Follow Us on Google
…insists gains must translate into better lives
From Fred Ezeh, Abuja
The Health Sector Reform Coalition has called for stronger financing, accountability and institutionalisation of Nigeria’s ongoing health reforms, warning that the gains recorded so far must translate into measurable improvements in the lives of Nigerians.
Chairperson of the Coalition, Dr. Muhammed Lecky, made the call at the mid-term review and policy dialogue on Nigeria’s health reform agenda, organised by the Nigeria UHC Forum and the Health Sector Reform Coalition in Abuja.
Lecky said the current reform agenda had provided a stronger framework for coordination among the Federal Government, states, local governments, development partners and communities.
He, however, said the reforms should ultimately be judged by whether they were sufficiently financed, institutionalised and implemented to deliver lasting improvements in health outcomes.
He identified primary healthcare, health financing, maternal and child health, nutrition, family planning, health workforce and community accountability as areas requiring sustained attention.
He suggested that the next phase of primary healthcare reform should focus less on the number of facilities renovated and more on whether the facilities are actually functioning consistently.
He said functional primary healthcare centres must have adequate health workers, essential medicines, basic diagnostic services, electricity, water, infection prevention measures, referral systems and maternal and child health services, as well as mechanisms for community feedback.
On health financing, Lecky expressed concern over high out-of-pocket spending, delayed releases and fragmented funding, stressing that funding should be assessed not only by what government allocates but by what reaches frontline facilities and the services ultimately produced.
The Coalition also raised concerns over persistent gaps in maternal and child health.
Lecky cited findings from the Nigeria Demographic and Health Survey 2023–24, which showed that 79 per cent of women received antenatal care from a skilled provider, while only 43 per cent had four or more antenatal care visits.
He added that only 50 per cent of live births were assisted by a skilled provider, while 39 per cent of children aged 12 to 23 months were fully vaccinated with basic antigens and 14 per cent received no vaccinations.
He further said 40 per cent of children under five were stunted, including 21 per cent who were severely stunted.
The Coalition called for targeted interventions for rural communities, poor households, conflict-affected populations, displaced persons and other hard-to-reach groups, noting that these populations continue to face greater barriers to healthcare.
Lecky also demanded improved working conditions for health workers through timely payment, supportive supervision, rural incentives, training, career progression and transparent deployment.
On accountability at the community level, he cited findings from the Social and Citizen Accountability for Primary Health Care Performance project conducted by BudgIT and the Health Sector Reform Coalition across the 23 local government areas of Kaduna State.
He said the project demonstrated that Ward Development Committees could contribute to improved health facility performance, community mobilisation and advocacy when adequately supported.
However, he noted that political interference, inadequate training, low awareness, weak institutional support and limited operational resources continued to undermine their effectiveness.
Lecky said an analysis of 862 Ward Development Committee (WDC) meetings showed that only 11.6 per cent discussed the Basic Health Care Provision Fund (BHCPF) with limited attention to allocations, expenditure, procurement and retirement of funds.
“The lesson is clear, communities cannot effectively hold facilities accountable for resources they do not know exist,” he said.
The Coalition therefore called for the BHCPF to become a regular item on Ward Development Committee meeting agendas, with communities given access to information on allocations and expenditure.
It also recommended stronger financial oversight by WDCs, community scorecards, town hall meetings and citizen report cards.
Speaking at the event, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said the Federal Government had expanded emergency care for women to reduce financial barriers to Caesarean section when complications arise.
Pate said hundreds of higher-level health facilities had been upgraded, transfer centres reformed and emergency care expanded.
He also disclosed that President Bola Tinubu had approved 79 new ambulances as part of plans to deploy 400 ambulances nationwide.
On the health workforce, the minister said the government had increased the intake of medical students from about 5,000 to more than 10,000, while nursing and midwifery schools in the states were also being supported to increase the number of health workers.
Pate said the Federal Government was working with states through quarterly performance dialogues, joint annual reviews and operational plans to ensure that all tiers of government worked towards common health goals.
The minister also said the Presidential Initiative for Unlocking the Healthcare Value Chain was attracting domestic investment in medicines, vaccines, test kits and medical equipment.
The Chair and Co-convener of the Nigeria UHC Forum, Moji Makanjuola, said the mid-term review was necessary to determine whether the reforms could be sustained and continue to deliver results.
She identified leadership, institutional capacity, community ownership, sustainable financing and accountability as critical to sustaining the gains.
Makanjuola said the Forum would use the 2027 election cycle to push health higher on the political agenda.
She disclosed that a stakeholder workshop would be held in October with development partners, the Health Sector Reform Coalition and other stakeholders to review the citizens-led health agenda and develop an action plan for the electioneering period and beyond.
She said findings from the Gates Foundation-funded Exemplar Analysis Project showed that progress was possible even with limited resources, but noted that improvements remained uneven across states.
“While we are elated to know that significant progress is possible even with limited resources, we are concerned that the uneven progress observed across the country is limiting national progress,” she said.
Makanjuola urged stakeholders to identify what was working, why it was working, where it was working and what was required to sustain the gains.
She also called on civil society organisations to maintain a common position on health, strengthen citizen participation and demand greater accountability.
