PPP makes health services prosper better–KSCHMA retreat participants 

PPP makes health services prosper better –KSCHMA retreat participants


PPP makes health services prosper better–KSCHMA retreat participants 


|By Muhammad Hamisu Abdullahi

For sure, when it comes to planning, certain factors must be taken into consideration, but however, it is important to understand that no matter the strategy, planners will find it difficult, if not impossible, to plan for when and where to access health services by an individual or a group.

In fact, it is just like saying that one may not know when to fall sick or happen to be in health risks.

It is obvious that even symptoms to health risks may be difficult to come to one’s notice, if not for a premonition.

Ideally, taking proactive measures that will pave way for availability of facilities, drugs and personnel in them, as well as sufficiency and efficiency in services to be obtained in terms of care at the facilities are factors that will assist greatly in quick responses to emergency cases which can occur without prior notice.

Absence of the above factors could lead (in fact, as they have, in previous records or experiences, led) to the deaths of patients in the process of requiring emergency attention as obtained in the previous cases of road accidents and other health issues.

The intervention may include the drugs, personnel and equipment that may be readily available as well as the affordability of the drugs and services at those facilities which are supposed to be, in an ideal situation, proportionate to the ratio of the population to be covered in order to further suit the requirement of the universal health coverage.

In achieving the universal health coverage, which stresses the need for everybody in the society to be opportune to have access to health services irrespective of his or her background or status, there is need for decentralisation of effort to allow for private sector participation, rather than leaving everything in the hands of public sector, for value adding in health services.

In fact, governments across the globe are expected, with the new trend, to rely very heavily on the concept of public private partnership (PPP) if really they are ready and prepared to promote better health of the citizens, as they alone could not shoulder all the responsibilities in view of the fact that there are enormous tasks before them to accomplish, even though the health sector should be their primary responsibility as it is the engine of growth.

These and many more issues took the center stage of the recently conducted feedback meeting and retreat in Kaduna, the capital of Kaduna State, by the Kano State Contributory Healthcare Management Agency (KSCHMA), where stakeholders, to include development partners, like DFID-Partnership to Engage, Reform and Learn (PERL), gathered to help the agency towards achieving its laudable goals and objectives.

The theme of the event was ‘Achieving Universal Health Coverage in Kano State: Appraisal of Implementation of the state Contributory Healthcare Scheme.’

It was a brainstorming exercise, which was declared open by the Speaker of the state House of Assembly, Rt. Hon. Abdulaziz Garba Gafasa, who was ably represented by his deputy, Rt. Hon. Engr. Hamisu Ibrahim Chidari, along other lawmakers.

The Speaker, who felt honoured to be invited for the event, appreciated Governor Abdullahi Umar Ganduje of the state for the passion he has for the health sector by considering it among his top priorities.

Gafasa assured of continued support to all health sector ministries, departments and agencies in order to strengthen health system in the state.

He called for synergy among all stakeholders in order to ensure sustainability of the scheme with a view to enabling all residents of the state to have access to effective, quality and affordable health care.

He mentioned that the Assembly has succeeded in reforming the health sector by passing various laws to include that of KSCHMA itself, the state Private Health Institution Management Agency (PHIMA) and the state Health Trust Fund (KHETFund), saying that the laws were aimed at strengthening the state’s health system.

“Equally, let me point out that the House always considers all laws as living documents, hence, we assure you that we are ever ready to consider any law that needs review in order to meet the needs and aspirations of our people and existing realities,” he assured.

Even at the point of declaring the retreat close, the Speaker, who was, this time around, represented by the Vice Chairman of the House Committee on Health, Hon. Musa Ali Kachako, said the state had some headways as far as health care is concerned, congratulating the state for the feat recorded.

He said if capacity would be improved, the gesture would enhance the health care system of the state, reiterating that health care is key to everything, not only in the state, but across the globe.

The Speaker said public private partnership was about to start in the state in earnest.

In his welcome address, the chairman of Governing Board of the agency, Dr. Bashir Ibrahim Muhammad, who doubles as the District Head of Tudun Wada, thanked members of the House and other stakeholders for partaking in the retreat.

On her part, the Executive Secretary of the agency, Dr. Halima Muhammad Mijinyawa, spoke at length on the implementation of the scheme in the state, noting that healthcare delivery in the nation was characterised by poor indices and predominantly financed out of pockets by households.

PPP makes health services prosper better–KSCHMA retreat participants 

According to her, access to health services ensures healthier population, while risks protection prevents people from being pushed into poverty.

She reaffirmed that universal health coverage (UHC) remained critical component of sustainable development and poverty reduction, saying that it was also a key to reducing social inequalities.

Dr. Mijinyawa stressed the need for the implementation of sustainable health care financing path ways to achieve the universal health coverage.

The Executive Secretary told the gathering that the process of creating the agency emanated from the proposal of National Health Insurance Scheme (NHIS) to give state governments power to create an organisation that will manage the programme to facilitate how to achieve the universal health coverage with its (NHIS’s) ssupervision.

She said the agency was established by law No.3 of 2016 which vested it with the responsibility to manage the scheme, adding that deduction started in May 2018, payments of capitation begun in June and officially it was launched by the then Minister of Health on June 20 of the same year, while access to it commenced the following day.

Dr. Mijinyawa explained that the programme involved both formal and informal sectors as well as equity health initiative.

She said, according to their projection, the scheme would cover 600,000 civil servants, political office holders and their dependants, pointing out that so far over 390,000 civil servants and their dependants have been registered in the state, saying further that male beneficiaries constitute 53.2 per cent, while 46 per cent is for female.

She said they have succeeded in establishing a contact center with six dedicated functional telephone lines operating 24 hours; developing monitoring and evaluation tools for facilities; developing referral system and framework for the vulnerable thus targeting pregnant women and children under five among others, adding that they were now in the process of registering 20,000 vulnerable beneficiaries across the state.

According to her, refusal of some institutions to join the scheme, identified gaps in the agency law and operational guidelines, fixed contribution rate not based on percentage, funding for the vulnerable groups, attitudes of health workers/beneficiaries of the scheme and multiple registration by enrollees are some of the challenges militating against the operations of the agency.

Part of ways forward, Dr. Mijinyawa said, they were in continuous dialogue with Kano University of Science and Technology, Wudil; Yusuf Maitama Sule University, Kano and the judiciary on the need for them to key into the scheme as they have not yet done so, which is a minus to the agency.

She said the implementation of the programme in the state has significantly improved access to healthcare and efficiency in health service delivery and contributed in strengthening the state’s health system by providing additional sources of funds and also in job creation.

In fact, information abounds at the agency for better understanding of the scheme.

In their separate paper presentations, some consultants were able to make more impact at the retreat.

Dr. Olamide Okulaje’s paper, entitled: ‘Concept of PPP for PHCs’ significantly highlighted some salient aspects on how the private sector can enhance efficiency in public health sector.

Dr. Okulaje saw it as high time for governments at various levels to begin to see private sector as an investment to develop their health systems, adding that they should look at health not as an expenditure but an economic venture as it will go a long way in creating more jobs under the PPP arrangement by driving private funding into public sector, reiterating that the private sector can bring about efficiency, funding and quality in the public sector.

He stated that in order to get better result, the nation must be innovative as much as it could and rely heavily on PPP to finance health sector so that partners can come in to invest to make access to health care very easy.

While thanking the state for playing a lead in the scheme in the nation, he expressed the desire to have a synergy or collaboration among health agencies in the state towards moving the scheme forward, stating that the PPP would revitalise health care delivery not only in the state but the entire nation.

In her presentation on ‘Achieving UHC: Prospects and Challenges,’ Dr. Frances Ilika, stressed that the state must be counted first in making a great breakthrough in the scheme among the states that queued into the system, adding that the commitment of the state to make the scheme workable showed that it has the interest of its people at heart in achieving the universal health coverage.

PPP makes health services prosper better–KSCHMA retreat participants 

She spoke extensively on UHC, explaining that it has not been a new thing in the country, adding that since 1948, there was a declaration of the universal health coverage in the nation, stating that in 1977, there was another declaration by the then government intending to achieve the concept of health for all by the year 2000.

She said in 2012, the United Nation adopted a resolution calling for all countries of the world to move towards UHC, while in 2014, there was a Presidential Summit in the nation on it, while in 2016, there was decentralisation of NHIS where UHC became global department agenda leading to creation of Social Development Goals (SDGs) with concentration on how to remove barriers in health coverage to pave way for access to effective and highly qualitative health services without experiencing financial hardship.

“Financial hardship is actually preventing people from accessing good health care and drag people into poverty,” said her.

She described UHC as a social equaliser, adding that equity helps people to get exactly what they need, but not to get equal share from it, as everybody’s need varies.

Dr. Ilika stressed the need for mobilising more resources in order to cover more health, reiterating that adequate money is needed to cover the population, stressing the need to also make compelling case, as in economic and political cases, to those in authorities on the coverage, adding that when the authorities spend on health, it would reduce poverty, still stressing the need for investment in health, saying: “For economic growth to be achieved, there must be investment in health.”

Another unique presentation on ‘KSCHMA Monitoring and Evaluation System’ came from a PERL Consultant, Malam Zakari Zakariya, who said already the agency had succeeded in developing its monitoring and evaluation mechanism and provided indicators for it since last year.

He therefore said this year’s exercise was intended to develop tool for the scheme to capture quality.

Malam Zakariya made another presentation on ‘Development of Tool for Identification/Selection of Vulnerable’ with emphasis on being scientific, rational and logical in selecting the size of the people to conduct research on.

Another presenter, Dr. Dayyabu Yusuf, in his paper presentation on ‘Introduction to Equity Programmes (Free MNCH, BHCPF, KHETFund),’ said in achieving UHC, equality is not the concern but equity.

Hajiya Halima Kasim Usman of PERL joined the paper presenters to speak on ‘The Role of Non-Government Actors in Promoting Contributory Healthcare Scheme.’

Usman said citizens and community participation paves way for inclusion, which is a great avenue to promote the scheme.

PPP makes health services prosper better–KSCHMA retreat participants 

According to her, community participation can take place through evidence based activities, advocacy, need assessment, mobilisation, training, implementation, monitoring and evaluation, trust building, complementation and synergy.

Her presentation was in style with co-optation of the representative of civil society organizations (CSOs), Malam Salisu Yusuf and the village head of Gandun Albasa, Engr. Alkasim Yakubu.

Yusuf said CSOs’ contribution, currently, stood at N400 million injected into the free maternity programme in the state, stating that part of their contribution was collation of community inputs to factor in the state budget, while Yakubu highlighted on a positive reform that took place in his community through advocacy paid to the nation’s Accountant General, Alhaji Ahmad Idris, a resident of the community, who instantly assisted them with funds to the tune of N3 million to rehabilitate their KSCHMA-approved primary healthcare facility at the Gandun Albasa quarters.

Earlier in a goodwill message, Dr. Dayyabu Yusuf of MNCH2, a DFID-funded programme, said they assisted the agency to attain its current feat, explaining that the meeting was very critical to the future success of the scheme; while Malam Auwalu Hamza, Reform Manager of PERL, another DFID programme, said PERL was keen to have noted that in terms of governance, it is necessary for the executive, lawmakers and representatives of civil society groups to come together to brainstorm for a way forward.

On his part, the Country Director of Health Policy Plus, Dr. Gafar Alawode, said he was highly delighted to be part of the success story of the agency toward achieving the universal health coverage, adding that he was proud of the achievement made by the state through the programme.

Dr. Shamsu of Bill and Melinda Gate Foundation used the occasion to congratulate the management of KASCHMA for hosting the meeting, which he described as a major milestone that would help the organization in collecting information as feedback from people.

The representative of CSOs at the event, Nalam Salisu Yusuf, passed a big thank you message to the agency, saying that it has carried them along.

The Director of ICT of the agency, Malam Abdulnasser Abdu read the objectives of the meeting to include assessing the implementation of the scheme from inception to date, getting feedback and sharing experiences with various stakeholders on the implementation of the scheme, developing framework that will harness the contribution of all stakeholders for the smooth implementation of the system and setting target for the agency for 2020 and beyond.

During feedback and experience sharing segment of the retreat, trade unions were not left out.

The Nigeria Labour Congress (NLC), through its state Vice Chairman, Comrade Muhammad Hambali, cried out for lack of mobilization from the agency, pointing out that many people in the society, to include workers, do not know the importance of the scheme.

The representative of Trade Union Congress (TUC), its state Secretary, Comrade Sani Babangida Jibrin, described the scheme as a good initiative, thanking former president, Chief Olusegun Obasanjo for his courage to introduce the concept to federal workers, which today became a good omen to the nation.

Also, the Joint Negotiation Council (JNC) was represented by its Secretary, Comrade Musa A. Ibrahim, who used the opportunity to thank Governor Abdullahi Umar Ganduje of the state for borrowing a leaf from the Federal Government to bring the programme to the state, saying that it has succeeded in promoting and enhancing health coverage down to rural areas thus improving service delivery across the state.

He urged the agency to maintain independent monitoring and evaluation of the scheme, adding that new staff should be inducted or trained, hoping that the agency would work in close partnership with the labour.

While the state branch of Medical and Health Workers Union sent in an apology for inability to participate at the retreat, CSOs shared their experience at the event through their representative, Malam Salisu Yusuf, who noted that in some instances, patients at some facilities could end up not getting all prescribed drugs, stating further that not all sicknesses were covered by the scheme, adding that referrals, sometime, take longer time than necessary due to some hitches in code sending.

He observed that there used to be blind prescriptions rather than committing patients to test first.

He however commended the agency for its efficiency in filing system at facility level.

Engr. Alkasim Yakubu, the village head of Gandun Albasa in Kano Municipal, spoke on behalf of Ward Development Committee, where he mentioned that the scheme was quite helpful as it eases a lot of hurdles to patients while accessing care at their facilities.

He however cried out for non availability of drugs that are expensive or out of stock at some facilities, alleging that some patients have to go out of their facilities to purchase such drugs.

On his part, the state chairman of NLC, Comrade Kabiru Ado Minjibir, urged the agency to engage membership of the union across the 44 local government areas of the state in monitoring the scheme, commending the state government for its ability to implement new minimum wage in the state.

The Director General of the state Hospital Management Board, Dr. Nasiru Alhassan Kabo, observed lack of sufficient drugs and lack of manpower or staff to be some of the problems affecting the scheme.

His counterpart of the state Drugs Management and Consumables Supply Agency, Dr. Sulaiman Mudi, explained that KSCHMA has improved drugs availability in the state, while the Executive Secretary of the state Health Trust Fund, a newly established agency, Dr. Nura Idris Bebeji, said the state was the only one that established functional trust fund to cater for pregnant women and under five children, noting that Bauchi State was copying from Kano to come up with its own.

On day two, the event, held between Wednesday and Saturday, March 18 and 21, 2020, was graced by the state Commissioner of Health, Dr. Aminu Ibrahim Tsanyawa, who was represented by the Permanent Secretary of the ministry, Dr. Binta Umar Bala, who registered the apology of the commissioner, saying that he could not be there due to exigencies of duties as the state was taking measures on containing corona virus where the state was considering deploying some check points to check people’s health, thanking the state government for its concern on health sector and House of Assembly for its contribution to the development of the sector.

The event featured communiqué presentations, group works and presentations with participants from various relevant ministries, departments and agencies at both state and national levels as well as the organized labour and development partners.

Dignitaries at the event included the Majority Leader of the state House of Assembly, Hon. Kabiru Hassan Dashi and the chairman of the state Pension Fund Trustee, Alhaji Sani Dawaki Gabasawa, the District Head of Gabasawa among others.

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