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From Fred Ezeh, Abuja
Passive health purchasing has been linked to the continuous decline in quality of health infrastructure in Nigerian hospitals. This has been responsible for the poor medical services therein.
Experts, stakeholders and health economists recently raised concerns that Nigerian government, local and international donor agencies have been spending resources “unwisely” in the health sector by channeling energy and resources without recourse to the health needs of the people, hence, the abysmal results achieved in the efforts to improve Universal Health Coverage (UHC).
They suggested retracing steps to forestall future catastrophe that might befall the health sector in Nigeria, as witnessed during the early days of the COVID-19 pandemic. They made their suggestions at the Health Policy Research Group (HPRG) meeting in Abuja, with the theme “Achieving Strategic Health Purchasing in Nigeria: Where Are We and What Do We Need To Do?”
HPRG coordinator, Prof. Obinna Onwujiekwe, disapproved of the huge financial wastage and misapplication of funds in the health sector. He cited “Saving One Million Lives,” a five-year programme implemented using $500 million loan procured from international donors. He said the funds and resources of the programme were misapplied, hence the poor results achieved: “We need to spend money efficiently so the meagre resources we have can be efficiently and effectively used for maximum benefit. Strategic health purchasing is about how we spend money on the health system for efficient, equitable and effective distribution.”
His key concern was that health purchasing in Nigeria has been passive, and never designed to strategically achieve long-lasting objectives: “At the end, billions of naira is spent with poor results. Everybody is at fault in this case, beginning from the government, donor agencies and other stakeholders, particularly those implementing the policies. They should be held responsible for these lapses because they don’t imbibe strategic purchasing.”
He predicted that bad health indices would change for good if the culture of strategic health purchasing is imbibed in hospital settings, in addition to the fact people in rural areas would get good and quality health care services.
“Another key benefit is the issue of out-of-pocket spending, which will end.
“Nigeria is among countries with highest out-of-pocket spending for health care services, in spite of several health care interventions, including the Basic Health Care Provision Fund (BHCPF) that was meant to close the gap.
“But that won’t be possible. BHCPF as it is currently designed won’t close 10 per cent of out-of-pocket spending gap in our health care system. We, therefore, demand that the fund provided in the BHCPF should be used strategically to achieve the desired result. Until then, there should be collaborations between all stakeholders to ensure that health purchase is strategic in the implementation of BHCPF programme.
“But at this level of funding which is one per cent of the consolidated revenue fund, there is little that BHCPF could achieve unless there’s a strategic purchase to maximize the funds. There is need to increase it to 10 per cent so that it can grow to appreciable amount.”
Health economist, Uche Ewelike, stated that poor strategic purchasing was responsible for poor medical services in Nigerian hospitals: “The outcome of a recent survey we conducted revealed that most of our purchases in the hospitals are passive and not strategic, hence the unimpressive results being achieved in hospital services.
“We need to entrench strategic health purchasing into what we are doing in Nigeria’s health system, both on the demand and supply side of health financing, so we can have value for money in whatever expenditure we are making on the health sector.
“When we purchase strategically, it makes things more efficient, and people would get improved access to service delivery. There is a need to develop institute where people can learn about strategic purchasing. We can leverage on existing structures or built a new one completely.”
General manager, formal sector, National Health Insurance Scheme (NHIS), Dr. Jonathan Eke, said: “We have been spending ‘unwisely’ in terms of health care and that should stop forthwith. Health financing is not about pooling resources but strategically using the resources for the benefit of the people who need them.
“Strategic health purchasing, in simple terms, means to ask ourselves: what do we want to buy, where do we buy and who do we buy from? In NHIS, we have a good knowledge of that; hence, we have packages for our people.”
BHCPF desk head, Federal Ministry of Health, Dr. Okara Dogara, said: “In December 2021, we made disbursements across all the gateways and strategic purchasing was seriously considered. The States Oversight Committee oversees the implementation of BHCPF funds across the gateways in the states.”
