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The health sector is one of the Tinubu administration’s axes of policy dynamos and triumphs. Reforms initiated to upskill manpower, strengthen structural integrity, upgrade infrastructure, provide essential equipment, and ensure efficiency in healthcare delivery are crystallising with evident outcomes. In December 2023, President Bola Tinubu unveiled the Nigeria Health Sector Renewal Investment Initiative – a programme steered by the Ministry of Health and Social Welfare under the Coordinating Minister of Health and Social Welfare, Dr Muhammad Ali Pate.
The Nigeria Health Sector Renewal Investment Initiative is a strategic blueprint— with a sector-wide knack for improving population health outcomes through the primary healthcare system and enhancing reproductive, maternal, and child health services in the country. Primary healthcare is as fundamental as the base structure of an edifice in building a resilient and integrated healthcare system; hence, the Tinubu administration’s comprehensive revamp of infrastructure and equipment and retraining of frontline health workers.
Specifically, the administration set out to raise the number of functional Primary Healthcare Centres from 8,809 to over 17,600 by 2027 across the 36 states and the Federal Capital Territory, train 120,000 frontline health workers over 16 months, increase health personnel enrolment capacity of accredited nursing and midwifery institutions by two-fold to accommodate the demand created by new facilities, and establish a paid volunteer youth force of social accountability officers to monitor the functioning and financial integrity of these primary healthcare centres.
In addition, the administration sought to address the high cost of healthcare and enhance access to healthcare services by redesigning the Basic Health Care Provision Fund. The BHCPF is a foundational element of the sector-wide approach – with pooled and non-pooled financing to advance the primary health system nationwide.
So far, the policy intentions and actions are yielding winsome outcomes.
Here are the outcomes.
Human resources for health
The target of the Federal Government is to train 120,000 health workers. So far, 40,240 health workers have been trained, of which frontline health workers comprising doctors, nurses, midwives, Community Health Extention Workers, and Junior CHEWs, to provide clinical services in government-owned PHCs are 36,087.
Also, 24 states plus the FCT have completed Phase One training—Phase One training will be completed in the outstanding states in the coming months.
Meanwhile, conversations are ongoing with states to accelerate the recruitment of health workers to meet their PHC functionality gaps, starting with an accelerated transition of volunteers to full-time salaried employees.
Furthermore, transitioned volunteers and newly recruited health workers will be trained during Phase Two.
To ensure sustained and continued capacity building, an e-learning programme is being developed to be deployed.
Community health programme
The National Primary Health Care Development Agency, in collaboration with the Federal Ministry of Health and Social Welfare, state governments, and partners, is redesigning a community health programme that will extend essential health services to remote and underserved communities towards improving health outcomes.
Also, the community health programme will create 126,000 jobs for community health workers.
The services will include reproductive, maternal, newborn, and child health and nutrition, and routine immunisation . It also entails disease surveillance for non-communicable diseases, HIV, TB, and Malaria. It also involves health data collection, risk communication, community engagement, and health insurance.
Reproductive, Maternal, Newborn, and Child Health service delivery
Under reproductive, maternal, newborn, and child health service delivery, the progressive outcomes are:
The Expanded Midwives Service Scheme, which is redesigned across four major areas. The scheme has expanded and has recruited skilled birth attendants, enhancing maternal and child healthcare nationwide. 730 skilled birth attendants are to be deployed to prioritised PHC facilities in the first six months using the eMSS as an interim solution.
Also, the RMNCH commodities quantification was done for pooled procurement. This will enable the establishment of seed stock of a reliable end-to-end system that guarantees regular availability and visibility of the MNCH commodities in PHC facilities.
Also, service delivery models for traditional birth attendant referral and midwifery outreach were developed to generate demand and provide maternal and child health services to hard-to-reach communities.
In addition, a service readiness assessment is conducted across 1,508 BHCPF health facilities to identify service gaps and define interventions required to ensure all suites of maternal and reproductive health services are provided. These services include family planning, post-delivery and miscarriage care, adolescent sexual and reproductive health, maternal health, and gender-based violence services.
A draft framework for sustainable commodity distribution is being developed.
Primary healthcare revitalisation
A total of 8,421 health facilities were assessed across the 36 states and the Federal Capital Territory. Among them, 1,786 level 2 functional Primary Health Care Centres (PHCs) were identified, fully equipped to provide 24/7 safe delivery services for pregnant women. Additionally, 5,447 level-one functional and 1,189 partially functional PHCs were identified. These facilities lack at least one key component but can offer basic services such as antenatal care and routine immunisation.
Revitalisation efforts have begun to increase the number of functional health facilities in the country. The federal government has identified 577 PHCs for revitalisation, while state governments have targeted 2,737 centres to achieve similar and robust gains. A public dashboard is also being developed to track the status of facilities and ongoing revitalization efforts.
Basic healthcare provision fund 2.0
A new set of guidelines is currently under review by the Ministerial Oversight Committee to improve basic healthcare in the country.
The BHCPF 2.0 will see that more facilities will receive Direct Facility Funding, and this DFF will be increased from N300k to N600k-N800k per quarter.
Also, Performance and Financial Management officers will be engaged to ensure transparency and improve PHC service quality by tracking financial and operational activities to support data-driven decisions.
Data and digitisation
The NPHCDA has developed a comprehensive 3-year digitalisation agenda that encompasses facility functionality and readiness, supply chain management, financial management, and the community health information system.
The facility functionality dashboard developed and operated from NPHCDA is currently awaiting the first round of data refresh.
Digital platforms would serve as public platforms to provide a wide access view of PHC functionality in progress. It will also provide details of citizen engagement mechanisms in progress.
Routine immunisation and polio
The Identify, Enumerate, and Vaccinate strategy was launched in 89 wards to improve the quality of polio campaigns and data usage, with expansion plans underway.
Also, synchronized type 2 Novel Oral Poliomyelitis Vaccine campaigns are scheduled for October 25 and November 22, aiming to reach 38 million eligible children across 20 states.
HPV vaccination has been rolled out nationwide, with 12,345,572 girls vaccinated across all 36 states and the Federal Capital Territory.
Health campaign strengthening
To strengthen health campaigns, the government launched the diagnostic process to streamline campaigns, enhancing efficiency and inclusivity for diverse audiences.
Nigeria has joined the Collaborative Active Strategy as one of two pilot countries, aiming to effectively implement health campaigns and strengthen the nation’s health system. This has resulted in the establishment of a technical working group tasked with tailoring CAS recommendations to align with Nigeria’s priorities and overseeing their implementation.
It is in light of the sector-wide health initiative that the World Bank recently approved $1.57 billion to support the health sector in Nigeria. The World Bank financing is from the International Development Association, which is highly concessional, attracting zero interest, with a 10-year moratorium and 30-year repayment plan. According to the bank, the funds will strengthen human capital through better health for women, children, and adolescents.
“The World Bank has today approved three operations for a total of $1.57 billion to support the government of Nigeria in strengthening human capital through better health for women, children, and adolescents and building resilience to the effects of climate change such as floods and droughts through improving dam safety and irrigation. The new financing includes $500 million for addressing governance issues that constrain the delivery of education and health―known as HOPE-GOV, $570 million for the Primary Healthcare Provision Strengthening Program; HOPE-PHC, and $500 million for the Sustainable Power and Irrigation for Nigeria Project. The HOPE-GOV and HOPE-PHC programmes combined will support the government of Nigeria to improve service delivery in the basic education and primary healthcare sectors which are critical towards improving Nigeria’s human capital outcomes,’’ the bank said in a statement.
President Tinubu understands that health is not merely the absence of disease, but the embodiment of physical, mental, and social well-being. Hence, his abiding efforts in this sector will have a tremendous impact on the nation’s human capital index.
Fredrick Nwabufo is Senior Special Assistant to the President on Public Engagement
