Submission Of Final Report Of The Presidential Health Reform Committee To President Muhammadu Buhari

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REMARKS BY HIS EXCELLENCY, PROF. YEMI OSINBAJO, SAN, GCON, VICE PRESIDENT, FEDERAL REPUBLIC OF NIGERIA, ON THE SUBMISSION OF THE FINAL REPORT OF THE PRESIDENTIAL HEALTH REFORM COMMITTEE TO PRESIDENT MUHAMMADU BUHARI AT THE VALEDICTORY FEDERAL EXECUTIVE COUNCIL MEETING ON THE 24^TH OF MAY, 2023

PROTOCOLS

On September 6, 2021, Your Excellency established the Presidential Health Reform Committee, to develop a Health Sector Reform Programme for Nigeria, in close collaboration with State Governments and the Federal Capital Territory Administration.

Membership included the Hon. Ministers of Health, a Governor representing the Nigerian Governors’ Forum, the Chairman of the Senate Committee on Health, Heads of relevant Government Agencies, State Commissioners, Private Sector Experts, and representatives of International Development Agencies. To ensure wide and inclusive consultations, several other sector experts who could add value to the process were also co-opted.

The Committee received memoranda from members of the general public.

We also took extensive proposals from committee members and the organisations they represent, including the National Assembly, State Governors, and Unions in the Health Sector and the Private Sector. This was followed by a retreat to brainstorm several policy options which arose from the submissions.

Finally, we held several meetings in Technical Sub-Committees and in Plenary, to streamline the contentious issues and agree on a consensus position, with the assistance of consultants, including the Bill & Melinda Gates Foundation, who were engaged to support the Committee.

We thank Mr. President for giving the Committee this historic task. Our deliberations have been especially productive, and this has afforded us the much-needed opportunity to set Nigeria on the path to Universal Health Coverage. The committee is mindful that investing in health will enable our country to unlock its immense potential and ensure that all Nigerians, regardless of their social class, can access quality health services.

However, we also realized that this would require structural reforms, hence the intentional effort to cover the poor and ensure the mobilisation of large amounts of private investment.

One of the first insights that confronted the Committee was how the structure of our federalism unwittingly contributes to poor health outcomes.

The report addresses this in three ways: first, is the use of National Accountability Agreements on health performance. Second, is the proposal for a national partnership agreement on health sector reform recommendations – to be signed by all States and FCT. Third is the strengthening of institutional arrangements for pandemic preparedness and response.

Mr. President, achieving Universal Health Coverage for Nigerians is really the essence of this report. This is to be realized through the prioritization of government spending on health and boosting of per capita health expenditure by scaling up the National Health Insurance System as the preferred public financing arrangement. This approach is one where the National or State Health Insurance Authorities would benefit from general budget transfers from the relevant Federal or State government.

The report, therefore, recommends a healthcare guarantee for all Nigerians registered on the National Social Register, currently 12 million registered households, (equivalent to about 55 million Nigerians). The report further recommends that the share of total health expenditure flowing through our health insurance schemes must be more than 10%.

The committee is fully aware of a reform programme’s governance and institutional requirements. We have proposed a number of institutional changes, including the establishment of the National Tertiary Health Institutions Commission (whose function is similar to the National Universities Commission) and the National Quality and Healthcare Standards Commission (NQHSC). In view of obvious funding constraints, the Committee hesitated to recommend new institutions. However, on balance, we agreed that for us to make progress with our human capital agenda, these institutions are essential.

Other recommendations vary from Human Resources in Health (HRH) issues such as “brain drain” to the expansion of access to primary health care services, medical tourism, and mobilizing or leveraging private capital for health investments as well as their role in expanding the supply of health workers for Nigeria in the medium and long term. Lastly, this report recommends that vaccine manufacturing in Nigeria should be seen from a perspective of national health security rather than purely as commodity production.

Mr. President, we do not harbour any illusions that these reforms are easy to implement. Beyond the financing requirements, there would be a need for global expertise and collaboration. In this regard, local and international development partners are much needed.

For this and other purposes, we have proposed the setting up of a programme Delivery Unit in the Office of the President. This independent but empowered unit would monitor and drive the reforms. An important part of the report are the draft National Health Amendment Bill and draft amendments of other relevant bills.

Mr. President, while it was our duty to prepare this comprehensive roadmap towards universal health care in Nigeria, it has become the responsibility of the incoming administration to take this journey to its much-desired destination. And we wish them well in that patriotic enterprise.

Mr. President, again we thank you for this opportunity, and on behalf of the members of the Presidential Health Reform Committee it is my privilege to present the Health Reform Report and draft Bills to Your Excellency.

Thank you, and God bless the Federal Republic of Nigeria.