The Partnership’s 18th Board Meeting 19-20 May 2016, Copenhagen, Denmark

Secretariat Hosted by the World Health Organization and Board Chaired by Mrs Graça Machel

Professor Isaac F ADEWOLE FAS, FSPSP, DSc (Hons)

Honourable Minister of Health Federal Ministry of Health, Abuja, Nigeria (The Partnership for Maternal, Newborn & Child Health)

Secretariat Hosted by the World Health Organization and Board Chaired by Mrs Graça Machel

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Sexual, Reproductive, Maternal, Newborn, Child and Adolescents Health

(SRMNCAH)

Action at country level, Nigeria.

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Sokoto

Kebbi (3.08)

Zamfara Borno Yobe

Gombe Bauchi

Kano

Jigawa

Oyo

Kwara

Osun

Ogun Ondo

Ekiti

Lagos

Kaduna

Niger

Nassarawa

Taraba

Adamawa

Akwa lbom

FCT Abuja

Kogi Benue

Cross river

Delta

(5.1) Bayelsa

Plateau

Edo Enugu

Ebonyi

Imo

Anam- bra

Abia

Katsina (3.6)

(3.2)

(5.7)

9.3

4.3

(4.6) 6.0

(3.9)

(2.3) (1.8)

(3.2) (4.2)

(3.1)

(2.3)

(2.3) (4.1)

(2.3)

(3.1)

(5.5)

(3.7)

(9.0)

(3.4)

(3.4)

(2.3)

(3.22)

(4.0) (2.8)

Rivers (1.7)

(1.4)

(3.9) (2.8)

(3.2)

(2.1) (4.1)

(3.9)

Nigeria is a federation, with 36 states spread across 6 zones

North west (35.8) North east (18.9) North central (18.8) South east (21) South South (16.4) South west (27.5) Total population

( )

National capital

Region/state map of Nigeria Population in mn

▪ 36 states plus 1 Federal Capital Territory

▪ 774 Local Government Authorities (LGAs)

▪ 9,423 wards

SOURCE: Nigeria Population Census 2013

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…and a diverse population of over 180 Million people

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The country’s population is projected to double in 20 years and increase by 146% by 2050, to ~400 million making it the 4th most populous country in the world.

SOURCE: United Nations Population Division, Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

450

400

350

300

0

250

200

150

100

50

+146%

USA

Russia

Pakistan

Nigeria

Mexico

Indonesia

Brazil Bangladesh

Estimated growth trends in the 10 most populous countries millions

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This has been largely driven by very high fertility rates that have persisted over the last 30 years

SOURCE: United Nations Population Division, National DHS 2013

1980 1990 2000 2010 2020

7

3

2

6

5

4

0

-48%

-21% Nigeria

Indonesia

Trend in total fertility rates #

Fertility rates have dropped at a significantly faster rate in comparable countries

North East 6.3

North West 6.7

4.3

South East 4.7

North Central 5.3

2.2

2.7

Indonesia

Malaysia

South South

4.6 South West

Total fertility rate (2013) #

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Health sector outcomes show mixed performance …

Source: World Bank Estimates; NDHS 2003, 2008, 2013

Maternal Mortality Ratio (per 100,000 live births) Under Five Mortality (per 1,000 live births)

100

75 69

201

157

128 125

99.3 73.9

0

50

100

150

200

250

2003 2008 2013

IMR U5MR MDG4 Target

0

100

200

300

400

500

600

700

800

900

2000 2003 2008 2013

MMR MDG5 Target

8

7

24.6

5.7 0.9

79.5

94.5

85.3

23.4

0

10

20

30

40

50

60

70

80

90

100

DPT3/Penta3 Antenatal Care Skilled BirthAttendance

Modern CPR

Poorest Richest

Sector performance is disparate across income quintiles…

Source: NDHS 2003, 2008, 2013

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Source: NDHS 2003, 2008, 2013

Nigeria has made limited progress in service delivery in the last decades

8.2 9.7 9.8

60.1 58 61

32.6 35

36

41.8 39 38.1

20.1

35.4 38

31.4

41.4 42

0

10

20

30

40

50

60

70

2003 2008 2013

Modern Contraceptive Prevalence Rates Antenatal Care Coverage Delivery in a Health Facility

Skilled Birth Attendance

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Antenatal Care Coverage By Geopolitical Zones

0

10

20

30

40

50

60

70

80

90

100

2003 2008 2013

North Central North East North WestSouth East South South South West

and varies across geo-political zones

Source: NDHS 2003, 2008, 2013

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Effort made so far in Nigeria Government of Nigeria is committed to program and

activities that contribute to general well-being and sustainable development of mothers, newborn, children and the adolescents. Launched the IMNCH Strategy in 2007 with these

objectives: • Promote MNCH as a priority national/state agenda • Ensure effective coordination of partners and stakeholders efforts • Collaborate to rapidly scale up proven, chosen cost effective

interventions • Mobilize and maximize resources • Monitor Progress

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Maternal Health

Repositioning family planning and child spacing services- (free distribution of commodities)

- Payment of $3m for the procurement and distribution of contraceptive commodities (including yearly incremental

Task-shifting/sharing Policy - Provision of injectable antibiotics by CHEWs - Provision of Long-Acting Reversible

Contraceptive Maternal and Perinatal Death Surveillance and

Response Inclusion of Magnesium Sulphate and Misoprostol

in the Essential drug list for the management of Pre-eclampsia, Eclampsia and Postpartum haemorrhage

Midwives Service scheme

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Newborn and Child Health

Articulating a National Essential Newborn Package

National Essential Newborn Action Plan

Establishment of Kangaroo Mother Care centers for preterm/low birth weight babies

Working towards publishing annual report of

status of newborn in Nigeria (modalities on-going)

Local production of, and use of 4%

Chlorhexidine gel(25gms) multiple application for cord care

Introduction of Community Based Newborn

Care

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Newborn and Child Health/2

Implementation of iCCM (curative intervention for malaria, diarrhoea and pneumonia) to children under 5 years in hard to reach areas

Infant and Young Child Feeding

• Early initiation of breastfeeding

• Exclusive breastfeeding for the first six months of life

• Community management of acute malnutrition including severe acute malnutrition

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Adolescent Health

Decentralization of PMTCT and Adolescent Health Services to PHCs

Youth Friendly Health Services Elimination of Harmful Practices

• Female Genital Mutilation/Cutting

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Mr. President’s passion for a New Healthy Nigeria

Health is one of key promises of the current administration

A healthy nation is a wealthy nation

Health is a human rights issue as enshrined in Nigerian constitution

Access to health must be UNIVERSAL

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To ensure that ALL Nigerians, especially the poorest, have access to basic, quality healthcare …

… to ensure that mothers deliver their babies safely …

What is our vision?

… and that that as many Nigerian children as possible

live past the age of five …

… and that Nigerians do not suffer financial hardship as a result of seeking healthcare

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Our Targets

By year 2020; Nigeria hopes to achieve

• Maternal mortality ratio: Less than 100 per100,000 live births • Neonatal mortality ratio: Less than 10 per 1,000 live births • Under 5 Mortality: Less than 25 per 1,000 live births • Routine immunization (DPT): 100% coverage • Malaria related mortality: 0%

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To achieve Universal Health Coverage, we are setting a vision, bold in its scope and ambitious in its scale

Achieve Universal Health Coverage by ensuring 1 functional PHC per ward in Nigeria

UNIVERSAL

HEALTH

COVERAGE

Responsiveness

Greater

Equity

Improved Health

Outcomes

Financial protection

Efficient, accountable

and transparent

system

Increased job

Reduction in poverty

Greater productivity

• To achieve UHC, Nigeria will scale up the inputs required for efficient service delivery.

• 10, 000 PHC facilities will be revitalised over the next 2 years.

• Significant resources are required to achieve this

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To achieve this, we need to start thinking differently…

New Strategic Vision Current View

• MDGs

• Silos of interventions

• Multiple investments without a strategically focused approach to addressing health issues

• Primary focus on inputs

• Public sector lens only

• Poor data management, utilization monitoring and evaluation

• Fragmented approach within Departments and Agencies and across sectors

• SDGs • Systems reform • More aggressive prioritisation of

high impact interventions and innovations

• Focus on system processes, outputs and outcomes

• Multi-sectoral lens • Performance review and

management • Integration of programmes;

coordination of results and clear lines of accountability

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Universal Health Coverage

Health Financing for Reproductive, Maternal, Newborn, Child and Adolescent Health

• National Health Insurance Scheme & Community Based Health Insurance Scheme

• National Health Act PHC Under One Roof

Saving One Million Lives Program for

Result Rapid Results Initiative

Public Private Partnership

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The platform for delivery towards achieving Universal Health Coverage is …

ENSURING ‘1 FUNCTIONAL PRIMARY HEALTHCARE CENTRE PER WARD’

• 30, 000 primary healthcare facilities in Nigeria (~20% of which are fully functional)

• Focus will be on 10, 000 PHCs (1 functional PHC per ward)

• ~10,000 political wards

• ≈ 10,000 population per ward

• NPHCDA mapping the facilities with corresponding functionalities based on the Minimum Standards for PHC

General Hospital

Patient Midwives

Patient

PHC PHC

PHC PHC

referral

WDC

WDC

Mid\wives

Patient

Patient

Midwives

Midwives

VHWs

CHWs

VHWs

CHWs

VHWs

CHWs

VHWs

CHWs

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One PHC per Ward

Ward Level Local Government Level State Level

… and an effective referral system across the levels of care

Tertiary Hospital

Referral

General Hospitals

Referral

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Our Basic Minimum Health Care Package will cover

Control of communicable diseases (Malaria, TB, STI/HIV/AIDS) Child Survival – Vaccination Maternal and newborn care Nutrition Non communicable Disease Prevention – cancer screeing Health Education and Community Mobilization

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25 … and critical actions must be taken at Federal and State levels

Fiscal space analysis Programme design

Mapping of existing PHCs Pilot testing through a rapid result initiative

Passage of the NHAct Program implementation

Presidential declaration on UHC

Monitoring and Evaluation, Grievance & redress mechanism

Development Implementation

framework

Legislation Client Feedback

Design System/Integration Testing

Political will Parallel Test Specifications

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Achieving Universal Health Coverage is consistent with broader Sustainable Development Goals (SDGs)

• Having at least 1 functional health facility per ward offering quality health services 24 hour 7 days a week for FREE, will go along way of closing the gap between rich and poor as well as a jump start to tackle geographical inaccessibility's for health services

• One functional PHC per ward concept will offer one of the fundamental rights of communities to free health, which is basic primary health care contributing to keep human settlements safe from diseases, resilient and suitable for development.

• One functional PHC per ward concept also fosters employment and development, reduces inequities absolutely critical for creating sustainable cities and communities

• A functional primary health care system is an ideal setting to implement a 10-year framework of on sustainable consumption and production in relation to the pharmaceutical sector publicly/privately financed leading opportunity for growth and sustainable development

• The above argument is also valid for Capital and Maintenance costs for PHC an opportunity for growth and sustainable development

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At the FMOH…..

Promote Efficiency by Establishing Efficiency Management Unit

Promote Transparency: Displaying the budget on the FMOH web; Regular briefing of the public at every stage of implementation

Accountability: We will want to be held accountable for our actions

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Nigeria will champion PMNCH agenda with other Ministers of Health in Africa Pursue the continental agenda of mainstreaming PMNCH

programme into the forum of African Minister of Health Fastrack implementation of SDG 3

Continental wide resource mobilization effort for health for all

policies agenda We will promote accountability framework

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Conclusion

We need to DELIVER health to ALL Nigerians especially those who are poor…

and

EVERY LIFE COUNTS

The time to start is NOW!

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Thank you