Dr Aminu Magashi Garba is the Founder/Coordinator of Africa Health Budget Network (AHBN) and Chair of the Board of Trustees of the Community Health and Research Initiative (CHR). In this interview with ADAM ALQALI, he advocates an increase in budgetary allocation to health, as well as ensuring timely release of the budgeted funds towards enhancing healthcare delivery in Africa
What role do you think increasing budgetary allocation to health will play in enhancing healthcare delivery in Africa, particularly reducing maternal and infant mortality?
Looking at the continent as a whole and Nigeria in particular, we need to consider some of the indicators for measuring the performance of governments; to be able to determine whether or not the governments are doing well. We need to look at the Abuja Declaration which is calling on African governments to commit 15% of their annual budgets to the health sector and call by the World Health Organization which seeks that 86 dollars be spent per capita (per individual) on health as well as 3-5% of a country’s GDP be allocated to health.
Across the continent, you can see that majority of the countries in Africa are lagging behind in terms of abiding by these international instruments. And coming back to Nigeria, you will also see that we are yet to achieve the requirements of any of these 3 indicators. The allocation to health in Nigeria’s 2016 budget was just 5% ,while the per capita spending, which was supposed to be 86 dollars, was less than 30 dollars and the GDP allocation to health was less than 3%. The story is the same at the level of the states. So, looking at all the major yardsticks one can say that Nigeria also still has a long way to go.
It means for us to reduce maternal and infant mortality, the budgets have to increase, both in terms of allocation and also in terms of release. This is because sometimes you will discover that governments will allocate huge sums to health in their budgets but by December of the budget year, you will realize that only half or even less than half of that amount has been released.
As such, if we are doing advocacy, we must not only target budgetary increase for health. Rather, we should also advocate for timely release of budgeted funds. And for us to see increase in the reduction of maternal and infant mortality, there has to be adequate resources to buy essential drugs, pay for the salaries of health workers including doctors, nurses, midwives, and community health workers as well as improve infrastructure in the healthcare facilities.
Like you said, it is one thing to budget huge sums to the health sector and entirely another for those funds to be judiciously utilized. What parameters do you think need to be brought in place to ensure judicious utilization of funds for healthcare services?
This is where the NGOs and also the media need to be very vigilant in terms of tracking the funds. And this is also where the issues of scorecards, dashboards and report cards come into play, whereby the NGOs and the media use the government calendar system to ensure the budgeted allocations are released every quarter. For example, if money for immunization is released from the finance ministry, the funds need to be tracked such that if the money goes to a primary healthcare agency, the NGOs and media should go there and determine whether or not drugs are released to the healthcare facilities as well as go to the facilities to check if drugs and health workers are available in the healthcare facilities 24 hours a day.
Among others, the 3rd Sustainable Development Goal (SDG) seeks for the reduction of maternal deaths by 70% per 100,000 births by the year 2030. How achievable is that goal in Africa?
The global goals are talking about incremental reduction in maternal deaths by 70% among the countries of the world, from between 2016 and 2030. It means every country needs to plan well and of course every country in Africa can achieve that if they can come up with say a 15, 10 and 5 year plans as well as a 1 year operational plan.
The plan should for example, say that every year we are going to increase the number of doctors, nurses and midwives by a certain percentage, and we are going to ensure lifesaving drugs are available in the healthcare facilities. We are going to ensure capacity building for health workers, and provide modern equipment.
If all these could be done, I can guarantee you that all countries in Africa can achieve the goal but certainly it is not going to be a tea party, there must be a lot of hard work, concerted efforts as well as commitment by stakeholders, transparency and accountability and cooperation between professional bodies, NGOs and the media.
According to the National Demographic Health Survey, 576 maternal deaths are being recorded per 100, 000 births in Nigeria. What do you think must be done by government, NGOs and the media to arrest the trend?
First and foremost, governments at federal and state levels must declare a state of emergency in the health sector and that declaration of state of emergency should go beyond mere statement rather there should be action, the minister and commissioners must be proactive by coming up with measures to arrest the trend of maternal mortality which is really unfortunate.
We need to do a lot to ensure we improve the numbers of skilled birth attendants since a lot of pregnant women deliver at home and there are communities where there are no healths facilities operating 24 hours a day hence pregnant women have no option than to deliver at home.
We therefore need to ensure hospitals function 24 hours a day, so that anytime pregnant women go to a healthcare facility they will be attended to and the health workers also need to be motivated. If you have healthcare workers whose welfare is well taken care of then you will have a very serious and committed human resource in the health sector. If we want drugs to also be available we need to bring the private sector to support the government and even community and religious leaders including ward heads, Imams and pastors to create more awareness on these issues.
Like you said, healthcare is too important to be allowed in the hands of the government alone to provide it for the people. How much do you think public-private partnership will help in addressing the healthcare challenge in Nigeria?
We are encouraging partnership between the government and the private sector, for example, if there is need for a healthcare facility or pharmacy in a community, a private company can build it and give it out to the government to manage or even manage it itself. The private companies can also buy mattresses, diesel for generators and drugs for hospitals. On the other hand, community leaders should also use all available platforms including wedding and naming ceremonies to create awareness about these issues and encourage people to come forward to support the government on these issues.
