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PAGE 18—SUNDAY Vanguard, MARCH 29, 2020
NSHIP How NSHIP h<strong>as</strong> stopped removed
cat<strong>as</strong>trophic health
expenditure in Nigeria
Akanbiemu, Ondo PHC Executive Secretary
By Dayo Johnson, Akure
Dr Francis Akanbiemu is the Executive Secretary, Ondo State Primary
Health Care Development Agency. In this interview, Akanbiemu speaks
on the activities of the Nigeria State Health Investment Project, NSHIP,
which will lapse in May after six years of operation in the state.Excerpts:
Now that the NSHIP program is
ending, can we know the activities so
far?
NSHIP h<strong>as</strong> been working in Ondo since
2011 when they did the pilot at Ondo E<strong>as</strong>t
local government area but, in 2014 or early
2015, it w<strong>as</strong> extended to all the 18 local
government are<strong>as</strong> of the state, and, since that
time, NSHIP h<strong>as</strong> been working to strengthen
the health system of Ondo with focus on the
primary health system. Activities include
antenatal care, safe delivery practices, inpatient
care, family planning, immunisation
and w<strong>as</strong>te management. Surgical care is also
part of the package though it is minor surgery.
The system also <strong>as</strong>sists secondary facilities to
carry out major surgery because when you’re
provided with funds, you can provide facilities
and engage the staff. Part of the NSHIP
mandate is to ensure that you have human
resources to strengthen the health system
holistically. Before you spend money on any
NSHIP project, however, you must prove that
you are going to get result for what you’re
going to be paid. For instance, if you were
attending to 10 patients before and you want
to incre<strong>as</strong>e the number to 20, what you need
to do is to have a good environment for
patients to access you. You need a business
plan. There is usually a committee headed by
each community leader and the mandate is
to ensure full community involvement in the
health system. We also have what we call
improvement in management system. Before
NSHIP came, there w<strong>as</strong> no meeting or
information about income and expenditure;
people just spent money. But under the new
dispensation, you must hold management
meeting, there must be documentation,
everything you want to do must be agreed.
You now send the business plan to the NSHIP
Coordinator who reviews the business plan.
B<strong>as</strong>ically, NSHIP h<strong>as</strong> changed the way we do
things while w<strong>as</strong>tage h<strong>as</strong> reduced. Another
critical <strong>as</strong>pect of the project is drug
management. Drugs are made available to
health facilities and it is the facilities that
decide the drugs they want to buy.
ls there any sustainable plan after the
expiration of NSHIP?
ln 2017, we started putting the work plan of
NSHIP into the state annual budget. This is
part of our sustainability plan, so that when
the project winds up, government can now take
over. Some intervention might come also but
I will not be able to say exactly what type of
intervention that is coming, except the one
being currently funded by the Federal
Government which is known <strong>as</strong> B<strong>as</strong>ic Health
care Provision Fund. This fund is meant to
strengthen at le<strong>as</strong>t one health centre per
political ward in every part of Nigeria. Ondo
is close to accessing the fund which provides a
window for sustainability apart from
government effort to see the rise in the
principles and practice of NSHIP. I am sure
that by 2021, government will provide fund to
sustain NSHIP. Apart from this, government
believes this is the best way to manage the
health system. Though the annual budget of
NSHIP is funded by the World Bank, <strong>as</strong> soon
<strong>as</strong> the project winds up, government will take
over. NSHIP is a principle that helps to do
things better, so it is that principle that
government will fund and will not rele<strong>as</strong>e
funds when the funds will not produce results.
If you are going to be paid, it will be b<strong>as</strong>ed on
results like how many patients you attended
to or the number of deliveries. That is the
model government is going to adopt for the
sustainability of the project.
Do you envisage any problem in the
payment of counterpart fund by the
state government
thereafter?
With the type of governor
we have, who gives priority
to health, he h<strong>as</strong> already
opened up discussion with
us on what will happen
after NSHIP. But I want to
let you know that
government is not funding
NSHIP but the health
sector b<strong>as</strong>ed on the gains
recorded by NSHIP. What
the World Bank actually
came to do is to tell us that
this is a better way to
manage the health system
and that’s why government
signed that agreement. In
2018, the governor signed
about N375m <strong>as</strong>
counterpart fund to show
the World Bank that we
want this project to
continue.
•Akanbiemu
Our indicators
have
improved, our
people have
stopped dying
like fowl and
the health
system is
better
generally
What is the specific
impact of NSHIP in
b<strong>as</strong>ic health centres
across the state?
This project h<strong>as</strong> improved the quality of care
in health facilities and that of health care
services utilization. It h<strong>as</strong> also reduced outof-pocket
spending, removed cat<strong>as</strong>trophic
health expenditure and created employment.
And apart from the fact that NSHIP h<strong>as</strong>
improved monitoring and supervision of
health facilities, it h<strong>as</strong> also improved interagency
and inter-stakeholder collaboration
among the staff of the Ministry of Health,
Hospitals Management Board and the
Primary Health Care Development Board to
work towards achieving a common goal.
NSHIP h<strong>as</strong> autonomy and uses the autonomy
to improve facilities. So there h<strong>as</strong> been m<strong>as</strong>sive
infr<strong>as</strong>tructural upgrade apart from the direct
intervention of the state governor on the health
system of Ondo State.
You talked about likely federal
government intervention in the health
sector...
There is already an intervention going on
now through what they call B<strong>as</strong>ic Healthcare
Provision Fund and under which each state
pays N100 million counterpart fund. Mr.
Governor h<strong>as</strong> paid since l<strong>as</strong>t year. There are
processes that will make us access the fund
and the processes are almost completed.
In late l<strong>as</strong>t year, the National
Assembly called a meeting of
Speakers of state <strong>as</strong>semblies,
Commissioners for Health,
Executive Secretaries. I w<strong>as</strong>
part of that meeting. In that
meeting, it w<strong>as</strong> discovered that
there were anomalies in the
B<strong>as</strong>ic Healthcare Provision
Fund and they gave
instruction that the project
must stop until the anomalies
are corrected. They wrote to
the Federal Ministry of
Health that the manual that
w<strong>as</strong> developed w<strong>as</strong> not in line
with the National Health Act
of 2014. That is why we are
not accessing the fund yet.
They set up a committee to
design another guideline. The
committee h<strong>as</strong> completed the
<strong>as</strong>signment and waiting to
present the guideline to
stakeholders.
Once it is ratified, Ondo will
get its own fund and it will be
used in the same model of
NSHIP.
Recently NSHIP w<strong>as</strong> suspended. What
happened and why w<strong>as</strong> it brought back
so quickly?
They <strong>as</strong>ked Mr. Governor that if he wanted
the project he had to pay N375 million and he
paid immediately.
Will the health insurance scheme
introduced by the state government be
useful when the NSHIP winds up?
The health insurance scheme which Mr.
Governor established for the good people
of Ondo h<strong>as</strong> commenced and government
h<strong>as</strong> started funding it. Besides
government funding, B<strong>as</strong>ic Healthcare
Provision Fund h<strong>as</strong> two part way. The
primary health is one part way while the
insurance part way is another. The fund
that is coming to the state is divided into
two: Major part way and small part way.
The small part way is the emergency
medical treatment. So, 50 per cent of that
fund will be going to the insurance part
way, 45 per cent to our part way while five
percent will be for emergency. That 50
percent, insurance will use it in
collaboration with the fund Mr. Governor
h<strong>as</strong> already rele<strong>as</strong>ed to strengthen the
health system. The same model will be
the NSHIP model. Pay for the services you
have produced. You can see that the
intervention is more of strengthening the
PHC system and secondary is going to act
<strong>as</strong> referral from the primary health care
system. So, the insurance project is on course.
When the B<strong>as</strong>ic Healthcare Fund is rele<strong>as</strong>ed
to us, it will add to the fund already with the
state insurance scheme and you will now have
funding from two sides. We are funding the
PHC, the insurance will also be funding.
We learnt that the W<strong>as</strong>te
Management h<strong>as</strong> just been introduced
to NSHIP. Can you expatiate?
W<strong>as</strong>te management h<strong>as</strong> been part of NSHIP
but, of recent, NSHIP Project Coordinator
decided to make it more robust with our
agreement that w<strong>as</strong>te is better managed,
not just using the burnt and bury system.
We must use incinerator which is the
standard practice worldwide. We agreed
that we should handle w<strong>as</strong>te in a more
standard way especially with all kinds of
dise<strong>as</strong>es springing up everywhere <strong>as</strong> a
result of poor hygiene.
Would you describe the NSHIP era
in Ondo <strong>as</strong> a blessing?
NSHIP is a blessing to Ondo. In the p<strong>as</strong>t
six years, it h<strong>as</strong> been a success story. Our
indicators have improved, our people
have stopped dying like fowl and the
health system is better generally. This h<strong>as</strong>
been made possible because the present
administration in Ondo h<strong>as</strong> provided the
enabling environment and h<strong>as</strong> been
supportive. One good thing about NSHIP
which w<strong>as</strong> piloted in Ondo is that it gives
opportunity to every member of the
community and representatives of health
facilities to confront any challenge in the
course of implementing the programme.
They are allowed to deploy their own
strategies when it becomes imperative.
The community h<strong>as</strong> a say in what happens
to their health. The emph<strong>as</strong>is on
community participation at the same
time gives people the zeal to take full
ownership of the project. Community leaders,
religious leaders, traditional rulers, market
women and other stakeholders gather to
discuss the are<strong>as</strong> where they need NSHIP
intervention in the health facilities in their
environment. This new idea h<strong>as</strong> brought
tremendous development to the 532 health
facilities across Ondo.