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The Millennium Development Goals , Reproductive Health and HIV/AIDs

The Millennium Development Goals , Reproductive Health and HIV/AIDs. A Presentation by the Senior Special Assistant to the President on the Millennium Development Goals at the African Conference on Sexuality, Poverty and Accountability Abuja February 3 , 2008. Outline. Preamble

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The Millennium Development Goals , Reproductive Health and HIV/AIDs

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  1. The Millennium Development Goals , Reproductive Health and HIV/AIDs A Presentation by the Senior Special Assistant to the President on the Millennium Development Goals at the African Conference on Sexuality, Poverty and Accountability Abuja February 3, 2008

  2. Outline Preamble MDGs Current Status & Trends Historical Trends in the Health Sector Reforms in the Health Sector The Debt Relief Gains (DRG) Achievements & Challenges Way Forward: A Call to Action Final Thoughts

  3. Preamble At the United Nations’ Millennium Summit in September 2000, World leaders from 189 nations reinforced the global agenda by adopting the Millennium Declaration. The Declaration informed the Millennium Development Goals (MDGs) as the minimum baseline which set clear targets for reducing: poverty, hunger, disease, HIV/Aids, illiteracy, environmental issues, and discrimination against women by 2015. 3

  4. The Eight (8) MDGs Goal 1 – Eradication of extreme poverty and hunger Goal 2 – Achieve Universal Basic Education Goal 3 – Promote gender equality and empower women Goal 4 – Reduce child mortality Goal 5 – Improve maternal health Goal 6 – Combat HIV/Aids, malaria and other diseases Goal 7 – Ensure environmental sustainability Goal 8 – Develop a global partnership for development • For each goal, a set of targets and indicators have been defined to track the progress in meeting the goals. These goals have galvanized unprecedented efforts to meet the needs of the world’s poorest with a target date of 2015. 4

  5. Why are the MDGs Important to Nigeria? Highlights of the 2005 MDGs Report illustrate the following: 54.4% of the population in Nigeria live on less than N135 per day Over 7 million primary age children are out of school % of girl-child enrolled in primary and secondary schools is still very low especially in the North (34% for Primary and 10% for Secondary) For every 1000 children born, 201 may die by the age of 5 Out of every 100,000 women in Nigeria, 800 die during child birth Based on the analyses of these data, the achievements of the MDGs is a compelling and urgent reality for Nigeria. 5

  6. Current Status & Trends Source: National Planning Commission. “Goal 5: Improve Maternal Health.” MDG 2006 Report Card- Nigeria Goal 4: Reduce Child Mortality, Goal 5: Improve Maternal Health & Goal 6: Combat HIV/AIDS, Malaria & other diseases are very crucial to Rep. Health According to the 2006 MDG Report, the status and trends of Goals 4 and 5 have either shown marginal improvement or have in fact worsened. The Under Five Mortality Rate (U5MR) made marginal improvement from 201/1000 live births in 2003 from 197/1000 live births in 2004; however, Goal 4’s trend has worsened with the rate increasing from 100/1000 live births in 2003 to 110/1000 in 2005. These trends call for critical attention and improvement

  7. Sadly & Unacceptable…. • Reproductive Health Issues in Nigeria • Maternal & Infant Mortality: • rated world’s second highest with almost 55,000 women dying each year from preventable pregnancy-related complications • in addition with infant mortality, have contributed to the declining life expectancy rate in Nigeria • in comparison to the attention that an incident of a plane crash receives, the urgent reality of maternal mortality is underestimated because most women who die during pregnancy tend to be poor, underprivileged, uneducated and young • irresponsible behaviour and uninformed reproductive education, coupled with lack of care and counselling • early marriage phenomenon will results in VVF • HIV/AIDs and other sexually transmitted infections “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.” Professor Mahmoud Fathalla, past President of the International Federation of Gynecology and Obstetrics (FIGO)

  8. Historical Trends in Financing the Health Sector….1/2 • Structural Adjustment Program (SAP) - Federal budgetary allocation to health fell from 2.3% in 1987 to 1.8% in 1988 • A system of total or partial cost recovery was introduced for service, and revolving funds were set up for drugs, X-rays, laboratory materials and food which caused a considerable decrease in service use, particularly in the hospitals • FMoH budget for development of PHCs services fell from 6% in 1987; 4.2% in 1988 & 4.4% in 1989 • Extra budgetary allocations to FMoH for PHCs was 160% of that in the regular budget which continued for many years & showed political will. • PHC services became LGs’ responsibility & FMoH charged with leadership and support; however intergovernmental collaboration and coordination have remained longstanding issues

  9. Historical Trends in Financing the Health Sector…2/2 • National Primary Health Care Development Agency (NPHCDA) set up in 1992 to fill coordination gaps & sustain Federal assistance to LG health service development • 1985-1991, %age of Federation account funds allocated to LGs was increased from 5% to 15% • Funds paid directly to LGs for resources to pay for primary education and health services now that it has been made their responsibility • 1990, grant of $35 million given by the U.S. government to support PHC programme • 1993, all conditions met by the Ministry to receive the last trench but funds were withdrawn by the donor due to lack of coordination and corruption • It was reported that most Schools of Health Technology did not receive their grants to upgrade their schools • The Millions of Nigerians (particularly the poor and those in the rural areas) suffered the greatest loss

  10. Reforms in the Health Sector • Health Sector Reform Programme (HRSP) - seeks to strengthen the national health system by improving availability and management of health resources, expanding access to quality health services & promoting effective partnership, collaboration & coordination • National Health Insurance Scheme (NHIS) has become operational and provides the poor with a source of stability in their health expenditures .

  11. Debt Relief Gains (DRG) As a result of the $1bn Debt forgiveness Nigeria received in 2005, the N100bn representing the Federal share was allocated to the 10 MDGs line Ministries in the 2006 Appropriation. This serves as an additional spend to scale up current efforts towards the attainment of the MDGs In Budget 2006, N100bn while in 2007, 110bn was appropriated. Debt Relief Gains was used as an entry point to scale-up pro poor projects & programmes and quicken the achievement of the MDGs Health is a major focus of the DRG investments 11

  12. Achievements Education • Step down training on family life and HIV/AIDs education curriculum for 256 teachers and 24 inspectors in 18 states Armed Forces • Skill building training for women in barracks (PLWHA) in Lagos, Kaduna • Training of 30 M&E officers for the armed forces Youth Development • Training of 120 HIV/AIDs focal officers on HIV/AIDs issues • Capacity building for peer education trainer for NYSC

  13. Achievements Agriculture and Water Resources • HIV mainstreaming workshop for focal persons in state ministries and Agric Development Programmes • Workplace policy Nigeria Prisons Service • Training of HIV/AIDs counselors from 6 prison hospitals • Procurement and distribution of HIV kits within the National Algorithms Women • Workplace policy in place • Capacity building for Desk officers/focused NGO’s and CBO’s

  14. Achievements- Targeting the vulnerable groups • Social Safety Nets - provides cash or in-kind transfers to the poorest of the society • In Budget 2007, N10bn was appropriated to the Social Safety Nets Scheme • Keke NAPEP (N2bn) • Micro Credit (N5bn) • SMEDAN (N1bn) • Conditional Cash Transfer (CCT) N2bn • Pilot in 12 states with the lowest poverty indicators (HCDI) • Borno, Yobe, Nassarawa, Niger, Kebbi, Jigawa, Osun, Ogun, Ebonyi, Enugu, Bayelsa, Cross River • Rollout Late 2007-Early 2008 • Seeks to foster partnerships with Departments & Agencies to tackle extreme poverty by targeting vulnerable groups such as physically challenged households, VVF patients, people living with HIV/AIDS, unemployed youth. 14

  15. Achievements 2006 2007 Sustainability: The 7-Point Agenda of President Umaru Musa Yar’Adua includes health as a priority area for the current administration

  16. Key Challenges • Lack of local data necessary for targeting interventions for the prevention of maternal mortality and HIV/AIDs • i.e. identifying factors such as high poverty & low education levels, distance to health facilities, ignorance, lack/limited access to health facilities, financial constraints • Women’s Education and Empowerment • Mainstreaming of HIV/AIDs as a cross cutting issue • Scaling up of poverty alleviation programmes with focus on women • Ensuring that resources are available for sustenance of reform programmes • Primary Healthcare Infrastructure and Referral System • Emergency Response Care Units/Services (esp. in Rural Areas) • Political commitment not only at the national level, but a shared vision at the states and local levels

  17. The Way Forward Accepting reproductive health as a NATIONAL rights, medical, moral and political ISSUE Increasing political will through a National Policy on Reproductive Health that would support and improve maternal health care at local level Improve funding of poverty alleviation programmes and development of successful strategies that will empower women through access to poverty alleviation programme /micro credit scheme. Increase multi sectoral support in main streaming of HIV/AIDs as a cross cutting issue; mobilization of more resources for the prevention of HIV/AIDs

  18. The Way Forward • Training & provision of more skilled birth attendants (especially in the rural areas) keeping in mind that most women are affected by cases like bleeding and emclampsia which the average unskilled worker cannot handle. • Be more proactive! • Funding is important, but not necessarily the immediate solution • It is important to have better (organization and personnel) service delivery ; training & motivation of staff; collaboration with the departments and parastatal of government at the sub-national level • Ensure value for money of government allocations and donor assistance

  19. Thank you for listening

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