Interviewee: Dr Ben Anyene, Microbiologist, Physician, and Public Health consultant for the National Primary Health Care Development Agency (NPHCDA) responsible for immunisation programmes nationwide.
Once you are able to contextualise health care delivery as part of development, you focus on making quality health care available. Quality should be in terms of efficienc y, lives saved, and what will give happiness to mothers and, by extension, to children. Once you are able to contextualise it that way, it will be very easy for you to start to see what to do and the cost- effectiveness because of limited resources.
Immunisation is the most cost effective public health intervention you can get anywhere. If a child doesn’t fall ill, it is a huge saving both for the country, for the family and for the child himself because it simply means those hours that the child will be sick are the times the child should have been in school. If a child spends more time at home being sick than being in school, by the time the child becomes employed and working those illnesses will not catch the child so it is a life time saving for the country.
That is why I said they should conceptualise health as a means of economic development. There are so many challenges in the system. The teaching hospitals are not working, the secondary health system are not working, we have to put things right.
Where should putting things right start, do you think?
The disease burden of this country says 70 % are at the PHC level, what constitutes that disease burden?
They are mostly vaccine preventable diseases. A rational person will go for that because if you can stop or eradicate 70% of disease burden of this country it simply means 70% of the country is healthy.
Now we should be talking of what it costs to fully immunise one child in Nigeria. The figures is about N13,500, and if a child is fully immunised about 9-10 childhood diseases that are vaccine preventable can never come to that child again.
The sort of funding Nigeria has for Vaccines are mostly donor driven, why does it seem so difficult for Nigeria to continue if the country graduates from this funding model?
The question we should start asking is where the health budget is spent. The challenge we are having now is that the country cannot fund its own immunisation cost and how much is it? Less than N500 million annually. What is going on is simply in terms of prioritisation, making health a priority.
By July we will be saying that Nigeria has interrupted Polio transmission, but what people don't know is that the federal Government has not given up to 10% funding for Polio the rest of the cost is from outside Nigeria but it shouldn't be, because government must understand that the people are the ultimate resource that any government can talk about.
To what extent does Nigeria have to cough up money for immunisation?
It is shameful that 500 million for instance this year, the Global Alliance for Vaccine Initiative based in Geneva, have been paying for 60% % of Nigeria vaccine need for the past 10 years, should that be so? Then the balance of 40% that is left, Nigeria cannot pay even that, they go cap in hand looking for money all over.
Now because Nigeria has been rebased its economy, it can no more qualify for [immunisation funding for countries with lower daily dollar spending]. This year we are supposed to pay about N286 million, Gavi is paying 50% of that, the remaining money is about $105 million. Nigeria cannot pay, so it is the World Bank that is coming in to pay for that, because everybody is afraid because we know that if we don't pay this money, and the children are not immunised we go back to square one, there will be stock out as we had about five years ago.
I don't think anybody will be celebrating if by next year, we start witnessing stock out and children are not immunised; even polio we are about to eradicate will come back.
Where does Nigeria stand with GAVI and UNICEF and others then?
What GAVI said is that they will withdraw the money gradually, by reducing our payment by 20% every year, so that by 2020 we would have exhausted the 20% and from 2021, Nigeria will be paying 100% of the cost of vaccines.
This would have taken place in 2015, we said it will affect us, they said ok, we are giving you one year of grace, so in 2015 they paid the normal 5% they have been paying, but for next year they will reduce 20% out of that and it will continue, now Nigeria is not prepared, for 2015, Gavi paid 50%, but Nigeria couldn't pay the remaining 50%. Nigeria was putting up $36 million when we are looking at about $105 million, so World Bank has paid, for 2016. World Bank will not be paying for Nigeria again, and Gavi will reduce by 20%, so we have a lot already to pay and nobody is thinking about it now.
Why not?
Vaccine is not something you get off the shelf to buy like Panadol, it takes at least six months from placing the order and paying for the order. For vaccine it is pay based on request, it is not manufactured and kept on the shelf for you to go and buy, so we have to make that commitment.
What we will just be doing, which we do sometimes and nobody know this, is to go around where we still have some vaccines left in stock we mop up to move to other places.
But resources are always the fallback?
I'm worried because if the resources are not there one would understand, the resources are there but it is the efficiency in the use of resources that we need. It is prioritising the use of resources and effectiveness, because I'm aware that in the physical space there lot of contending issues, but once the priorities are gotten right no one will be worried.
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