Better use of our limited health resources

Posted: February 4, 2013 in HEALTH AND HEALTH POLICIES
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People-centered and integrated health services are critical for reaching universal health coverage.

People-centered care is care that is focused and organized around the health needs and expectations of people and communities, rather than on diseases. Whereas patient-centered care is commonly understood as focusing on the individual seeking care (the patient), people-centered care encompasses these clinical encounters and also includes attention to the health of people in their communities and their crucial role in shaping health policy and health services. People-centered care as a principle is driven by efficiency in the use of health resources, towards priority issues, and with sustainable interventions.

Evolution towards People-centered care is touted as the only way to guarantee a healthier future for today’s young people and the coming generations.

The auspices of People-centered care continue to be extensively discussed, but is definitely not the focus of this article. The issue on hand is an examination of our health expenditure and a critical look at the issue of wasting health resources. This article was mostly inspired by a recent run of events, that included the purchase of 34 ambulances by the Oyo state government and the budgeting of N5 billion by the FCT mostly for the rehabilitation of commercial sex workers.

Some schools of thought across the country advocate that any health expense by the government should be applauded and rubber-stamped. This may stem from a culture of government not for the masses, or from the really low bars that have been set for our leaders, for what qualifies as people policy. It may also stem from a lack of understanding of some principles of health economics and public health. This writer’s thoughts and conclusions are a bit different. They may qualify as optimistic and far-fetched to some, but a look at the good health achievements in Ethiopia, India, Brazil and Cuba, at relatively low costs, provides hope, as to what is possible and achievable.

Extensive research and documentation show that in the post-World War I era, the basic view of success shifted, and success became more a function of public image. This shift was one that public servants noted very quickly. This is increasingly manifest by health policy approaches filled with social image consciousness, techniques and quick fixes, with social Band-Aids that address acute problems (and sometimes even appear to solve them temporarily), but leeave the underlying chronic problems untouched to fester and resurface time and again.

We will all agree that there is great health import to the purchase of ambulances by the state government, and or the allocation of funds to rehabilitate commercial sex workers. The merits of ease of access to health services, through speedy ambulance conveyance, increase in voluntary testing and counseling for HIV associated with rehabilitation of sex workers and the general support to curbing the spread of sexually transmitted infections, can not be over stated.

The issues that then come up can be summed up under 3 headings: Priority; Long-term solutions; Inefficient use of limited resources.

Health-care systems hemorrhage money. A recent study by the PricewaterhouseCoopers’ Health Research Institute estimated that more than half of the US$ 2 trillion-plus that the US spends on health each year is wasted; a Thomson-Reuters study reported a lower but still substantial figure of US$ 600–850 billion per year. The European Health care Fraud and Corruption Network says that of the annual global health expenditure of about US$ 5.3 trillion, a little less than 6%, or about US$ 300 billion, is lost to mistakes or corruption alone.

While some countries lose more than others, most, if not all, fail to fully exploit the resources available, whether through poorly executed procurement, irrational medicine use, misallocated and mismanaged human and technical resources or fragmented financing and administration. But there is nothing inevitable about this and there are many shades of inefficiency. Some countries obtain higher levels of coverage and better health outcomes for their money than others, and the gap between what countries achieve and what they could potentially achieve with the same resources is sometimes enormous.

While raising more money for health is crucial for lower-income countries striving to move closer to universal coverage, it is just as important to get the most out of the resources available. Finding the most efficient ways to meet the multiple challenges health systems face is also an issue for those countries that might be struggling to sustain high levels of coverage in the face of constantly increasing costs and growing demand.

There are many opportunities for efficiency gains. This does not mean simply cutting costs. Efficiency is a measure of the quality and/or quantity of output (i.e. health outcomes or services) for a given level of input (i.e. cost). So efficiency gains could help to contain costs – an important objective in many countries – by reducing the costs of service delivery. However, no one wants to contain costs by reducing health outcomes, so seeking efficiency gains should also be seen as a means of extending coverage for the same cost.

As richly pointed out in the 2010 World Health Report, no country, no matter how rich, has been able to ensure that everyone has immediate access to every technology and intervention that may improve their health or prolong their lives.

This is even more so, in a country like Nigeria, with less than 6% of total national expenditure for the 2013 fiscal year, allocated to health. The health system of such a country must then be built on prioritization, sustainability and efficiency.

If the FCT ministry, wants to commit N5 billion to curtailing STIs and providing social reform for commercial sex workers, would it be more prudent to spend the same allocation and Provide skills acquisition programs for young people (N1 billion), focus on job creation (N3 billion) and use its extensive network of NGOs and the support of the international community to provide sex education, screenings and free condoms to young people across the FCT (N1 billion)?

There is no perfection or analysis justifying the proposed numbers above. The emphasis is on the broader scope of interventions, affecting more young people across the capital and also looking to provide long term benefits all round. This is of course, just the opinion of this writer.

If the government of Oyo state wants to make healthcare more accessible to its citizens, would it have been more prudent to prioritize the improvement of state health facilities and provision of social health insurance to students, children under 5 and pregnant women across the state? Again, just the opinion of this writer.

It is not to say that some of the proposed alternative expenses are not in play. They may be and the pioneers within the ranks of government do not just feel like sharing these aspects of their work with the masses.

If however, the elements of government have done the needed research and have found that the areas they have chosen to invest in, merit the commitment of our meager health resources, and have found that their approaches mirror best practices, the masses will appreciate that they share the evidence with us all. Through such transparency, the masses will be educated and will be carried along by their government. This is the expected framework of democratic policy making, in all its tenets.

The Federal Government of Nigeria, through the Federal Ministry of Health continues to reiterate its recognition of the fact that, to improve the health and wellbeing of Nigerians, there needs to be a scale-up with strengthening of the health system including additional financing for health and with building and strengthening of the Primary Health Care System in line with the principles outlined in the Ouagadougou and Abuja declarations. As clearly captured in the Nigerian National Strategic Health Development Plan 2010 – 2015, quick fixes and band-aids, will not achieve the required scale up.

The 2013 health budget is riddled with only 20% capital expenditures, numerous duplications and inconsistencies, inadequate investment towards universal health coverage and an inclination towards catering for the upper class and the civil servants, more than the masses. When put together with some of these so-called health investments and projects, it makes a mockery of some of the well-meaning efforts to improve health and healthcare across this country.

Our generation, as young people, need to see beyond the quick fixes and demand political effort with a backbone of efficiency, priority and sustainability. We must stop pretending like or acknowledging that any bone thrown to us, is a good bone!

 

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Comments
  1. ken nwokocha says:

    Thanks for your submissions and I hope ‘they’ read it and even if they don’t, we must continue to tell them. People oriented health care is encapsulated in principles of primary health care and if implemented conseciously with efficient referral system, things would start looking better.
    When they come up with such proposals, do not take them to be naive; they are concerned with personnal gains. At the end of the day, allocation will be made, csw not found and fund spent.

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