PROTOCOLS
It is indeed a privilege and my pleasure to be invited to this distinguished gathering to discuss issues that revolve around the strategic role that the key stakeholders in the Health Sector need to play in the achievement of the MDGs, within the national developmental framework of the Yar’Adua Administration. I am delighted by the choice of the theme “Meeting the challenges of the health Millennium Development Goals” as it is timely and this will afford the opportunity to critically analyze burning issues and key challenges as we strive to collectively achieve the Health MDGs in Nigeria.
As policy makers and implementers drawn from Federal, State and Local Governments, who are directly responsible for the formulation and implementation of policies, there cannot be a more auspicious audience for this discussion. I am optimistic that the outcome of our interaction today will impact positively on the realization of the Health MDGs, which is of great concern to this Administration and the United Nations, given the wider challenges of the global financial crisis on our economies and thus the knock on effect to our social agenda.
THE MILLENNIUM DEVELOPMENT GOALS- ORIGIN AND SUMMARY
It will be recalled that at the United Nations’ Millennium summit in September 2000, World leaders from 189 Nations reinforced the global development agenda by adopting the Millennium Declaration which informed the eight Millennium Development Goals (MDGs) as the minimum baseline which set clear targets for reducing: poverty, hunger, disease, HIV/AIDS, Illiteracy, environmental issues, and discrimination against women by 2015.
It was acknowledged that progress is based on sustainable economic growth, which must focus on the poor, with human rights at the centre. The objective of the Millennium Declaration is to promote "a comprehensive approach and a coordinated strategy, tackling many problems simultaneously across a broad front."
It is also a global compact between rich and poor nations to address the resource gaps.
The eight Millennium Development Goals (MDGs) – which range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education promote gender equality, reduce maternal mortality, reduce child mortality, ensure environmental sustainability and develop a global partnership, all by the target date of 2015.
Goal 1- Eradication of extreme poverty hunger
Goal 2 – Achieve Universal Basic Education
Goal 3 – Promote Gender Equality & empower women
Goal 4 – Reduce child mortality
Goal 5 – Improve maternal health
Goal 6 – Combat HIV/Aids, malaria & other diseases
Goal 7 – Ensure environmental sustainability
Goal 8 – Develop a global partnership for development
These Goals constitute an ambitious rights based agenda to significantly improve the human condition by 2015. It is worthy to mention of the eight goals, three are health specific, namely: goals 4, reduce Child Mortality, goal 5, Improve maternal health and goal 6, Combat HIV/AIDs, Malaria and other diseases.
We are today, a little over the halfway mark to the target date of 2015. In September 2008 a mid-term assessment of where Nigeria and Africa stand in terms of achieving the MDGs was exhaustively discussed and key issues addressed in the outcomes of further commitments made by national governments, multilaterals and bilateral. New inflows also came from the private sector and Foundations such as the Bill & Melinda Gates Foundation.
Highlights of the findings of the Mid-term assessments include:-
• Worsening indices for child and maternal mortality
• Weakening health systems, management capacity and huge health worker resource gaps
• Inadequate infrastructure to support access and service delivery
• Insufficient resource flows for routine services
• Poor attendance of rural populace to healthcare
• Inadequate involvement of communities and key stakeholders
These challenges for Nigeria as a nation are daunting but not insurmountable. During the next 7 years our countdown strategy will have to clearly lay out a road map that has concrete milestones and articulate and define the roles and responsibilities of the 3 tiers of Government, the Private Sector, Civil Society and our International Development Partners. They must build on the current and past efforts of government while learning from the past strategies and investments that have not borne the desired fruit for our teeming population. They must be center and front of the 7 Point Agenda and integrated into the Vision 2020, in other words we must domesticate all the MDGs ensuring they are kept interdependent and mutually reinforcing.
For example we will continue to build on the gains of the Paris Club Debt Relief granted to Nigeria in 2005. This resulted in $1billion debt relief by the Paris club, out of these $750m represents funds accruing to the Federal Government, while $250 is for states affected by the debt relief. The Federal government committed its share of these savings to a Virtual Poverty Fund targeting and achieving the MDGs. Overall the debt relief gains support to the health sector since 2006 is in the sum of N57.3billion. Specifics of these are, between 2006 and 2008, the sum of N16 billion was expended for immunization activities through the National Primary Health Care Agency, the National Malaria Control Program of the Federal Ministry of Health was supported to the tune of over N4billion for the roll back malaria, while the HIV/AIDs was supported in the sum of N15billion. The sum of N1.089billion was also appropriated through the Federal Ministry of Health in 2008 for the take off of the Midwifery Service Scheme with an additional 3bn in 2009. The CHIS in 6 pilot States targets pregnant women and children under 5 with an investment of N5bn.
The Conditional Grants Scheme (CGS), which is another strategy for using debt relief, also provides a platform for partnership among the tiers of Government, and has reinforced issues that target maternal and child health projects, including Emergency Obstetrics Care (EMOC). In 2007, 19 States (including the FCT) accessed N18.4bn of these funds, out of this amount 40% was used for strengthening of Primary Health care systems. In 2008 N1.5bn under the CGS was provided for the November/December Polio eradication rounds in line with the Geneva Pledge. The “QUICK WINS” projects of the National Assembly which commenced last year and currently ongoing, also has as a component the construction and equipping of Primary health Care Centers nationwide.
We have been able to make significant progress in the area of HIV prevalence among 15-24 year old pregnant women which fell from 5.8% in 2002 to 4.3% in 2007. However, in other areas the indicators show that mid-point to the target year, our progress is too slow: Infant Mortality rate has risen from 81 per 1000 live births in year 2000 to 110 per 1000 in 2005/2006, which is farther away from the global target of 30 per 1000 live births ; Under- five mortality rate also increased from 184 per 1000 live births in 2000 to 201 per 1000 live births in 2007; maternal mortality has also risen from 704 per 100,000 in 2002 to 800 per 100,000 in 2007; the number of children orphaned by HIV/AIDs has increased in from 1.8m in 2004 to 1.9m in 2007.
So clearly investments have been made albeit concerns of coherence and strategic targeting are being raised.
The Health Millennium Development Goals In Nigeria
The Health MDGs address specifically; Child Mortality, Maternal Mortality, HIV AIDS, Malaria & other diseases. The key causes of mortality being measles, diarrhea, malaria, post partum hemorrhaging
The challenges of the Health sector are well known to almost all of us gathered here for this meeting. Over the years investments have been made, in some cases such as immunization, phenomenal amounts yet our indices worsened. Today we are burdened with some of the highest maternal mortality and child mortality rates in the world.
Without a healthy populace, of which the measure is our women (who should not be dying giving life) and without a knowledge society with relevant skills our vision will amount to nothing. As we strive to reposition our Health Sector under the able leadership of Professor Babatunde Osotimien, our investments in Primary Health Care Systems, revamping RBM, TB &HIV/AIDs, eradicating polio and providing relevant health care workers, will be re-addressed with a strategic vision and plan that reinforces local level actions on the ground. This can only succeed if the various stakeholders at this meeting buy into and own the vision.
There are clear concerns to the achievement of Health MDGs in Nigeria as they are clearly off track but understanding these challenges and placing them in our country reality means that they can be overcome. I would like to share a few of the key issues which I hope will be discussed at this National Council as I believe addressing them at all 3 tiers of government will pave a concrete path towards putting us back on track to meet and sustain the MDGs.
• A National policy framework not a Federal one….genuine inclusion the watchword
• Implementation strategies and plans that are smart and linked to an investment plan which has a budget behind it. Key investments for inputs such as data, statistics, mapping to improve the quality and relevance of our planning outcomes
• Genuine partnerships with clearly defined roles and responsibilities within given mandates and the constitution.
• Legal instruments to enable a robust primary health care system that delivers service to the populace at the local level
• Health reforms that address infrastructure, human resource gaps, health worker production, immunization and other vertical programs
• Financing strategy that goes beyond quick fix but looks at sustainable recurrent expenditure at local level
• Health systems and management challenges
• Governance and accountability
• Advocacy, Education, Monitoring & Evaluation
• IDP coherence and funding the gaps to achieve the MDGs
Meeting these health challenges of the MDGs is complex and collaboration intensive. It requires political commitment at levels going beyond communiqués into budgets. Our people not only deserve for us to serve them they have a right to basic healthcare. Our women do not deserve to be on the edge but mainstream, for only a healthy nation can deliver on the economic dividends. Remembering that half our population is female and therefore we cannot afford to neglect half our national assets.
We have the leadership, the resources, the political will, the demand and no excuse not to deliver on what is one of the most important dividends of democracy. In the MDG Office we will continue to work with the Federal Ministry of Health and the States to reinforce local strategies and scale up interventions that target the sustainable delivery of basic health care services to our people especially our women and children.
I sincerely believe that together we will be able to deliver the MDGs by 2015, so let us join hands firmly today towards a better health for all tomorrow.
Thank you and God bless Nigeria.
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