 As you'll the breakfast in plus TV Africa, a first conversation I beg your pardon is that the governors of the Federal Republic of Nigeria have decided that they will increase funding for primary health care, I mean that sounds like you know Santa Claus coming quite early but a bit of it to what led to all of this is that at the launch of the primary health care center leadership challenge in the state house Abuja, the Nigerian governor's forum pledged to increase funding for primary health care. Now governor Kayo Defaemi who spoke on behalf of the 36 state governors promised that prompt release of approved budgets to the state PHC that's the primary health care institutions. The state also pledged to recruit requisite health workforce to ensure that all primary health care facilities have the minimum staffing required for their level in line with the state's minimum service package. Now on behalf of all of us the 36 states governors and members of the NGF this is our statement of commitment to strengthen the primary health care system in Nigeria. Following the induction to the Seattle Declaration by the 36 states governors in November 2019 hereby affirm our commitment to strengthen the primary health care system in the country. We therefore adopt and confirm our commitment in line with the Seattle Declaration as that line it includes improving the governance of primary health care system at the sub-national level by fully implementing the primary health care under one roof policy and providing active leadership for primary health care through regular engagement with relevant primary health care stakeholders and quarterly primary health care performance review at the state executive council meetings that we could requisite health workforce we talked about that prior to now to ensure that all primary health care facilities have the minimum staffing and what have you are the levels that he should and so these were the consent and thoughts of this governor's as they were represented. Now institute the culture of use of evidence for decision making by ensuring that data quality across the primary health care facilities is approved. We have Dr. Tuyi Mabawandu who is a public health expert all the way he joins us right here via Zoom in Lagos. Dr. Tuyi it's good to have you join us. Thank you for having me. How do you respond and how do you react to this development by the governors although not entirely because 22 of them were present and so it felt like not everyone but what's your response? Well let's be clear the greatest requirements in business environment in our strategy and development plan you know of course on the other hand there are five pillars there are 15 priority areas. The first pillar speaks to the issue of governance and leadership and then the issue of governance and leadership speaks to how the most commitments the political leadership is bringing into driving the primary health care system. A political leadership represented by the president or the governor will determine what's going to be the basic health care provision funds they're going to determine how to start they're going to determine how to drive the primary health care system. So rightly so we need this kind of conversation to enhance and improve the primary health care system in Nigeria. Don't forget out of the 30,000 primary health care system all over the country barely 600 of them are functioning and of course you know the challenge is one fund money money money we're not having money to do a lot of things I don't know if we equip it appropriately. The basic health care provision fund which is a 1% of the potential revenue it has been decreasing in 2018 it was 55 billion now in 2021 it came to 35 billion I mean you can see how it is reducing Nigeria's financial challenges. Thank God for partnership okay from some of those partnerships I want to call Bill American but that gets financial dissent with the variation trying to incentivize our performance at that level. But it's good to speak we just hope that speaking them trusted to action and we see that this primary health care system has started functioning and functioning under the primary health care under one roof PST core which means that one management one land one monetary and the radiation one authority. I hope we're going to see that happening with this variation. Alright Dr. T you can you talked about because I'm not sure that I got you and I'm also sure how many persons had what you said but did you did you say that out of how many thousand health care centers that are functioning that is the data. Why? Well you know fund is an issue and I tell you how the funds are in short supply. Puberty sources is another issue monetary and evaluation is another issue so there are a lot of gamut of issues that confronted the primary health care system for them to be able to provide the basic services the basic plan for the nation. So now if you have this kind of coming around and saying that in terms of Bill and Bill Foundation coming around and incentivizing good practices you know giving incentives for the primary health care system. We should embrace it but I can assure you that because money is involved the governors are talking now we hope they can sustain that speech. Okay because all talks that's in the website action is also. Dr. T let's also look at you know the structure and scope you know of the primary health care if you look at the the structure of the health care system in Nigeria it cuts across the tier of government so you have the federal you know the state and the local government and so why do we still have the the governor's you know meddling in the affairs of the local government because if we say that it cuts across the three tiers of government then the local government should be solely responsible for the administration of the primary health care you know at the local government level so I like to get all of that. Of course we expect the action to be at the community level okay now the primary health care system are actually the most basic health provision when we have the community participating and then of course it is implemented by the national primary care development agency and also this which is also do me side in the state primary health care development agents who ensures that the basic officials the social services are to be right for emergency at the short funding reset and being streamed into the primary health care at the local government level okay now yes we see that every day very funding but that they really come from different sources one of the major sort of funding is the basic health care fund which is which that cruise from up to set cost on the same revenue from the federal government and some of these donors okay and normally we expect the state to actually put money into the primary health care development at the local government level we expect donors to also put money but what we're seeing is that we've seen shortage of funds from different level from the federal government from the state government and the donors are actually being careful what the fund so that has led to challenges still challenges in terms of delivery of services at the primary health care level so what we're seeing now essentially is the commitment because leadership is very keen if you want to actually get results in terms of the you know art comes in primary health care at primary health care level leadership is key leadership will determine the fund that comes in that will determine you know how we fund it to like how the places start now the other key thing is that human resources you know for health and just level there just in 90 quid how do you want to drive primary health care services without human resources just what are just in the quid now we need fund to do on the stage now we see governors making commitment we love the commitment we love the way the partners have to certifies the performance at that level announcing grants announcing awards for those who come in that perform at 30 awards we love those things but we just hope that the governor can actually move last money move last money sources to drive function at that level that is exactly what it is now you you have mentioned you know the responsibility of the federal government but once upon a time about in 2018 the former minister you know the minister of health Isaac Adewale says that you know the primary health care is not really the responsibility unit of the federal government so yeah he mentioned that it's not the responsibility but out of the local government is so why should we be talking about you know the federal government being responsible here now I don't know what I was talking about let's get the streets there are three types of government of health care system in Nigeria the first one is primary health care okay and then the primary health care no speaks to the majority of the population of Nigeria okay the policy framework the controls of that family care is determined by the national council of health okay the national council of health involves a lot of people federal government, commissioner of health, family sector, different state instead of their donors they come together and do a framework who is now to supervise it. The supervising role is based in the national primary health care development agency. They receive the control data level from 1% they receive it and then this person down to the state primary health care development agency and then define actually the kind of packages that supposed to be rendered. Now everywhere you are going to do national strategy, health development, monitoring and evaluation or you are going to do your internal review or mid-term reviews. It still have to come from the federal government trying to look at those indicators that you need to use to try those things. So like I said I don't know what I was talking about. Do you work how to ensure that the primary health care system works inside primarily of course essentially with the federal government funding. Now the state will not take the team for that now by monitoring, evaluation and I bring those data and send those data right straight you know to the federal government which will be the input in assessing where we are as far as the system is concerned. You know what that would mean if I do what it says that the primary health care is not the responsibility of the federal government. Different states, different government will have different indicators, different methods of preventing anything. I don't know where that is done in the world. Okay that means that the individual have priority to understand different confirmed legal system, different laws of state or for example. That means that we have a disjointed system and we cannot be able to monitor. So I don't know what that provost was talking about essentially. Sincerely when you are talking about policy direction, the primary health care under one policy came from the federal government, okay. The primary health care system of the basic health provision came from federal government which has to do with domestic state. What I was talking about is that looking at that the actual activities that should reflect should be happened under government. But in terms of policy and direction it has to come from the federal government. Well because if you look at it, I mean the way you have the primary health care being organized or being structured, I mean you say it's part of the three-tier system of government. So you have the federal government, you have the state government, and you have the local government. And that's how it is and that's why you have you know the tertiary, you know you have the secondary and you have the primary health care, okay. So whichever comes first. Maybe it's based on that premise that he's coming from that there's some level of administration. If something goes wrong then you need to ask you know those who are at the hem of a first of controlling it. Local government, state federal government, and you know state government. That's what that I'm sure that that the argument is coming from that premise. But on the other let's also look at the budget allocation because maybe we have to talk about the financing. Not that I'm holding brief for the former minister here. But if you look at you know the budgetary allocation every year at the time you should trickle down you know to what happens in different strata. And so whatever is allocated you know to the health sector should also affect you know the state and the local government. And we haven't really fed well with our location with the budget for the health sector. We have not really met you know the 15 percent Abuja declaration as it were. So we're still dwindling between five, six, seven percent in terms of budgetary allocation. Do you think that this might also be the issue or it's also the issue that the former it's also the issue that's you know our stake here. And it's also the issue that the former minister is also addressing in terms of how the lean resources are being managed. Well, my professor told me if you want to change the health system, follow the money. You need money essentially to mobilize where it succeeds, to boost infrastructure, to maintain the infrastructure, to do monitoring and validation. Health system is heavily money dependent. Again, it's not due when I talk about health and health. First and foremost, we're doing five percent and very sad. We have been basically at the wrong time. Maybe it's the same about eight, nine years ago for health budget. And most of those budgets actually require expenditure. It's not on TV. But we have seen some support, a lot of support from the donors, okay. And then continue to pass the health act bill, the health bill, the national health act. Putting one percent of cost on the revenues and federal government into primary health care. One percent primary health care. In 2018, that one percent was 55 billion dollars. You have 25 billion dollars to get that for 30,000 primary health care transition. White, you know what that means. And it's not all the money. Yeah, because part of the money could be used to maintain some other things, response to emergency, you know, that's the health and money structure. And then, secondly, by the year 2021, the money had gone down to 55 billion, okay. So we have seen dwindling revenue from that regard. People have suggested so many things, including increasing that cost of revenue to two percent and not even that one percent. One percent is two mega, of course. And then looking at how to raise funds, actually formula taxes, you know, like taxes on smart taxes, like tax tobacco, taxing alcohol, and then put this in the consolidated fund for health. And then we're starting to think of it to also contribute to that consolidated fund and the donors and partners. But what we have seen is that state government can nearly, you know, pay the salaries of their health workers. I know how to get them to contribute to their primary health care, to that basic health fund. It is challenging. So that's why, for instance, without that direction from the federal government, without that funding from federal government, without leadership, without governors, without that partnership that can work, you know, a functioning primary health care system would be a difficulty, but at the starting point, the first pillar is for us to create a liberal environment for health to function. And without that liberal environment, governors, leadership, partnership, community participation and ownership are very, very key. Dr. Tsuyu, so do you think that, you know, these governors will leave up to the expectation of a statement? Because at some point, I'd like to describe, you know, what was said, and you have the governor of the state fire me coyote or coyote fire me, putting out a statement as a policy statement. It's just a policy statement because we're not sure of implementation of the latter. We remember that with this, you know, salary increment, and we're talking about the minimum wage, some governors have not really settled up until this moment with paying the $30,000 minimum wage that was agreed because of, oh, we don't have resources. We don't have what it takes to sustain all of that. And so do you think that it's a thing that these governors will be able to, you know, follow suit with that statement that was put, having some sort of increase, even though it wasn't really stated, it was just said that there will be an increase and it probably would just fly as a statement, a policy statement. Right. But do you think that the 36 states' governors would follow suit with increasing funding for the primary healthcare? Well, we hope so, but let's get to the point. How did this statement come about? It was trying to fulfill this year to declaration primary healthcare of the world, you know, to move funding, governors, one of the key things in governance, it tells us what we call another official plan called AOPs. AOPs are supposed to actually, you know, structure the health system and look at the budget and everything and then you put that AOPs to the budget. The AOPs should come, which one of the other official plans should come before the budget step. Okay. So what the Bill and Melinda Gates Foundation and their partners are doing is to say, okay, look, guys, if you can follow through in this regard and follow all these clear indicators, I will score you and follow that you are so, I'm going to give you additional money. Okay. We're going to support you furthermore. We're going to give about 13 awards, looking at different geopolitical zone. Okay. Nice. That's what they're telling them. And of course, when this governor hears about money, it's okay, you have to make policy statement. But the point is this, a policy statement does not actually translate into time use, until you work the plan. And working the plan means that you have to get committed people, get the website, human resources, company, you have to get the monitor and the evaluation, you have to get the website funding. So we hope that the governors will look at this and it will be funding to actualize these things. So you have to get the right contribution and ownership. You have to be able to get the feedback from those communities. Some of those things involves ordinary meetings. If you look at some of those things, they will have partnership meeting for a long time. If you don't have partnership meeting, how do you monitor? So in reality, that is what we have been saying, looking around the health system in Nigeria. So ordinary AOB and other operation plan for health, it's not done. Under the national state, in fact, the state council has to be in health care. So how do you now assess health system in that kind of state? We just hope that it will be just a statement that we will be seeing. I hope something comes out of it. Well, we have to go on. I wish we had more time to talk about this. But thank you so much, Dr. Tuyi Mayba-Wandu. He's a public health expert right here in Lagos. Thank you for joining us. Thank you for having me. All right, then. That's the size of a conversation. But fingers are really crossed. Every other time, it feels like it's very convenient for us to put out statement chunk out policies. You have these governors. Governors who have really not been in agreement with the payment of the minimum wage will also there be an agreement to increase funding for the primary health care, which is very, very important for our economy. That's the size of our conversation. We take a break when we return. We'll be talking spots. Stay with us.