The report revealed that health systems in the states are weak, resulting in poor healthcare service delivery, especially in public facilities. 

This is even as the Chairman of the Senate Committee on Health, Senator Ibrahim Oloriegbe blamed the Federal Ministry of Health for not fully utilising the budget allocated to the health sector.

The report titled ‘The state of primary healthcare service delivery in Nigeria 2019-2021’ reviewed the implementation of the Basic Health Care Provision Fund by the National Primary Health Care Development Agency, the National Health Insurance Scheme, and the National Emergency Medical Treatment gateways.

The report also evaluated states based on enabling legal and policy environments for health and health planning; health financing, human resources, health products and technologies, health management information systems, service delivery, and community involvement.

According a report in 2014, the National Health Act established the BHCPF to address funding gaps hampering effective primary healthcare delivery across the country. The BHCPF comprises one percent of the Federal Government Consolidated Revenue Fund and additional contributions from other funding sources. 

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It is designed to support the effective delivery of Primary Healthcare services, provision of a Basic Minimum Package of Health Services, and Emergency Medical Treatment to all Nigerians.

The report published by The ONE Campaign, in partnership with National Advocates for Health, Nigeria Health Watch, Public & Private Development Centre, and other partners, showed that Zamfara state leads as the worst state in Nigeria, to be a citizen in need of healthcare with 38 per cent.

Other states ranked poorly are Sokoto -41 per cent; Taraba – 43 per cent; Kebbi -43 per cent; Katsina -43 per cent; Borno -43 per cent; Yobe -45 per cent; Kogi -45 per cent; Jigawa -49 per cent; Rivers -50 per cent; Gombe -50 per cent; Cross-River 51 per cent; Edo -52 per cent; Bayelsa -52 per cent; Akwa-Ibom -52 per cent; Plateau (54 per cent); Imo (54 per cent); and Kaduna (55 per cent).

Although, the findings showed that the Federal Capital Territory is the best place to need healthcare in Nigeria, the differences between states and the FCT, and within states and the FCT, highlight that access to and utilisation of health services continues to be marred by stark inequalities across Nigeria.

However, the report also ranked Enugu -66 per cent; Anambra -65 per cent; Ekiti -63 per cent; Delta -61 per cent; Abia 60 per cent; Lagos -60 per cent; Nasarawa -60 per cent; Adawawa -59 per cent; Kwara -59 per cent; Benue -58 per cent; Ebonyi -58 per cent; Oyo -58 per cent; Bauchi -57 per cent; Ogun -57 per cent; Ondo -57 per cent; Kano -56 per cent; Niger 56 -per cent and Osun -56 per cent as best performing states, with the FCT topping the pack with 68 percent.

“The findings from this report do ultimately awaken cautious optimism for health delivery across states. In finding that the key challenges driving poot performance amongst states are not insurmountable, this report aligns with many other reports, and yet this report also provides citizens with a tool to demand that the necessary steps be taken to address these challenges,” the report noted.

Speaking at the unveiling of the report, the Chairman of the Senate Committee on Health, Senator Ibrahim Oloriegbe expressed disappointment that the FMoH does not fully utilise the budgetary allocation to the health sector.

Oloriegbe said “It is very sad to say that even the budget allocated to health, the health sector does not consume its money. Can you imagine that the health sector returned money back for not spending? It happens in 2022. In 2021, it almost happened.

“We are crying that we don’t have enough but the little given to us cannot be spent despite the fact that the budget implementation was extended up to May 31st, the Federal Ministry of Health did not spend all this money.

“Relating to that, the BHCPF, we have 2018, 2019, 2020, 2021, and 2022 money but it is only two years -2018 and 2019 that has been released. we still have three years of money lying in our account and Nigerians are suffering; why? These are the questions we should raise as advocates. We have a long way to go, not only in getting the money but how do we get the money to do what it’s meant for?”

The senator, however, urged Nigerians to call on their state governments to release appropriate funds and ensure adequate monitoring of the funds to improve public health facilities, especially the primary health centers.

 Speaking with Newsmen, The ONE Campaign’s Nigeria Director, Stanley Achonu said weak governance continues to pose a major obstacle to improved healthcare delivery. 

“It hampers efficiency and effectiveness and results in weak infrastructure, poor user experiences, and poor health outcomes. The burden of strengthening the healthcare systems and services lies heavily on governance and leadership. At all levels, the government needs to take responsibility as a building block of the health system, especially in system design, policy guidance, oversight, regulation, accountability, coalition building, monitoring, and enforcement. The success recorded with polio eradication, containment of Ebola, and the COVID-19 pandemic has shown that Nigeria can deliver on critical health issues given the required political will and leadership commitment. We have to act quickly to avert primary healthcare collapse.”

The Chairman of National Advocates for Health Group, Muhammad Usman, called on the government to provide the required leadership to ensure that primary healthcare is improved across the country. 

According to him, “The Federal Government must ensure timely release of funds allocated for the Basic Health Care Provision Fund and effective utilization of the same at the sub-national level to improve primary health care performance nationwide.”

As part of its recommendations, the report proposes that states should provide political leadership for establishing a State Health Insurance Agency, develop an electronic workforce registry at the state level, support management of human resources for health, and develop a health system-wide accountability and performance management framework.

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