President Muhammadu Buhari addresses the summit at the UN General Assembly

History is being made as the world leaders unanimously adopts the #GlobalGoals and President Muhammadu Buhari addresses the summit at the General Assembly on 25^th Sept 2015.

 Here is what the President of Nigeria, President Muhammadu Buhari had to say:

AT ADOPTION OF POST-2015 DEVELOPMENT AGENDA, BUHARI URGES WORLD LEADERS TO DO EVERYTHING POSSIBLE TO ELIMINATE ILLITERACY, HUNGER AND DISEASE BY 2030

President Muhammadu Buhari Friday in New York reaffirmed his Administration's total commitment to the entrenchment of a fully transparent and accountable public revenue management system in Nigeria. Addressing the United Nations Plenary Summit for the Adoption of the Post-2015 Development Agenda,

President Buhari said that his administration was taking steps to improve and streamline internal generation of revenue, and to plug all loopholes that have led to illicit capital flight from Nigeria.

The President told the gathering that his government was also putting mechanisms in place to prevent oil theft and other criminal practices that are detrimental to Nigeria's economy. Applauding the adoption of the Post-2015 Global Development Agenda, President Buhari said that he was very pleased that world leaders had reaffirmed their commitment to sustainable development, international peace and security, and the protection of the planet. "These are really the major issues of the day. For the first time, we have at our disposal a framework that is universal in scope and outlook, with clearly defined goals and targets, and appropriately crafted methods of implementation. "The Declaration that we have adopted today testifies to the urgency and the necessity for action by all of us. It is not for want of commitment that previous initiatives have failed or could not be fully realized.

What seemed to be lacking in the past were political will and the required global partnership to pursue and implement the programmes to which we committed ourselves.

"This Declaration enjoys global consensus. We have agreed to deliver as one and to leave no one behind. This is a promise worth keeping. We have agreed to create viable partnerships and to adopt the means of implementation for the goals and targets of the global sustainable development agenda in all its three dimensions; namely economic, social and environmental. "The Post-2015 Development Agenda and the Sustainable Development Goals (SDGs) together with the Addis Ababa Action Agenda that we adopted in July 2015, offer us a unique opportunity to address the unfinished business of the Millennium Development Goals (MDGs).  "They also provide the basis for a new set of global development priorities to usher in a peaceful and prosperous world, where no one is left behind, and where the freedom from fear and want, and for everyone to live in dignity, is enthroned," President Buhari said. Noting that illiteracy, hunger and diseases are associated evils that go hand in hand with poverty, the President urged the assembled world leaders to do everything possible "to eliminate these ills from our midst by 2030 as the Declaration loudly proclaims". "The bottom billion that has neither safety nets nor social protection, need to be rescued from their perpetual state of hopelessness, fear and indignity. This is a task that should have been accomplished decades ago. Now that it has fallen on our shoulders to discharge this responsibility, we should do so with the enthusiasm and commitment that is worthy of the cause. "We must adopt targeted interventions at both policy and practical levels, to address extreme poverty and combat illiteracy, hunger and diseases. We must create viable partnerships that bring together national, regional and global actors with shared objectives to carry this forward.

"We must also create the enabling environments for executing this global agenda, by developing the relevant frameworks for working with different types of partners and constituencies that recognize the contributions of civil society, religious and cultural bodies, private sector, academia and most importantly, governments.  "Just as the relative success of the MDGs was underpinned by national ownership, the Post-2015 and the SDGs frameworks must also be guided by national priorities and ownership. Domestic resource mobilization supplemented by improved terms of trade between industrial and developing economies should drive the implementation processes in both streams.

The facilitation of remittances by migrant and overseas workers, as well as efficient tax collection are needed as complimentary sources of financing for development," the President said.

He said that Nigeria was proud to have availed her services to the United Nations in co-chairing the Intergovernmental Committee of Experts on Sustainable Development Financing, whose work contributed in no small measure to the expansion of financing for development strategies.

Femi Adesina

Special Adviser to the President

(Media & Publicity)

September 25, 2015

Now that today marks a year without a single case of wild polio virus in Nigeria, Can the country eradicate polio like Guinea worm?

vanguardngr.com

It is no longer news that the country is celebrating a year without a case of polio, Donors and Agencies are celebrating. We cannot but also give credibility to community health workers and village health workers, these health workers at local level are known for their house-hold visitations and are responsible for the massive awareness creation and general acceptance of polio vaccine. Recall that nine health workers were killed while vaccinating children against polio in 2013. It’s also noteworthy to commend the efforts of community leaders and religious leaders.

At the local level, health workers, often drawn from the communities they serve, have partnered with polio survivors and religious leaders to help parents understand the importance of the vaccine for their children.

Even though Nigeria is long due for this breakthrough, it is worth the celebration.

However, we are not to be carried away by this achievement but to long for more. Need I mention that the country must go an additional two years without a case to be certified polio-free? Nigeria is the only country in Africa that is not polio free and along with only Pakistan and Afghanistan where the wild poliovirus has never been stopped.

We should see this development as an indicator telling our country that polio can be eradicated in no time just as we did Guinea worm. I know that President Buhari’s priority right now is to restore stability and peace in the North East, but I seriously advise Mr President to take this up so that the great achievement of polio eradication in the largest African economy is recorded in His time. While restoring peace and stability in the North East, the coming Health minister should strengthen surveillance in the region and ensure that all children are vaccinated. Efforts should also be concentrated in the household visit (outreaches) particularly hard to reach areas.

Whoever the health minister will be, He must prioritize polio vaccine and work tirelessly to see polio eradicated in His time. Aids tracking mechanisms should be in place to achieve efficiency and effectiveness.

Achieving polio eradication requires sustained actions by all the critical stakeholders. Governments from local to state and federal levels must redouble their efforts to ensure that the financial resources to eradicate polio are rapidly and fully mobilised. There is also the need for sustained effort to cover the last mile of making history at this most critical time.

Big Congratulations…God Bless Nigeria!

Things to consider in achieving Health for All through Primary Health Care

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NIVERSAL HEALTH COVERAGE:

Things to consider in achieving Health for All through Primary Health Care

It is note worthy to bring our memory back to Alma Ata Declaration in 1978 in discussing this issue, after which I will briefly talk about the present situation to the best of my knowledge in my country Nigeria before I discuss possible interventions (actions) and the challenges.

Primary Health Care is an essential health care which is practical, scientifically sound and socially acceptable to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of development in the spirit of self reliance and determination.  The key words that make effective primary health care are;

1.      Inter-sector approach and

2.      Community participation

Primary Health Care is practiced in Nigeria. Administratively, there are governmental bodies called National Primary Health Care Development Agency (NPHCDA), State Primary Health Care Development Agency (SPHCDA) and Local Government Authority Primary Health Care Department (LGA PHC) at federal, state and local government level respectively.  Their responsibilities are to provide regulations, over sights, technical supports and capacity building for Basic Health Centers (BHCs).  

The agency get funds and grants from the government and donors like the World Bank, IMF, Bill Gates foundation fund, UNICEF, WHO etc. Consequently, their interventions are horizontal and vertical. Referral system is also in place although the effectiveness of it is questionable.

Even with all these, I can say we are not yet there; we need interventions that are scientifically designed to help improve limitations that we have in the system.  Hence, I identify three specific actions that contribute toward achieving Health for All through Primary Health Care.

·         Action 1: Community mobilization  

·         Action 2: Health Financing

·         Action 3: Health determinants consideration

Action 1: Community mobilization 

Community mobilization is defined as a capacity-building process through which community individuals, groups, or organizations plan, carry out, and evaluate activities on a participatory and sustained basis to improve their health and other needs, either on their own initiative or stimulated by others.  

It can be deduced from the above definition that community mobilization goes beyond gathering community members and just passing information. Community participation is a subset of community mobilization.  Community health interventions that will work effectively will have the traditional health workers and other community members trained and it will involve them through the planning and implementation of the project.  How much of health interventions set up by the government considers the community people? The answer is not farfetched, it can be easily said that if most of the project had fully involved community members, we should hear more of success stories than the failures recorded even at pilot phase.

According to the Alma Ata Declaration, Primary health care: “relies, at local and referral levels,

on health workers, including physicians, nurses, midwives, auxiliaries and community workers (applicable), as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community”.  “Health services, no matter how efficient, cannot change the condition of the marginalized people unless they are helped to become self-reliant and the root problems addressed. People who are poor and illiterate are like uncut gems hidden under the dirt and stone. Given the opportunity, they can reach their full potential and live as responsible, sensitive human beings, possessing self-reliance and the liberty to shed those old customs and traditions that impede health and development.” Arole and Arole, 1994

Health programmes today often identify empowerment rather than participation as an objective. Empowerment can be defined as the process and outcome of those without power gaining information, skills, and confidence and thus control over decisions about their own lives, and can take place on an individual, organizational, and community level. Community mobilization, by it definition, is a way to support this empowerment process and reach this empowerment outcome.  All the successful projects like; Nepal, Jamkhed etc. have the component of ‘capacity building’. Also, the choice and the voice of the community people must be empowered. Community members should be able to talk with an action following their voices when they decide how their health centers should be. Their opinions should be highly respected.

·         Action 2: Health Financing

The importance of health financing at the country level to the community level cannot be over emphasized.  A good financing system is however essential for effective and efficient delivery of primary health care.  Health financing policies from the perspectives of the basic financing are functions of collecting revenues, pooling resources, and purchasing services. It evaluates these functions for their capacity to improve health outcomes, provide financial protection, and ensure consumer satisfaction in an equitable, efficient, and financially sustainable manner. For primary health care delivery to function effectively for all, the available scarce resources should be efficiently distributed.

The importance of efficient distribution of scarce resources can be seen well practiced in Brazil health interventions. The country was known to be a very poor country in the 1940’s and 50’s on the par of countries in Africa. And during that time it created a special service for public health that was focused on improving the public health in rural isolated areas giving priority to immunizations, maternal and child health, and improving water and sanitation. Their projects clearly demonstrated cost efficiency. The very sparse distribution of health centers created only had minimal resources, but is was well administered and the staffs who worked in it were well paid, it had a good management structure.

Action 3: Health determinants consideration

The Alma Ata Declaration in 1978 also illustrated that Primary health care reflects and evolves from the economic conditions and socio-cultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience. Health according to WHO is defined as a state of complete Physical, Mental and Social well-being and not merely the absence of a disease or infirmity. The Alma Ata declaration involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors. Most of the notable health programs focus on health care alone, leaving behind other health determinants such as quality water supply, hygiene and sanitation. For an effective program, inter-sector approach is highly needed.  Ministry of health is not the only agency that should be active in achieving health for all, other ministries like; agriculture, finance, environment etc. should be effectively involved.

CHALLENGES RELATING TO THE SPECIFIC ACTIONS

Top – down approach (hindering effective community mobilization)

Most of the Primary health care interventions in Nigeria are done without considering the community members that will enjoy the program; this could be as a result of their selfish interests. Top-down approach is mostly sought. The governments are the dictators and they single handedly plan and execute the projects. Asides that, minority groups in the community can show lack of interest in participating, they might not be carried along in the project and this could affect the project sustainability.

Cost Inefficiency

Ineffective allocation of resources is a frequent occurrence in most primary health projects. This mostly accompanies poor management, unclear institutional role.  If the management is controlled well, then will we have efficiency in primary health care programs, we can see a demonstration of cost efficiency in Brazil intervention where financial resources from federal, states and municipals are pooled and judiciously used.   

Conflict of interests between sectors

 This could be as a result of unclear description of agencies’ roles. Most agencies do not want to approach health programmes in horizontal manner but in vertical. For instance, Ministry of Health would want to claim the superior over ministry of agriculture when talking about tetanus eradication, forgotten that the bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. They should work together on the same level.

In conclusion, the three specific actions and three specific challenges identified above can make or mar the achievement of Health for All through Primary Health Care but it is not only limited to the factors aforementioned.

REFERENCES

 

Howard-Grabman L, Snetro G. How to mobilize communities for health and social change. Baltimore, MD: Health Communication Partnership/USAID, 2003.

Rifkin S, Pridmore P. Partners in Planning. London: MacMillan, 2001.

Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

Pablo Gottret, George Schieber. Health Financing Revisited A Practioner’s Guide. 2006

Arole, M., Arole, R. (1994). Jamkhed: A Comprehensive Rural Health Project (1st ed.). Macmillan.

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