By: Adetunji Morenike
longer is it news that the protest of members of the Islamic Movement of Nigeria(IMN), popularly known as the Shiites remains ceaseless in the streets of Kaduna and Abuja, over the bail denied their leader, Ibrahim El Zakzaky and his wife, Zeenah.
When El Zakzaky was arrested over the deadly clash between members of the Shiites and the Nigerian army, little did people know that he would be behind bars almost three years after. In the incident that led to his apprehension, in which about 350 members of the group were reportedly killed by the Nigerian army, El Zakzaky and his wife were taken into State Security Service (SSS) custody without trial.
Subsequently, several efforts were made to get him and his wife released since their arrest in December 14, 2015, but all proved abortive. Months into his detention, El Zakzaky through his lawyer, Femi Falana, approached a Division of the Federal High Court in Abuja for his immediate release, saying that his continued detention without trial undermined his fundamental human rights. Although the court ordered the immediate release of El Zakzaky and his wife in 2016, they remain in SSS “protective custody”.
More chaos have sprung up over the years as members of the group protest on streets of Abuja, calling for the release of their leader. One recent scenario was when the group marched in their thousands and stormed Kubwa expressway in the Federal Capital Territory, Abuja. It was reported that the Shiites blocked Dutse and Galadima ends of the expressway, causing traffic for hours as they chanted solidarity songs and displaying flags with El Zakzaky’s picture and that of another deceased member.
During this exercise, the group once again had a confrontation with the men of the Nigerian army, throwing stones and pebbles at the soldiers. The soldiers again retaliated, killing over 40 of the Shiites members, according to Amnesty international.
Members of the IMN claim that Shiites is a peaceful movement, however, many reports disagree. Recently, the police arrested some members of the movement in Zaria, Kaduna, for allegedly attacking police officers. Aside this, their processions have been said to be obstructing people from carrying out their daily activities and when police officers try to put them in check, they respond violently.
Many have faulted the military for firing shots at civilians, saying such action is inhumane. While we agree with this notion, we opine that managing protest, is not the responsibility of the military, but rather that of the police. The military are trained to use live ammunition, and this is not exactly a tool for putting a protest in check. The police however is supposed to be at the forefront of quelling the Shiites crisis, since the group is not tagged as a terrorist organisation.
On Wednesday, November 7, 2018, El Zakzaky and his wife were again denied bail. The judge, Justice Gideon Kurada in his ruling said that the accused persons did not provide substantial medical evidence to grant them bail. He however said that the matter would enjoy accelerated hearing from the next sitting, January 22, 2019.
Mean while, it is important to note that going forward, security operatives need to turn up their sleeves and ensure synergy with other relevant agencies to ensure proper handling of this sensitive matter during and after the trial, regardless the outcome.
Just as promised, the court should ensure rapid trial of the accused because of the security of the lives involved. The nation cannot afford to have another security threat resulting from this, the dangers of not quickly addressing the situation may be unbearable.
Already, Shiites affiliation in Iran, in one of their protests on the continued detention of the accused, have sternly warned the Nigerian government and threatened “In Sha Allah, by overthrowing the government of Nigeria, we will free Zakzaky and teach a good lesson to them.” This warning should not be disregarded as mere bluff, but should be taken seriously and met with proper strategy.
Awwal Garba AD: A Major Player in the Global Business Sector with Investments across Vast Terrains
It is not in the pursuit of happiness that we find fulfillment, it is in the happiness of pursuit.” Denis Waitley
Taking a cue from Waitley, it is safe to say since the soul is the power and core of who one is, fulfillment is therefore the feeling of being happy and satisfied with one’s life because of interesting, useful, or important things embarked upon.
Alhaji Awwal Garba is a major player in the global oil and gas sector whose sense of fulfillment is succinctly summed up in the above analogy, as his life for a long time, has been dedicated to meaningful and oftentimes sacrificial commitments to his fatherland as well as to the lives of his countrymen.
With particular interest in Nigeria, Alhaji Garba has been discovering untapped resources within the oil sector upon which he has over the years, successfully built his chain of business interests, under the Magma Group, thereby immensely contributing to the economic growth and development of Nigeria.
With a humble mien, a virtue instilled by his upbringing, Alhaji Garba is a highly self-motivated person with an unbridled and a fervent desire to change the oil and gas sector narratives in ways that will benefit indigenous players and the Nigerian youths.
His words; “I was motivated into the sector by the desire to make a change, especially in the upstream sector of the industry where it is believed that only the oyibos (foreigners) hold sway therein.
“Of course, also in that direction would be the desire to contribute one’s quota to the national economy, in terms of creating jobs, which of course would help in giving the youths a sense of worth and direction.”
Born into a family of affluence, Alhaji Garba may well be said to have grown up being fed with a silver spoon. His late father, a traditional title holder ‘Talban Kano’; a king maker, was also an astute businessman, with wide spread interests in commodity trading, exports and imports. It may not be out of place to say that Alhaji Garba cut his entrepreneurial teeth under the tutelage of his father.
However, with strict and disciplined parents, adherence to what is right was the only rule, and this helped in shaping his character and personality, which he himself admits was the greatest gift he received as a child.
“I thought my parents were being hard on us as children, but I have come to appreciate all those moments later in life. It actually made us humble, yet strong. This was the best gift I received as a child because it helped in shaping my character.”
The desire to discover himself spurred him to break away from the comfort and sureties that being under the umbrella of his father provided.
According to him, “I can say that I was born into privilege, but that did not stop me from finding my own niche. The most difficult thing was finding a balance by breaking away from my father’s umbrella in order to find myself. I call it the period of soul searching. It took time to find what makes me tick, and since then, it has become a passion to reach out to greater heights. More importantly, I have worked hard to create and maintain it. And I am still working hard.”
Alhaji Garba had his early education in Kano, Nigeria and spent his early years in Nigeria and the United Kingdom. A Nigerian and British trained Economist of a rare kind, Alhaji Garba attended the Bayero University Kano, Nigeria and the City University, London, United Kingdom, tucking two degrees in his kitty from these institutions.
A Member of the Nigerian Institute of Management (NIM) and a Member of the Chartered Institute of Business Management UK, Alhaji Garba also acquired a Master’s Degree in Business Economics in the UK. He has in practice been a major player in the oil and gas sector of the global business environment, with particular focus in Nigeria, since gaining his Master’s degree.
Awwal Garba is a man with very strong instincts which, interfaced with his realities have enabled him make life-changing decisions. One of the difficulties he had was deciding whether to go into private or public service. Looking back at the years of successful business entrepreneurship, his instincts to go for the former paid off handsomely, although from hindsight, it is clear to see that should he have chosen the latter, he still would have been profoundly successful.
A global oil and gas business mogul, Garba is an entrepreneur with an innate ability to sniff out business opportunities where many cannot; a rare disposition which has enabled him to excel in countless ventures and investments, especially within the oil and gas sector.
Garba’s major areas of focus cut across sectors like, Telecommunications, Power, Finance, Management Consulting, Marine, Oil and gas Exploration and Production (OEP), oil refinery and real estate development, among others. He is a consummate professional with strong interpersonal and effective communication skills, integrity, tenacity and strength of character.
Awwal Garba’s core area of specialization in the oil and gas field is Exploration, with eight assets so far. He is building a 100 thousand barrel refinery in Akwa Ibom State at the moment, on a hundred hectare land, close to Exxon Mobil, while also negotiating with 3 marginal oilfields from oil mill 370 with Exxon Mobil.
“In the gas area of the sector, we have made proposals with respect to the Brass LNG, into which my partners and I are ready to commit $1bn. This would cut the issue of oil importation and also provide 300,000 jobs for skilled and unskilled workers in Akwa Ibom.”
Alhaji Garba’s companies include Magma Petroleum Investment Limited; Magma Exploration Production Limited, which is working on a JVU with Total Upstream, and also working with MPDC. His other companies include Magma Agro-Allied Limited; Magma Logistics Limited; Magma Gas and Power Spectrum Limited; Magma Pipe and Coating Limited, Rhone Petroleum Limited and H. Oil Limited, among others, all of which are aiding the economy of the country in terms of investment.
“We have H-Oil Limited which has assets in Angola as well as South Sudan and Liberia, with offices in Paris and headquarters in Madrid, Spain. Magma Logistics works with the Department of Petroleum Resources. We also have Magma Petroleum Investment in the downstream sector with our downstream partners, having facility in Amsterdam and distributing finished products all over the world.”
With this wide spectrum of business concerns, there are bound to be challenges. These however, are usually viewed by the astute businessman in the context of growth opportunities.
” The challenge of prospecting for and then drilling of oil is something we enjoy doing. On the exploration side especially, we want to expand and never get tired, that is why we are on the brink of acquiring more assets. We love the challenge. To get in there, prospect and drill the oil is something we just enjoy doing.
“Today, what kills the exploration business is greed. Many want to have everything and there’s no way you could do that when it comes to exploration. We engage partners from all over the world and our logic is that ‘half bread is better than none’. We can give out an asset with 5% interest, an asset with 2%, it does not matter. What matters is that when you multiply the 2% x 10, you get 20%. This is our logic.”
It is not really commonplace to find the virtue of humility in the lives of many of the affluent. The life of Awwal Garba is a marked exception because it is the way he was brought up. Whether it was his father or friends of his father, who included the MKO Abiola’s, the Maitama’s and the Babangida’s, they all pointed to the importance of the virtue and instilled that in him. He also admits that life itself also taught him about humility.
“Life has taught me to be absolutely humble. Life has taught me to be analytical as well as critical with myself in my everyday dealings. My heart will never deceive me into thinking I am anything different or special. Ego is a recipe for failure in life.
“I mean all you have to do is to look around you. The seven-year-old selling sachet water or Moi-Moi on the streets of Lagos in the early morning rush hour could have been you. He, also given your opportunity, could perform as good or even better. There are always two sides of a coin.”
Patriotic Fervor, Leadership and Game Changer
Alhaji Awwal Garba is a de-tribalised Nigerian who sees his country as his constituency. Through his investments, he has been building bridges.
A unique vehicle with which he is stoking the embers of patriotism is ‘Game Changer’, a media established to ensure that the Muhammadu Buhari administration continues to change the whole game; from Agriculture, Corruption to Healthcare and very importantly, to unite Nigerians and give them a sense of belonging.
He uses Ghana as a yardstick in buttressing the importance of patriotism. “You will be shocked to realise the level of their patriotism. A taxi driver always has the Ghanaian flag in his cab as with every household, like it was in America perhaps before the Trump era when American schools taught American history, the need to be patriotic and love for country. So patriotism is very important. Game Changer is here to bring awareness about patriotism.”
His friends call him the preacher and this is not just based on his knowledge and adherence to the tenets postulated by the Quran, but because he never stops preaching the gospel of unity among Nigerians, believing in the oneness of the country as a pathway to wealth creation in a more sustainable way, strength and endless possibilities. No wonder his house is always like a beehive or a Mecca of some kind.
Garba sees leadership as the ability to see beyond tomorrow and to commit to that vision totally, when those around you follow you with absolute commitment even when they do not see what you see.
“Those who do not remember history are certainly bound to be consumed by it. It has happened in many countries before. The Asian tigers, from Singapore to Malaysia, Thailand to China, they have all gone through what we are going through. Mao Zedong closed up China for 50 years before opening up. America’s democracy took over 200 years to get to where they are now. Ours is only 50+ and with such multi ethnic groups, patience is the key.”
Philanthropy and Titles
Awwal Garba is a man with a heart of gold, compassionate, kind and in tune with his people. He believes in creating high-points in his life each day and one of those is the opportunity to make someone happy.
“There are just countless moments with that, but what you can do is to create one every day. Most importantly, put a smile on someone’s face and the picture stays with you permanently.”
It is not surprising then that he has been honored with the prestigious traditional titles of ‘Galadima Talban’, and ‘Talban Dan Hausa Daura’.
Alhaji Awwal Garba maintains a closely knit family even as a very busy person, understanding the importance of family. Despite his busy schedule, which has shrunken some social activities, he still finds time to spend with his family.
“The pressure of work increased with growth, so whatever time I can squeeze out now for personal issues, I spend it with my family. We take the children to game parks when they are on holidays and try to have a feel of their minds by coming down to their level and appreciating them. My biggest fear is not being able to meet up with the expectations of my family and my loved ones.”
Even though Awwal Garba a fulfilled man, he believes in breaking new grounds as long as life permits him.
“I feel fulfilled in life, all the time. Yet, life itself is like sweet nectar from the most beautiful thorny fruit bearing tree. Once you taste it, you cannot but go back for another bite. I am always setting new goals to conquer.”
As Eleanor Roosevelt aptly puts it, “Happiness is not a goal. It’s a by-product of a life well lived.”
It is from that standpoint that Alhaji Awwal Garba says,” I believe in what life has dished out my way and believe me when I say if I have to do it all over again, I would not change a thing.”
Indeed, there must be some unique feeling that comes with blazing trails and impacting lives.
Professor Charles Dokubo and the Stench of the Presidential Amnesty Programme
“The trouble with Nigeria is simply and squarely a failure of leadership. There is nothing basically wrong with the Nigerian land or climate or water or air or anything else. The Nigerian problem is the unwillingness or inability of its leaders to rise to the responsibility, to the challenge of personal example which are the hallmarks of true leadership.”
The concept of leadership is universal, cutting across several boundaries. Leadership is an important ingredient in the activities of government; the determining factor between success and failure in a society.
Because of its infinitely defining nature therefore, Leadership is serious business and essentially demands an innate ability to foresee, a commitment and dedication to serve, the selflessness to be equitable and honesty to be accountable, all of which underpin the operative words of Chinua Achebe’s quote above in ‘unwillingness or inability of leaders to rise to the responsibility’, buttressing yet that being in a position of leadership is not in itself an end, but only a means to an end.
The Niger Delta region in Nigeria, adjudged the world’s largest wetland, representing over 90% of Nigeria’s foreign exchange earnings has for as long as time been characterized by ecological squalor, high degree of unemployment, teeming youth restlessness, developmentally barren communities, and a heavy air of hopelessness, all of which have over the years been augmented by poor leadership both in the region and at the federal level.
This situation ignited appalling bloodbath, sabotaging of oil installations, kidnapping, piracy, oil bunkering, guerrilla attacks on the security agents and fierce militancy which held the region spellbound for many years, causing Nigeria’s oil production at a time to drop to as low as about 900,000barrels per day from 2.3 million bpd, costing the nation about N8.7 billion daily. This was critical to the economy for a country that over 90% of its income derives from crude, with over 200 million in population.
The amnesty programme, introduced by late President Umaru Yar’Adua in 2009 has since proven to be a recipe for peace in the hitherto restive region, but that peace which paved the way for oil companies to resume normal business activities and provided the necessary boost to the oil-reliant Nigerian economy is fast becoming fragile given the documented cases of corruption in the leadership of the programme.
As it turned out, most of the militants were jobless youths, driven by their conditions into living dangerously in the creeks. The three phases of the amnesty programme being Disarmament Programme, Demobilization Programme and Reintegration Programme were thus conceieved to ultimately reintegrate these militants back into society and so they were placed on monthly stipends, made to learn trades while others secured university admissions to study in Nigeria and abroad.
It is this reintegration phase that to a large extent shows the success or failure of the amnesty programme, and until the present regime headed by Professor Charles Dokubo, the programme seemed well on course.
Sidelining the mandate for which the Amnesty Programme was established, the leadership of the programme under leadership of Dokubo is being rampantly abused.
The programme is now obviously derailed given the festering corruption it has been caught up in and it would seem Professor Charles Dokubo does not have a good understanding of the dynamics of the program, the region or is simply too pre-occupied with inordinate interests to give a hoot.
It is sad indeed that even with the capacity of the programme to transform the economy of the region and Nigeria’s at large, its implementation has been compromised on the platter of mediocrity and self- aggrandizement.
Several allegations of mismanagement and embezzlement of money allocated to the Presidential Amnesty Programme have been made against the office.
Thousands of beneficiaries whose names made the original list do not receive payments anymore as their names have been reportedly swapped for ghost names, while beneficiaries who await calls for their various techno-vocational training have been left in limbo.
Appearing too elitist to identify with the common people of the region whose demands have remained the same from the onset, Dokubo does not engage with the core people behind the struggle in the region as reports have it that since he was appointed to head the programme, he has never visited any state, clan or kingdom in the Niger Delta, which sounds absurd, given the place of assuring peace, development and security which are the bedrock of the amnesty programme.
Dokubo lacks the knowledge or ability to deal with the grassroots, the true ex-agitators and prefers dealing with the white-collar ivy leaguers with little knowledge of the terrain and ghost ex-agitators, thereby mortgaging the essence of the programme.
At the Kaiama Amnesty Centre, mismanagement and vandalisation of equipment worth billions of Naira in the starter Pack Warehouse at the centre is one of the sad reminders of Dokubo’s incompetence.
In like manner, the Ondo State VTC commissioned several months ago with equipment at the center worth billions of naira, lies rotting away with none ever sent there for training, while stupendous sums of money are constantly awarded for training.
There has been reports of the award of fictitious contracts going on at the agency designed to siphon money from the system; as payments are often made for supplies never delivered; with contracts sold and awarded for projects that never served the purpose of the programme.
Immorality has also reportedly gained prime place in the regime of the prof by indecent relationships with female staff and female contractors while contractors now bring women to get contracts.
Funds meant for ex- agitators’ training are wantonly looted to the extent that about nine thousand ex field agitators who still await call to be fully engaged by the government are yet to be recognized and carried along by Prof. Dokubo’s team.
What’s more, the non-payment of tuition fees of students sponsored under the amnesty programme in tertiary institutions has resulted in these students being asked to withdraw, which might well be the summit of the ignominious charade by the amnesty office.
The office of the programme is reported to currently be in debt of over 20billion Naira and still accumulating. This is clearly a pointer to leadership failure, looting and mismanagement of resources in the amnesty agency.
Chicanery in government offices is not new in Nigeria, but after holding sway for so long, the coming in of President Buhari with his gospel of anti-corruption elicited huge breaths of relief from Nigerians who have been at the receiving end of the cankerworm.
With these grave cases of corruption in the leadership of the amnesty programme of the federal government, it can be reasonably expected that the president will be seen to take a decisive action on the matter, since the plan of the House of Representatives to set up an ad hoc committee to investigate the allegations is yet to see the light of the day for reasons not clear.
Dokubo himself alluded to the importance of working in close relationship with leaders in the region when he newly came in, but that spirit and resolve seem to have been vitiated by corruption.
According to his inaugural speech; “I have come to the conclusion that the Amnesty Programme would be better managed and better results achieved, if the managers of the Programme work very closely with leaders in the Niger Delta. In a nutshell, as the Coordinator of the Amnesty Programme, I intend to work very closely with you leaders in the region and other key stakeholders of the Amnesty Program.”
He may also unwittingly or subtly have alluded to the fact that there would be incidences of corruption when he admitted he will make mistakes.
“I am determined to radically improve on what I met on ground at the Amnesty Office. I am not perfect. I am most likely going to make mistakes along the line, especially given the peculiar nature of the Amnesty Programme.” And he did.
It is obvious that the leadership of the presidential amnesty programme has woefully failed in carrying out its mandate, and the situation demands that the government wades in urgently and put an end to the embarrassing reports of thievery and debauchery emanating from the office.
No time in the history of the programme have there been stentorian cries for the removal of its boss, as in the instant case with Dokubo, whose appointment is beginning to raise eyebrows, questioning the criteria with which he was appointed.
The Pan Niger Delta Youth Leadership (PANDLEAF) believes that leadership failure is the nucleus of the problems confronting the Niger Delta region and according to its leader, Mr. Akinawa, “We can’t fold hands as youth and expect change. The time for us to take action is now and that is the intent of PANDLEAF; to awaken the youths of the Niger Delta for common good where leaders have failed.”
Lending its voice to the rot in the amnesty programme is the Coalition of Niger Delta Ex-agitators under the auspices of Creek Dragons who have called on President Muhammadu Buhari to urgently remove the current coordinator of the programme, Prof. Charles Quaker Dokubo.
The former creek warlords in a statement released to the press maintained that Prof. Dokubo is alien to the Niger Delta struggle for emancipation, accusing him of incompetence and alleged that the entire amnesty program has become a caricature, while stressing that his removal from office will better the amnesty program in moving forward and achieving its aims and objectives.
For that matter, the office of the presidential amnesty programme is one the president should of necessity be very much interested in, as the stench of rot wafting from the office across the region it is meant to serve is becoming intolerable and stands at variance with the vision and resolve of Mr. President as it concerns uprightness and accountability in public offices.
The kind of person needed to man the affairs of the office is one well vested with knowledge about the core issues of the region and objectives of the programme as drawn by the federal government. A person who commands the respect of leaders in the region as well as the confidence of the ex-agitators. This crop of people exists but have seemingly been constantly sidelined because of the politics involved in the whole thing.
Apparently, the Profeessor may have gotten this far by his dis-ingenuity and it is not a hidden fact that he has also been expending colossal amounts of money to secure his being retained as head of the amnesty programme, but things cannot keep on going the way they are with different results expected.
Stakeholders and well-meaning Nigerians are now champing at the bit for a quick and worthy change of leadership in the office of the presidential amnesty programme.
Otherwise the fragile peace that has so far been enjoyed in the once violent region may simply crumble.
Manny Ita, a Public Affairs Commentator writes from Bayelsa.
EDITORIAL: Healthcare Reforms in Nigeria; A Mere Political Statement Lacking Commitment
By Manny Ita
Nigeria has since her independence in 1960 had a very robust verbiage or policies by successive gobernments on health reforms but with very little progress or success recorded in what might well be a lack of political will in reforming the health sector.
Over 90% of the Nigerian population are without health insurance coverage. The inability to effectively address the country’s numerous public health challenges has contributed to the persistent and high level of poverty and weakness of the health system.
Political instability, corruption, limited institutional capacity and an unstable economy have also been major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.
The health challenges of the country include:
National Health Insurance Scheme (NHIS),
National Immunisation Coverage Scheme (NICS),
Midwives Service Scheme (MSS)
Nigerian Pay for Performance scheme
After many attempts at implementing legislation on health insurance since 1960, NHIS, although established in 1999, was eventually launched only in 2005 with the goals to ensure access to quality health care services, provide financial risk protection, reduce rising costs of health care services and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services with the most vulnerable populations in Nigeria including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Free health care services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
The maternal mortality ratio for Nigeria remain quite high at 814 per 100000 live births according to 2016 World Health Statistics. Across the country, pregnant women and children under five years are generally charged fees when accessing health care services, despite the federal government’s declaration of free health for pregnant women and children under five years in 2005.
The Minister of Health, Professor Isaac Adewole in 2016 announced the Federal Government’s plan to provide free health services to 100 million Nigerians in the next two years. Under this new health agenda, pregnant women across Nigeria are expected to enjoy free maternal and delivery services at the primary health care (PHC) level.
Unfortunately, Free health care services and exemption mechanisms often arise as campaign promises of political actors to the electorate and fall short in meeting the health needs of the most vulnerable populations. According to Nigeria Demographic Health Survey (NDHS) in 2013, over 60% of pregnant women aged 15-49 deliver their babies at home without any antenatal care visits. In rural areas, this value reaches 76.9%. The situation is critical in North East and North West regions of Nigeria where over 79% of pregnant women age 15-49 deliver their babies at home. Over 60% of pregnant women in Bayelsa, Plateau and Niger deliver at home rather than a health facility.
The cost of health care and the low quality of care by the public have been argued to be the reason for the poor utilisation of maternal and child health services in Nigeria.
In addition, health spending in Nigeria is low and this is responsible for the over-reliance on out of pocket payments for health care services.
Despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.
CBSHIP was expected to meet their health needs as well as provide social and financial risk protection to this group, which mostly reside in rural areas. As evidenced in the high rate of out of pocket payments for health care services , poor people financially contribute more to health care than official care and funds programmes in Nigeria. Out of pocket payments for health care services limit the poor from accessing and utilising basic health care services.
The quality of health care services delivered is poor and remains a huge source of concern. Most of the PHC facilities that are supposed to meet the health needs of the poor and rural dwellers are in a poor state due to poor budgetary allocation.
In trying to solve these issues, healthcare in the country must be tackled headlong in order to stem the detyeriorating development therein, which could portend grave danger for citizens of the country in the no-ditant future.
Policy makers and political actors need to devise health care reforms to address the lack of social and financial protection for the poor and vulnerable populations. Part of this reform is the expansion of the NHIS. States should be mandated to provide health insurance coverage to all residents. Making health insurance optional for states over the years has affected the ability of the NHIS to increase the level of coverage for the people.
While the mandatory CBHI scheme is being scaled-up as a supplementary measure, state governments should enrol poor residents in a private health insurance plan and bear the responsibility of paying the monthly premium per person to Health Maintenance Organisations (HMOs). It is not enough to have a national health insurance policy, it is important to ensure that health insurance coverage is provided to the poor and most vulnerable populations as a matter of the human right to health.
Although the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence. The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
Another way of providing social and financial risk protection for poor and vulnerable populations is by establishing a legislative framework for a UHC scheme and setting aside funds for it. Evidence from Thailand has shown the effect of UHC schemes through PHC on expanding access to health care for the poor and vulnerable populations.
Political actors, policy makers and all stakeholders in the health sector should establish a government funded social and financial risk protection scheme through a general tax financing system for the poor and vulnerable, and invest in basic infrastructure for health care in rural areas for quality health care service delivery. UHC schemes are important in addressing the problem of poor coverage, limited access to health care, and poor quality of health care services.
Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. It is important to guarantee by law the right to health care of all citizens in Nigeria. Although the National Health Act (NHA) that was signed into law in 2014 stated that all Nigerians are entitled to basic minimum package of health care services, it is not clear if the provisions made in the NHA are capable of achieving UHC in Nigeria. In addition, the NHA is yet to be implemented over two years after its signage into law.
Some low- and middle-income countries (LMICs) have been able to provide social and financial risk protection schemes for poor and vulnerable populations as a matter of the human right to health. Therefore, there is a need to provide social health protection schemes targeted at these groups in Nigeria. The poor and vulnerable populations should not become impoverished because of failure to obtain much needed health care services. Governments must reduce out of pocket payments for health care services by households through the adoption of a tax financed non-contributory UHC scheme.
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