Sowore Omoyele Stephen

Health section

Improve healthcare access: The distribution of, and access to heath care resources is lopsided. The few doctors and medical resources that we have are concentrated in the urban areas. Primary Healthcare Centers (PHCs) where most of our rural populations access their health care tend to be grossly underserved and under resourced. As a matter of National Urgency our government will immediately deploy 160,000 new primary health care workers across Nigeria's 774 local government areas. This will ensure that each LGA has at least about 207 new primary health care personnel.

Close the gap in the quality of healthcare: Currently, the Federal Government has jurisdiction over the tertiary health care centres, expending a significant portion of the national Health budget on a few institutions and centers. The balance of the funding for healthcare is administered by individual states, in widely varying forms, causing a wide variation in the quality of care. We will set minimum resource standards at the state and local levels and ensure that these requirements are used as a basis for deploying resources and benchmarking performance across the entire sector.

Improving Healthcare financing: Healthcare financing must be urgently reviewed, and the private and religious sector must play a more significant role.In addition to finding a greater role for public - private - partnerships (PPP), we will evaluate the following additional means for funding healthcare based on contributions from the private sector and religious organizations.

Drive towards Universal Healthcare by 2020 by enrolling all Nigerians in NHIS in 2019: Healthcare by 2020 as proposed in the Sustainable Development Goals (SDGs1 is currently unachievable at the pace that current and past governments have grown health care access in Nigeria. Currently only about 30 million of Nigeria's 170 million peoples are covered by health insurance of one form or the other. About 7 million of these are people that are covered through Federal and State health insurance schemes for civil servants and their families. While the balance is mostly based on individual and private sector driven enrollments. Private, out of pocket health spend accounts for 74 per cent of all health expenditure in Nigeria, sometimes sending families into poverty. Health insurance is the only way to shield families from poverty, while also promoting health care access. Health Insurance allows individuals to pay some amounts of money into the National Health Insurance Scheme (NHIS) with the potential to access up to 10-25 times the amounts that are paid as fees in medical care and access costs. We propose that, using contributions from the private sector and religious organizations, a minimum capitation fee of N2,000 will be used to enrol the balance of 140 million Nigerians not currently covered by NHIS. The coverage will be basic, but it will be a start and we will strive to improve the level of coverage over time.

Reform the National Health Insurance Scheme: The National Health Insurance scheme is not fit for purpose as it pays healthcare providers very little for services rendered. Many private hospitals decline to accept patients on NHIS. Working with all stakeholders in the health care sector we will institute urgent reforms that will assure high quality access to enrollees and ensure that providers are fairly rewarded for all services rendered.

Enhance Primary Healthcare Training: The primary healthcare centres (PH Cs) should be the place to access all basic healthcare needs. Unfortunately, they are manned by low skilled and poorly trained workers. As a result, Secondary and Tertiary hospitals are burdened by uncomplicated ailments which should be managed in a robust primary care system.The lack of effective Primary care further complicates the disease profile as late presentation is the norm.We will urgently review the Family Health curriculum and set minimum certification requirements that will ensure that no private clinic should be providing primary care without their personnel being rigorously trained first. All of the 160,000 new primary health care workers that will be hired will also be provided this basic training.

Electronic Health records: Nigeria is data poor and this is partly due to the use of the old system of paper records across most government health institution.We propose that all health institutions are paper-free by 2025. All participants in the NHIS will be required to utilize electronic health management systems.

Enhancequality of Medical Training: We must bring our teaching hospitals to international standards. High minimum heath delivery standards must be established, and training must cover functional medical skills and ethical matters.

Rapidly address maternal and child mortality: Nigeria continues to have unacceptably high levels of poor maternal health outcomes and high infant and child mortality rates. There is an urgent need to improve maternal healthcare as well as Infant and child mortality rates.Because a significant amount of maternal health care delivery occurs at the PHC level, a significant effort will be expended by our government towards providingrobust training at the PHC level to shore up the capabilities and skills of our front-line heath care workers

Questions to ask Sowore Omoyele Stephen

1. For the proposed deployment of 160,000 new primary healthcare workers, which cadres and qualification levels are envisioned, and which government tier or agency will be responsible for recruiting, posting, and managing them?
2. What is the estimated annual recurrent cost (salaries, benefits, supervision) and upfront training/onboarding cost for the 160,000 additional primary healthcare workers, and what funding sources will cover these costs?
3. What is the timeline and phasing plan for recruiting, training, and deploying the 160,000 workers across all 774 LGAs?
4. Regarding minimum resource standards at state and local levels, who will set these standards, through what legal or regulatory instrument, and how will compliance be enforced?
5. What specific, measurable indicators will define the minimum resource standards (e.g., staff-to-population ratios, essential medicines availability, and equipment lists)?
6. How will funding be allocated or reallocated to help states and LGAs meet the new minimum standards, and will there be a transparent formula tied to performance?
7. How will contributions from the private sector and religious organizations be mobilized for healthcare financing? And will participation be voluntary or mandatory?
8. For enrolling all Nigerians into NHIS, what is the operational plan and timeline for identifying, registering, and issuing credentials to the approximately 140 million people not currently covered?
9. The plan mentions a minimum N2,000 capitation to enroll 140 million people, what total annual budget does this imply? And who will pay the capitation for those outside formal employment or those unable to pay the expected capitation?