His dedication to promoting health policy and systems research has seen him rise to represent the African continent on the board of Health Systems Global (HSG), an organisation of diverse professionals dedicated to promoting health policy and systems research and knowledge generation. Felix Abrahams Obi advocates for a change in the culture of budgeting for inputs in the health sector. He believes focus should shift to performance and results in order to improve Nigeria’s poor health outcomes and indices.
What more can be done to strengthen health systems in these times?
We are not lacking in beautiful policies, but our major weakness is staying on course to achieve our policy objectives and targets.
Governments and federal and state level need to invest more in healthcare and other sectors that contribute to improved wellbeing and positive health outcomes. State governments need to take more responsibility in strengthening health systems as no citizen is under the direct care of the federal government as we all live in the states. If the PHCs deliver quality care, our people will have more trust in them and patronise them for malaria or other common illnesses.
Patients are the number one stakeholder in the health system, but they are often sidelined. Health workers should remember that the patients are the real employees and they are paid salaries to take care of patients.
Health workers’ demands for improved welfare packages should be matched by improved quality of services and tangible results. We need a sense of urgency if we must improve our health system and health outcomes. We will not achieve the health-related SDGs same way we did not meet the MDGs, if we do other wise.
What are the roles of private sector led organisations in the public-sector space??
The private sector has played a critical role in the delivery of health services in Nigeria as we have more private health facilities than publicly owned hospitals in Nigeria. Over the years the government has realized the need to partner with the private sector through different PPP initiatives.
More recently the Federal Ministry of Health (FMoH) developed a National Policy on Incentivising Investments in the Health, which provides the framework for mutual collaboration and partnership between the government and private sector players. The PPP unit of the FMoH has been championing efforts to leverage private sector resources to support public health initiatives.
There is also the Healthcare Federation of Nigeria (HFN) which is an umbrella body of private sector players, who regularly engage with the public sector to ensure that private sector players contribute to policy formulation and implementation across the country.
One other critical role that the private sector is playing is in providing technical and policy advisory to government agencies in designing, implementing, and monitoring public health interventions at federal and state level. Increasingly Nigerian public health professionals are establishing health consulting and advisory firm who leverage the efficiency of private sector to support public sector initiatives.
What is working in the public heath space and what is not??
It is really shameful that since 2015, we have not been able to fully implement the provisions of the National Health Act after it was signed in 2014. It was hoped that its implementation will help transform the health system.
Budget released to the health sector must be used efficiently and the policy makers and duty bearers at the federal, state and LGAs need to account for all the resources that are budgeted and released yearly. The culture of budgeting for inputs is unacceptable in modern world where focus is on performance and results.
We need to have a rethink and find a way to tie the budget releases to results. The National Health Insurance Scheme (NHIS) should be repositioned to be the sole purchaser of services on behalf of the federal ministry of health. Rather than allocating budgets to these hospitals, the federal government should channel them through an insurance scheme, such that hospitals are paid for results; a concept called paying for performance and results. They should be given quotas and targets to meet yearly, and the government pays or reimburses them for the services rendered.
Our undue reliance on donors for technical assistance and funding needs to end or minimised at the least. So, Nigeria Centre for Disease Control (NCDC) need to be weaned off donor support through appropriate budgetary allocation in addition to ring fencing and earmarking special funds for health security. We need to build on the gains we recorded in implementing vertical disease programmes like HIV/AIDS, malaria, vaccine preventable diseases like polio, guinea worm and others and leverage the resources and systems to improve how we implement policies.
We need to ensure that we implement the policies we painstakingly have developed. We need to re-orientate key players in government to understand the nuances and complexities of publicly policy implementation and borrow models and project management approaches that the private sector regularly deploys to implement projects and other interventions.
Finally, we need to have citizens become more involved in all the cycles of budget formulation, appropriation, implementation and monitoring to ensure the budget meets the actual needs of the people.