Dr. Lambo's health reform agenda for Nigeria
--------------------------------------------
A General and his seven ambitious wars
A policy analysis: Part I - Background
Key message: Nigeria's health system is clearly in need of re-
form. Centralized, top-down reform policies, plans and programmes
would stand less chance of success in a plural and emerging de-
mocracy.
Since assuming office as Nigeria's latest Federal Health Minis-
ter, Professor Eyitayo Lambo, erstwhile Professor of Economics
and WHO Health Economist, has left no one in doubt about his zeal
to reform the country's health system. In interviews after inter-
views, he has clearly spelt out his vision for reform which has
aptly and politically being named; "Agenda for Making Good Health
a Real Dividend of Democracy under the New Administration." He
couldn't have taken on a much needed battle.
In spite of earnings from oil and gas variously estimated at
nearly US $80 million per day (Source: CIA fact book, Nigeria
2002 - http://www.cia.gov/cia/publications/factbook/geos/ni.html#Econ),
Nigeria's health system is notorious for not meeting the needs of
its citizens. All its health indices are poor. Annual health ex-
penditure per capita is estimated at a mere US $8.0. Average life
expectancy is 52 years for males and 54 years for females. 78 in-
fants die out of every 1,000 live births before they reach their
first year anniversary date. Under-five mortality is put vari-
ously at approximately 184 per 1.000 live births. Overall immuni-
sation uptake is reportedly less than 30%. One mother-to-be dies
in the process of giving birth for every 100 live births deliv-
ered. Less than 50% of all deliveries occur in health facilities
or are attended by skilled health staff. Just a little over one
in every three persons has access to clean water and less than
this proportion has access to sanitary waste disposal.
(Source: World Development Indicators Database 2001 -
http://www.worldbank.org/data/databytopic/health.html).
Stomach churning indices such as these, understandably informed
the new minister's vision for reform and according to reports, he
blames identified critical weaknesses in the health system.
Health is on the concurrent legislative list in Nigeria and de-
centralized management is prescribed through constitutional pro-
visions and policies. These, prescribed duties and responsibili-
ties for primary and secondary care for the federating States. In
spite of these provisions, the Federal Government has always cen-
tralized power and hijacked the commanding role of prime mover at
all levels of the health system. Dr. Lambo's reform agenda ap-
pears to entrench this Federal power more.
To achieve what he emphatically specified as a Federal govern-
ment-led reform with 'change agents' participation, the core of
Dr. Lambo's seven-point reform agenda consists of the following:
a) Re-organisation of the Federal Ministry of Health, review of
existing National Health Policies and creation of a new National
Health Act.
b) Rationalisation and re-organisation of all federal agencies
responsible for primary care delivery functions; building and
equipping more model primary health care facilities; rehabilitat-
ing existing PHC facilities and strengthening their capacity to
provide effective, efficient, affordable and quality PHC ser-
vices.
c) Strengthening the performance of tertiary health care delivery
system in the country through equipment refurbishment and stan-
dardization programmes as well as building accountable management
structure and system within the framework of a new agency identi-
fied as the National Hospitals Commission.
d) Advocacy for diversification and improvement in funding of the
National Health Account with institutionalization of management
processes for better and transparent accountability.
e) Undertaking studies to determine the country's burden of dis-
eases and directing priority attention and resources to reduce
these identified primary health burdens.
f) Promoting effective public/private sector partnering, and
lastly
g) Building and strengthening such diverse programmes as health
management information system (including research), national
blood transfusion and ambulance service; continuing the war
against fake, adulterated and unregistered drugs; stimulating lo-
cal production of health input such as vaccines, auto disable sy-
ringes, drugs, Insecticide Treated Nets (ITNs), amongst many oth-
ers.
The Honorable minister believes that his entire agenda for reform
as summarized above is achievable within his expected tenure in
office. This may be over-ambitious. Baring any unforeseen circum-
stances, including cabinet reshuffle, he has barely 42 months in
office.
Voicing the premonition that his vision for reform may attract
the angst of "enemies of change", the minister has fired what
amounts to two Lambo doctrines at his ministry's officials:
(a) "Dead woods in the ministry should either shape up or ship
out".
(b) "It is either you identify with me or you don't identify with
me, there is no third option. Of course, once I know that you
don't identify with me then you cannot work with me. It may not
be easy to identify those impervious to change, but God has a way
of revealing to His children those who are not ready for change
at the appropriate time".
Notwithstanding this Faith-based dependency, a la GWB, the Honor-
able minister would be best served to recognize that it is an ac-
knowledged factor in Policy Advocacy programming for change, that
antagonists to desired policy changes will always exist and work-
ing tactically and peaceably with such is imperative for desired
success.
Dr. Lambo is reported to have identified that for his vision to
be realised there had to be an enabling environment which he said
included peace and political stability in the country, commitment
by all and the availability of funds. The Honorable minister
should add to these hopeful assumptions and success factors; po-
litical suaveness, longevity and flexibility to consider alterna-
tive pathways to reform. This should never be foreclosed as his
current pronouncements may suggest.
"God willing" the minister could very well win his seven wars....
but what are his chances in plural Nigeria?
Comments are welcome in order to broaden the base of dialogue on
the proposed reform agenda
--
A. Odutola
Centre for Health Policy and Strategic Studies (CHPSS)
Lagos, Nigeria
mailto:chpss_abo@yahoo.com
Note: Part II of this analysis will critique the minister's re-
form policy agenda; while Parts III and IV will review policy al-
ternatives and make some recommendations.
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