Lancet Nigeria Commission report calls for ‘One Nation, One Health’

A UCL-led landmark report examining health inequalities in Nigeria has called for urgent action by policy makers to prevent disease before it occurs and to urgently increase access to healthcare for everyone.

The Lancet Nigeria Commission report, released on Wednesday, March 16, found that health outcomes remain poor in Nigeria despite higher spending since 2001.

A multidisciplinary group of Nigerian experts and academics based around the world, working closely with UCL’s Institute for Global Health and policy makers, reviewed over a two-year period the burden of disease existing and the possibilities of improving health. The team found that while Nigeria is Africa’s largest economy and most populous country – set to become the third most populous country in the world by 2050 – its dismal health outcomes are holding back progress and threatening the future of an otherwise vibrant nation.

In an accompanying Lancet article, the group also looked at population health outcomes in Nigeria between 1998 and 2019, compared to 15 other West African countries. They analyzed mortality patterns by sex, years of life lost, years lived with disability, life expectancy, healthy life expectancy and health system coverage. The authors concluded that Nigeria compares less favorably to similar countries in West Africa, despite recent improvements.

Professor Ibrahim Abubakar (UCL Institute for Global Health), who led the Commission, said: “Nigeria urgently needs to improve access to health care by improving health financing and the efficiency of existing spending. . Our report offers specific recommendations on financing innovation and specific interventions to improve the health workforce, information systems and access to care for all.

“Since the vast majority of factors that influence health lie outside the health sector, health should be at the heart of all policies. This will require rethinking governance for health with the establishment of intersectoral governance mechanisms that make it possible to measure the impact on health of different policies to empower all sectors.

“This includes tackling low access to water and sanitation; improve access to healthy food by addressing the double burden of malnutrition due to underweight and overweight; and addressing the health effects of climate change, including air pollution. Explicit consideration of equity in the implementation of programs and the provision of social protection, education and employment opportunities should be paramount.

Yet the report presents a positive perspective that Nigeria can deliver equitable and optimal health outcomes.

It identifies bold recommendations for action in collaboration with policy makers, contributing to lasting change in health policies and programs, national health outcomes and global health goals.

The report’s recommendations include:

  • Calling for a new social contract centered on health to respond to Nigeria’s need to define the relationship between citizen and state.
  • Prevention being at the heart of health policy, given Nigeria’s young population, requiring a whole-of-government approach and community engagement.
  • An ambitious health care reform program aimed at building a centrally determined and locally managed health system, including providing health insurance coverage to 83 million poor Nigerians who cannot afford to pay bonuses.
  • A health system that encourages innovation and engages communities, to ensure that existing national schemes have local ownership and are sustainable, and reform the policy and regulatory landscape to unlock the market potential of the private sector.
  • A comprehensive assessment of Nigeria’s health security investment needs, whose weaknesses the pandemic has revealed.
  • Federal and state governments are funding and leading the development of standards for the digitization of health records and better systems for data collection, recording and quality assurance.

Commissioners suggest action could be taken to dramatically improve people’s health, including targeted interventions to tackle unsafe water sources, poor sanitation, malnutrition and exposure to air pollution .

An urgent goal of the Nigerian government should be to rebalance prevention and curative care to improve the health of young people, according to the team. Priorities include improving access to water and sanitation and education – especially for women and girls – as well as adopting policies to promote environmental sustainability to reduce air pollution and create a healthier built environment.

They call for repositioning future policy to achieve universal health coverage.

Professor Abubakar added: “Health is a unique political lever, which has so far been underutilized as a rallying mechanism for people. Good health can be central to reviving a patriotic national identity and a sense of belonging.

“A commitment to a ‘One Nation, One Health’ policy would prioritize the achievement of universal health coverage for all, especially for the most vulnerable Nigerians, who bear an unacceptable burden of disease.”

The report combines analysis of population dynamics, disease burden and future projections based on available data from the Global Burden of Disease Study, the Nigerian National Bureau of Statistics and the Nigerian Center for Disease Control.

Other partners include University of Ibadan, University of Nigeria, Bayero University Kano/Aminu Kano Teaching Hospital and Ondo State University of Medical Sciences.

Credit: Lancet Nigeria Commission

/Public release. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the author or authors. See in full here.

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