Linking the dots between LG autonomy and primary healthcare delivery
By Folasade Akpan, News Agency of Nigeria (NAN)
The Supreme Court ruling of July 11, which held that henceforth, all Local Government Area (LGA) allocations should be paid directly into their accounts, came as a relief to proponents of LG autonomy.
The court also barred the 36 governors from receiving, tampering or withhold funds meant for the local governments
It is believed that development at that level would be enhanced if the LGs were given the opportunity to receive their allocations directly and manage their funds.
Among other things, the 1999 Constitution as amended, states in the second part of the Fourth Schedule that the functions of a local government council shall be “(A) the provision and maintenance of primary, adult and vocational education.
In section B it provides that the LGs should be responsible for the development of agriculture and natural resources, other than the exploitation of materials.
Similarly in section C it states tasks them with “The provision and maintenance of health services’’, while section D says it will undertake such other functions as may be conferred on a local government council by the House of Assembly of the State.”
Based on this and other matters, the Attorney General of the Federation (AGF), Lateef Fagebemi, SAN, on May 24 this year on behalf of the Federal Government took the 36 governors before the Supreme Court over alleged misconduct in the running of affairs of LGs.
The Attorney General instituted the court action against the governors primarily seeking full autonomy for local governments as third tiers of government in the country.
In the suit marked SC/CV/343/2024, the AGF had prayed the Apex Court for an order permitting the funds standing in the credits of local governments to be directly channelled to them from the Federation Account.
He argued that this was in line with the provisions of the Constitution as against the alleged unlawful joint accounts created by governors.
Stakeholders in the health sector welcomed the development. They see it as a breakthrough that would enhance Primary Health Care (PHC) delivery and ensure Universal Health Coverage (UHC) for all.
For the Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, the judgment was one of the milestones in the evolution of Nigeria’s healthcare system.
He referred to it as an opportunity to galvanise all levels of government to push healthcare delivery in one direction.
According to him, having all levels of government in one direction will ensure that healthcare is delivered using a ring fenced fund.
“This fund will be managed by the state but with an agreement of the local governments to implement fully the Primary Health Care (PHC) under one roof”, h esaid.
Pate explained that prior to 2011 the responsibility of PHC was highly fragmented between the states, making it a challenge as performance generally was low.
“That presentation resulted in poor performance across different elements including immunisation, maternal health outcomes, and several other things”, he said.
The minister said that not only the Federal Government, but states were key parts of the national health system and that the LG system by law was part of the system too.
“So we are all operating in the context of cooperative federalism where all hands are on deck and our development partners have joined in that and we have raised grant resources to provide incentives to the states to contribute their counterparts.
“With this development, even LGs will be required to step up and we will measure each other’s performance and Nigerians should be able to tell which state, which LG is doing its part”, he said.
Dr Joseph Enegela, Founder, Africa Diseases Prevention and Research Development Initiative (ADRAP), said there was a strong link between LG autonomy and healthcare delivery at the grassroots.
“By design, if you look at our healthcare system from the primary to secondary to tertiary level, there are strict roles for those who work in the PHC system.
“The same also goes for those in the secondary and tertiary health system, and those roles and responsibilities help to describe what kind of ailments each can handle”, he said.
Enegela said until full autonomy was given to the third tier of government while those who run local governments know their responsibilities to the people.
“To achieve the desired results, the system requires complete overhaul, with strict supervision,” he said.
Prof. Bala Audu, National President, Nigerian Medical Association (NMA), said that LGs having their funds directly available to them, meant that they would be able to channel the required funding to PHC facilities to prevent diseases.
“Since PHC is under the direct body of LGs, if the regulatory agencies set down standards for these facilities, and these regulatory agencies play their role, it will go a long way.
“If they ensure prevention of defecation in open places, provision of latrines, and all that, they can do a lot in preventive health, and therefore improve the overall health of Nigerians”, he said.
He advised that the quality of care at all levels of healthcare delivery should meet international standards.
According to him, this means that irrespective of which tier of government was in charge of a health facility, it must meet certain minimum standards.
“These minimum standards must include the infrastructure, the equipment needed for diagnosis, the medications, that is the essential drug list needed to treat those ailments that are appropriate for treatment at that level of care.
“Very important also is that the required manpower to deliver the quality of healthcare is there.
“So at PHC level, we must have a certain number of doctors, nurses, midwives, Community Health Extension Workers (CHEW), and dispensers”, Audu said.
Dr Sofiri Peterside, the National President, National Association of Government Medical and Dental Practitioners (NAGMDP), said that full autonomy for LGs should engender and embolden the tier of government in carrying out their constitutional duties.
According to him, over the years, their dependence on the state apparatus has more or less whittled their capacity to carry out their function.
“So we are hoping that the coming of LG autonomy will help the system, both in the health sector, the educational sector, and in discharging other responsibilities in agriculture and every other concerns of the LG”, Peterside said.
Peterside said if funds to the LGs are channelled appropriately, it would help improve on poor health indices such as maternal and child mortality.
According to him, LGs should allocate enough funds towards the provision of PHC services, renovation of health facilities, basic hospital infrastructures, common drugs and employment of social mobilisation officers.
“We hope and pray that these funds will be used judiciously, and not be considered as another jamboree for a few persons at that local level to see themselves as lords”, he said.
For State Commissioners of Health, it is an added advantage as it enhances their work.
The Commissioner for Health, Niger, Dr Ibrahim Dangana, said that the ruling presents an opportunity and some challenges in terms of the management of the PHC landscape in the country.
“When the resources are available to them, they have other sectors to look at, education, agriculture, sports, women development, and even infrastructure development in their respective LGs.
“These resources will not be sufficient. Even many will grapple with paying staff salaries alone, not to talk of the developmental challenges of taking care of all these sectors.
“So autonomy should come with some sense of responsibility, I may have the resources directly to me now, but then I will need the support of other organisations to effectively deliver what my people want at the grassroots.
“The highest health decision-making body in the country, the National Council of Health, identified as far back as 2011, the need to have PHC under a one roof system.
“So the LGs need to understand that the framework is there and this is an opportunity for them to grab, rather than decide to go it alone”, he sid.
The Commissioner of Health for Akwa Ibom, Prof. Augustine Umoh, said implementing the provisions of the ruling would come with challenges, but he was positive such challenges would be addressed with time.
“The way I see it, none of the tiers of government can stand alone; from what we have seen so far, it is my belief that within a while, the state governments and LGs would dialogue.
“With this, they will be able to reach a point that will ensure that what is important is the health of the people, and not necessarily who controls what”, he said.
For the purpose of delivering healthcare to all Nigerians at all levels, the stakeholders emphasise cooperation by the three tiers as the best approach to healthcare challenges at grassroots.
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Boa noite, quero entender melhor sobre quanto apostar? dá pra confiar?