Dr. Nneka Orji-Achugo is a public health physician and health economist working with Nigeria’s Federal Ministry of Health (FMOH) in the Department of Health Planning Research and Statistics. As the UHC focal officer at the FMOH, she is committed to improving health care delivery in resource-constrained settings.
Dr. Orji also represents Nigeria’s UHC priorities for practitioner-to-practitioner learning in the JLN by both actively participating in the learning exchanges and steering JLN’s Nigeria Country Core Group. Her quest for new strategies to enhance equity in health care delivery has led her to publish research in international journals, including Health Policy and Planning and the Australian Health Review, and present at international conferences.
Dr. Orji is passionate about designing cost-effective strategies for engaging all UHC stakeholders as she believes UHC is everybody’s business. Dr. Orji sat down with the JLN Network Coordination team to share insights about UHC in Nigeria.
What is the current UHC landscape in Nigeria? Where has there been progress – and where have you experienced challenges?
The UHC landscape has been active over the past few years and Nigeria is currently working towards extending UHC to all its citizens. Since the return of democracy in 1999, the Nigerian government has explored ways of improving and strengthening the health system to improve the quality and affordability of services.
We are building on the results from the Millennium Development Goals (MDGs) era. During this time, Nigeria made progress in providing access to essential health services to critical populations, including people living with HIV/AIDS, tuberculosis and other infectious diseases. We’ve almost eliminated polio – which once looked intractable – and fewer women die during childbirth. And more children receive vaccines against serious diseases.
During the global push to meet the MDGs, Nigeria received funding through debt relief and implemented a lot of new health programs. Now, we’ve had to rely on mobilizing local resources to run UHC-related initiatives. Beyond issues around the funding of the health sector, we are optimistic that the Nigerian government is taking steps in the right direction towards achieving UHC.
What are some of the policies Nigeria has introduced to move toward UHC?
In 2016, the Nigerian government approved a new national health policy that articulates the country’s vision of extending UHC to all citizens. To implement this new policy, the Federal Ministry of Health has been working with the 36 states’ ministries of health and her parastatals to develop a new National Strategic Health Development Plan, which aggregates and outlines the interventions that each Nigerian state will implement to address their unique health needs over the next few years. Defining these actions will also help us direct our human and financial resources towards meeting our health priorities.
The new health policy is anchored to the 2014 National Health Act (popularly called NHAct), which provides the legal framework for our country’s UHC goals. For instance, the NHAct stipulates that every Nigerian should have access to a minimum package of basic health services, which will be paid for through the Basic Health Care Provision Fund.
The fund must be financed annually from at least one percent of the federal government’s consolidated revenue, contributions from donors and other sources. We’re currently finalizing plans to kick off implementation of the Basic Health Care Provision Fund, with an initial focus on poor and vulnerable populations, including pregnant women, children and those living in underserved areas. We then plan to scale up coverage to all citizens.
The NHAct also gives legal backing to the Primary Health Care Under-One-Roof policy, which seeks to strengthen and decentralize the management and delivery of primary health care (PHC) services while empowering and supporting Nigeria’s 36 states and 774 local governments in their efforts to improve the delivery of PHC services.
As part of efforts to strengthen PHC, the present government embarked on the PHC Revitalization Program to ensure that primary health care facilities are equipped with the right infrastructure, drugs and other resources needed to deliver basic health services. The first phase has been completed with over 100 PHC facilities revitalized, with more designated for revitalization throughout 2018.
Recognizing the need to mobilize and raise resources to fund our UHC initiatives, the Federal Ministry of Health – in consultation with key stakeholders – completed the development of the first National Health Care Financing Policy and Strategy in 2017. Our hope is that the policy will help provide more resources to achieve our UHC goals.
You’re also playing a leading role on starting a subnational Joint Learning Network for Universal Health Coverage in Nigeria – why is this the right time for joint learning in Nigeria?
The government of Nigeria is extending the JLN sub-nationally to assist its states in addressing the challenges of implementing health care financing reforms. Mirroring the global JLN, the network plans to concentrate on joint learning and creating a platform for connecting practitioners and policymakers to enable learning exchanges and knowledge co-production at the state level in support of the health care financing reform.
The launch of the subnational JLN in Nigeria has been greeted with much enthusiasm by participants from the states, and the facilitation team drawn from the FMOH and its agencies and partners. There has been a palpable knowledge gap, which the JLN platform can and is helping to bridge. People are really interested in participating. The subnational JLN couldn’t have come at a better time, and I see the JLN as a platform for bringing together the right stakeholders, aggregating strategies to address their hunger for knowledge exchange and sharing lessons from implementing UHC initiatives in their respective states.
You have been recognized as a “UHC champion” for Nigeria. What does this designation mean?
I do not take it for granted being recognized as a UHC champion in Nigeria. It means a lot to me personally, but more importantly, it means I have an obligation to ensure that we deliver on our UHC commitments and help people have equal access to affordable care in general.
As the UHC focal officer at the Federal Ministry of Health, I will stop at nothing in ensuring the UHC agenda remains at the forefront of our policy objectives. It is also my responsibility to increase stakeholder awareness on UHC initiatives and mobilize partners to rally around the government as we work towards achieving UHC.
Another important task for me is to craft a UHC communication strategy and engagement plan that will guide our advocacy efforts. I’m also working with key partners and stakeholders towards publishing a UHC Bulletin through which we can disseminate useful information on UHC. It will also provide a platform for partners to showcase their UHC interventions and learn from each other.
As an advocate for UHC, I am also contributing to the development of strategies for domestic resource mobilization to ensure a sustained and expanded financing stream for health in Nigeria.
How do you think the joint learning approach can help states in UHC efforts?
The JLN’s joint learning modality suits the type of audience we have here in Nigeria. More so, the opportunity for joint problem identification and problem-solving gives everybody the space to participate actively in a safe space.
Nigeria is a very diverse and heterogeneous country, which makes the inclusion of all stakeholders critical and the JLN model is the most appropriate for us in that it gives all the states the platform to interface, share lessons and learn from one another.
If you could share one message to encourage health systems practitioners and policymakers around the world working toward UHC, what would that message be?
In our efforts to accelerate and sustain UHC, let us be wary of “episodic UHC.” We have been entrusted with ensuring that everyone has equal and sustained access irrespective of geographic location, financial capacity, gender or age. On our honor, we must not fail the trusting population.