The Board of Executive Directors of the World Bank Group approved a $500 million International Development Association(IDA) credit for Nigeria, last month.
The IDA is the window of the World Bank, which offers credits, grants and low-to-zero interest loans for projects, and programs that are aimed to improve standard of living, increase economic growth and reduce poverty.
The facility was granted to Nigeria to bring about significant improvements in maternal, child and nutrition health services for women and children in the country.
Domestic reforms aimed at improving cogent primary healthcare indicators in the country and engagements with multilateral funding agencies and donors fructified the credit. In 2012, Prime Minister Jens Stoltenberg of Norway and Chelsea Clinton, in her capacity as Board Member of Clinton Health Access Initiative (CHAI), arrived in Nigeria to join President Goodluck Jonathan and (then) Honorable Minister of State for Health, Dr. Muhammad Ali Pate, to launch the Saving One Million Lives (SOML) initiative with support from CHAI. The rationale for the initiative was that in Nigeria, an estimated one million mothers and children die each year from preventable causes. As a result, the Federal Ministry of Health decided to set new goals to
improve quality healthcare from 2013 and save the lives of Nigerian mothers and children.
Health sector experts and stakeholders credit Dr. Pate as the initiator of the SOML initiative. He had come into Nigeria's healthcare limelight following his trailblazing work at the National Primary Health Care Development Agency (NPHCDA), where he served as the Executive Director
from 2008 to 2011. Prior to his appointment, Nigeria was one of the four polio
endemic PAIN countries; the others being Pakistan, Afghanistan and India. Dr.
Pate tackled the polio epidemic headlong. By June 2009, he had instigated a
grassroots-oriented campaign of engaging respected traditional rulers in the
North, under the leadership of the Sultan of Sokoto, to assist with delivery of the immunization program messages in combination with the development of an
effective primary healthcare system. A decade earlier, the national
immunization program had suffered severe setbacks, especially in the North.
The effectiveness of the strategic approach adopted by Dr. Pate caught the attention of the international and local stakeholders in less than two years of his appointment. In 2010, incidences of the Wild Polio Virus (WPV) fell to only 11 cases from a staggering figure of 803 in 2008. His work also entailed the consolidation of the National Program on Immunization (NPI) into the broader framework of NPHCDA, in line with international best practices. The merger sought to address old issues of structural constraint, fiscal decentralization, mismatched burden of disease and low quality spending.
This effort resulted in the strengthening of core diagnostics, systems development and human resources capacity development within the new NPHCDA. With the critical arms of the agency thus strengthened, the national Midwives' Service Scheme (MSS) was launched, to mobilize midwives to selected primary healthcare facilities in rural communities to increase the pool of skilled birth attendants and boost delivery of services. The overarching objective of this program was to significantly reduce high maternal and child mortality and morbidity. The level of work done to achieve the targets of the MSS paved the way for the Saving One Million Lives initiative.
Subsequently, at the time of his appointment as Minister of State for Health by President Goodluck Jonathan in July 2011, Dr. Pate already had a clear focus on what his priorities were, namely continued fight for polio eradication and mobilization of public-private coalition for
SOML. Nigeria is now at the verge of being declared polio-free by the World
Health Organization. However, Dr. Pate resigned his appointment in 2013 to take up a professorial chair at the United States' Duke University's Global Health Institute. The position enabled him to serve as Senior Adviser to the
Seattle-based Bill and Melinda Gates Foundation (a major player in Nigeria and
other developing countries in the fight against major diseases like Polio),
among other high-level engagements.
Nevertheless, this high profile exit from Nigeria's
health policy sector, raised concerns on continuity of some of the programs
that had begun to gain traction under the purview of Dr. Pate. To address the
concerns, he offered to continue to provide his services on part-time basis as
chairman of the Presidential Task Force on Polio Eradication and the
public-private coalition for Saving One Million Lives initiative, in
fulfillment of his previous commitments to "see to conclusion of these
important national priorities."
obvious that Dr. Pate, a consummate Nigerian health professional, has a strong
passion and exceptional commitment to improvements in healthcare delivery in
Nigeria, especially to the most vulnerable groups. It always instills
confidence when donors are able to associate someone of this quality with a
development program they are giving funding consideration. The $500 million
credit will serve as a necessary fillip to the policy drive towards a Nigeria
where maternal, child and nutrition health services for women and children
would be significantly improved. Not least because of the existing constraint
in the fiscal space as a result of the sharp drop in oil prices.
challenges the $500 million credit is supposed to help address are enormous.
Nigeria accounts for 14% of all annual maternal deaths worldwide, second only
to India at 17%. Similarly, the country accounts for 13% of all global deaths
of children under the age of five years, again second only to India at 21%.
To address the
challenge of estimated annual 900,000 maternal and child deaths, SOML focuses
on increasing the use of high-impact reproductive and child health and
nutrition interventions, and improving the quality of these services;
strengthening monitoring and evaluation systems and measurement data;
encouraging private sector innovation; and increasing transparency in
management and budgeting for Primary Health Care (PHC) in the country.
The World Bank Group says it is expected that the new health
operation will start implementation on August 1, 2015 and run till December
2019. The Bank's support for SOML will utilize the Programme-for-Results
(PforR) instrument to encourage a greater focus on results, increase
accountability, improve measurements, strengthen management, and foster
innovation. Importantly, the PforR funds will only be disbursed to the Federal
and State governments for independently verified improvements in key services
such as vaccination coverage among young children, rates of contraceptive use,
Vitamin A supplementation, skilled birth attendance, HIV counseling and testing
among women attending antenatal care, and preventing new malaria infections
among children by using insecticide-treated bed nets. Also, the Federal and
State governments will receive incentive payments for effective tackling of
governance and management issues in the health sector and for improving the
quality of basic health services.
The incoming administration of General Muhammadu
Buhari now has the responsibility of successful utilization of the IDA credit.
Based on the passion of the President-elect to serve, there is high hope that
the $500 million funding will deliver its objectives, and that further general
improvement in healthcare delivery in Nigeria will be realized over the next
four years. Appointment of a competent Nigerian with experience in result-based
budgeting as Minister of Health will boost the chances of success in the
implementation of health policies and foster judicious use of available
resources. The need for such a professional to have exposure to the
international health policy community and global funding agencies cannot be
overemphasized, considering the significant international resources to be
mobilized for healthcare under the Sustainable Development Goals which will
replace the Millennium Development Goals in 2015.
asserts that "the enjoyment of the highest attainable standard of health is one
of the fundamental rights of every human being." This means children should
have access to healthcare when they need it. It also implies that pregnant women
should be able to receive antenatal care and deliver safely with the assistance
of skilled birth attendants.
Source: Nigeria Development and Finance Forum