The Board Chairman, Community Health and Research Initiative (CHR) Aminu M. Garba, in this interview with Tobias Lengnan Dapam, called for the need to strengthen accountability mechanism in the country’s health sector for effective service delivery. The CHR Chair who expressed worry over poor service delivery also spoke on some key challenges affecting the health sector. Excerpts:
Sir, why do you mobilize for health sector funding?
It is important to look at the trend of health budget in Nigeria for us to know why we advocate for more funding to health sector, and to also understand the budget mechanism on how resources are disbursed. For the last 10 years, the health budget has not been adequate in terms of the allocation to the health sector compared to the national budget. Consistently for the last 10years, Nigeria has never gotten six percent of the overall national budget dedicated to health sector. That tells you that it is low; and when you compare with the international benchmark like the 15 percent Abuja target that is called upon all head of states to commit 15percent of their budget to health. If any country had bellow 15 percent budget, that means they are left behind. We are also worried that even the small percent that is being approved by the National Assembly and signed by the President, and released through out the 12 month calendar of health budget is poorly achieved. That is why we are concerned.
Do you track health budget because your organisation doesn’t trust the system?
Lack of trust is one of them. Also, accountability in the sense that the government promise something and fails to do it. We track also to support the openness of the system to ensure transparency. If there is transparency, the people can interrogate the budget. For instance, if the people know that 2 billion was budgeted for family planing, they can be able to interrogate and know how the money was used. We are also tracking to support the communities, CSO’s and the media to ask questions so that the government can respond and provide service to them. At times what you see in the approved budget is not what comes to the health sector. Without tracking we won’t know how much was released to the government. So, accountability and transparency is necessary to know if the money was judiciously used for what it was meant for.
In your advocacy to end malnutrition, what do you think needs to be done?
Malnutrition is everywhere in the country. But there is more in the north than other parts of the country. Many parents are not complying with exclusive breast feeding. 80 percent of the breast milk is water, and as such no water is needed. Giving the child anything might affect the child and stimulate malnutrition. The child needs adequate nutrients, vitamins and proteins which will help the child grow well. Bad water also promotes it.
It is recommended that breastfeeding should begin immediately after the baby is born and continue as often and as much as the baby wants, until when the baby is up to 2 years. While exclusive breastfeeding is giving the baby only breast milk from birth till the baby is 6 months, breast milk has all the necessary nutrients the baby needs for the first 6 months of life and there is no need of supplementing the breast milk with water during this period. However multivitamins and other medications can be given when need be. In the first few weeks of life, babies needed to be given breast milk roughly every two to three hours, and the duration of a feeding is usually 10 to 15 minutes on each breast. Older children feed less often, mothers may pump milk so that it can be used later when breastfeeding is not possible but that must be done under a very hygiene condition. Breastfeeding has a number of benefits to both the mother and the baby, which infant formula lacks. Newborn(neonate) should not be deprived of the first breast milk(colostrums) the mother produces on the ground that it is not healthy for the baby. The colostrums has higher concentration of protein-antibodies compared to other subsequent breast milk produced by the breast. Children who are exclusively breastfed are better off than those that are only predominantly breastfed not to talk of those who have not breastfed at all.
This is because breast milk is the natural food for full-term infants and is the appropriate milk for early life. It is always available at the proper temperature and requires no preparation time. It is fresh and free of contaminating bacteria, thereby reducing the chances of gastrointestinal disturbances. Children who are not exclusively breastfed have higher prevalence of illnesses like diarrhea, otitis media(middle ear infection), pneumonia, bacteremia, and meningitis during the 1st year of life. Breast-fed infants also appear to have a lower frequency of certain allergic and chronic diseases in later life than formula-fed infants.
What do you have to say about the issues of midwives in the country?
The situation is bad. We want implementation of basic minimum healthcare package to take care of all health challenges. Midwives are lacking in most rural areas. We have to ensure that midwives have accommodations so that they don’t leave the rural areas. They need decent accommodations, water and adequate security not far from the facility. But all these are lacking and that is why midwives are not in rural areas. Before we post anyone to the rural areas, we need to provide the basic things they need.
What are the major challenges in your advocacy?
Influencing political actors to deliver on their mandate is a major challenge. eg there is a lot of resources in the health sector, through partnership with the world bank. The ministry of health has a programme called save one million lives initiative, aimed at supporting women and children. Unfortunately, many states are supposed to come to Abuja, working with the structure to access the funding earmarked for the state to go and deliver. But many states have not accessed the money; some no interest, some lack of capacity while others have not understood the scheme. The biggest challenge in engaging with the political actors to ensure that what they promised in the budget is what they approved and what they approved is what they release and they should also release on time because the patient is not going to wait for you. If they keep waisting time people will die in the facility.
Going forward, what should the government do differently?
Now that we have new government everywhere, we need to strengthen accountability mechanism in Nigeria. It is not only the NGO, the media and the community that should be part. We should have multi stakeholders country platform, where all the partners have a membership to strengthen accountability for government to deliver on their platforms. The media should also get the right information and at the right time so that they will publish to alert that a particular service is needed in a particular place. Every hand must be on deck to ensure that the Nigeria health sector in 2019 and beyond is successful and delivering universal health coverage and ensuring accountability and accessibility to effectively deliver on our mandate.