New Telegraph

Nine months to expiration, RMNCAEH+N plan yet to be fully implemented

The Nigeria Reproductive, Maternal, Newborn, Child, Adolescent and Elderly Health Plus Nutrition (RMNCAEH+N) COVID-19 Response Continuity (recovery) plan 2020-2022 was launched to harmonise health interventions, curtail wastages to achieve universal health coverage (UHC). However, as December, the month of expiration, approaches, REGINA OTOKPA reports there are no clear signs for full implementation unless government sits up

In October 2020, the Minister of Health, Dr. Osagie Ehanire launched a multi-stakeholder partnership coordination platform, the Nigeria Reproductive, Maternal, Newborn, Child, Adolescent and Elderly Health Plus Nutrition (RMNCAEH+N), to harmonise the health interventions of government and health partners, address the gaps frustrating the well-being of women, children, adolescents and the elderly in Nigeria in order to ensure funds were properly channeled and utilised to get the desired results of achieving UHC by 2030. The platform brings together government, donors, partners and traditional leaders for an effective overall coordination of RMNCAEH+N issues, by harnessing the relative strengths of individual players to leverage resources, reduce duplication and induce speed towards maximised health outcomes.

The RMNCAEH+N plan worth N12,190,045,688, was developed to mitigate the indirect impact of COVID- 19, as well as prioritise and maintain the provision of RMNCAEH+N services such as routine immunisation, reproductive health services, care during pregnancy and childbirth, essential care for new-born, young infants and under-five children, adolescents, older adults and the elderly.

Primarily, the plan was to ensure there was no disruption in the delivery of healthcare services to any Nigerian, regardless of who they are or where they come from. At the launch, the minister who emphasised on President Muhammadu Buhari’s unalloyed commitment towards improving the health and well-being of vulnerable populations in Nigeria; women, children, adolescents and the elderly, stressed that the current poor health indices further worsened by the COVID-19 pandemic, was not acceptable to the federal government and its vision of achieving UHC. Although there were hopes that by December 2022 a significant part of the plan would have been implemented, about nine months to expiration of the two year strategic multisectoral plan, there are still no clear indication of its full implementation to meet the objectives of accelerating coverage of interventions, reduction of gender and equity gaps, as well as improved quality of health care services to the targeted population.

Earlier in the year, experts in the health sector had expressed worry over the delayed implementation of the RMNCAEH+N plan by the ministry of health and by extension, government, and feared it could further be delayed given that 2022 was a pre-election year thus, in the next few months, governance is expected to be disrupted as majority if not all parliamentarians, policy makers and politicians would withdraw from governance to focus on election activities. Speaking at a 2 day Strategic Retreat with NGOs, Young People and the Media, the coordinator Africa Health Budget Network (AHBN), Dr. Aminu Magashi urged government and relevant players to increase efforts towards implementing the RMNCAEH+N plan due to technically expire by December this year.

Although little or nothing has been done as far as the RMNCAEH+N COVID- 19 Response Plan is concerned, Dr., Magashi who insists the plan is well articulated and has capacity t o touch many lives i n Ni – g e – ria, i s still optimist i c that within the n e x t n i n e months, a lot of progress could be achieved i f the ministry and other parties to the multi-sectoral plan do their bit to ensure reduction in illnesses and deaths.

“The Federal Ministry of Health (FMoH) in 2020 engaged different stakeholders through the RMNCAEH +N platform to develop a recovery plan as a response to the global call that every country should develop a recovery plan to ensure that services are not disrupted during the COVID-19 pandemic. “We must remember that this is a pre-election year, and therefore there is need for urgency in its implementation. RMNCAEH+N Plan has been available since 2020 but a huge per cent of the plan has not been implemented till date, and it is still lying on the shelf of family health department of the health ministry.”

“All stakeholders in the country including the media, CSOs, philanthropic organisations and wellspirited Nigerians have a huge role to play to ensure that the plan is implemented to the latter. Even though a member of the National Assembly, Sen. Istifanus Gyang representing Plateau North senatorial district had promised legislators under the power of oversight to take it up, the Plan is still dangling. Gyang agreed that the failure of the government to fully implement the RMNCAEH+N Plan a year and five months after it was launched, was a disservice to the nation.

“We have extended the life span of the 2021 budget to March, and the 2022 budget it is still an opportunity so that the fund will not only be released but also utilised.” Frowning at the consistent absence of political will by the government to address situations including implementation of policies, Hon. Muhammad Usman, a former vice chairman of the House committee for healthcare services, regretted that not until deliberate steps are taken to carry out proj-ects, implement policies and plan as at when due, Nigerians will hardly find the ability to trust government because of its lack of transparency.

However, at a stakeholders lunch meeting organised by AHBN and GemHub initiative to rally support for the plan, The focal person, RMNCAEH+N Partnership Coordination, FMoH, Dr. Femi James, noted that out of the seven priority areas of the plan, about 55 per cent of the operational plan for RMNCAEH+N has been achieved as at September 2021.

At least 48 out of the 93 activities under the coordination platform have been reached. Dr. Femi maintains that some good progress has been made in the national coordination of RMNCAEH+N; guidelines, plans and protocols sadly, majority of the states are dragging the plan backwards with a poor coordination plan in place. Out of the 36 states and FCT, only four states: Ondo, Lagos, Kaduna and Gombe, have so far adopted a multi-sectoral approach and are further working on putting structures on ground to bring out a more robust approach.

Identifying the need to incorporate the capacity of health workers during disease outbreaks and pandemics in the RMNCAEH+N plan, he said, “setting up of a guideline is underway to assist states put up an effective coordination mechanism. Some thematic areas of RMNCAEHN needs to be updated considering the impact of COVID-19 pandemic on health service delivery.” Not pleased with the delay in implementation, Civil society organisations have requested the FMoH to release current implementation data and status of RMNCAEH-N plan to determine gaps, strengths, challenges, possible solutions but also, indicators on how each state was responding, and put in place a clear cut interactive platform to explore how CSOs, donors and government can balance and support each other for a better coordination.

Representative, National Advocates for Health (NA4H), Lola Mabogunje who asked the government to make public, existing gaps in the RMNCAEH+N plan noted: “I don’t like silence on an issue. People are worried and are asking if an epidemic happens. Do we want to have the same experience with COVID-19? We should be prepared for the next epidemic, it shouldn’t meet us unprepared; we should safeguard our people.” The AHBN Coordinator, Dr. Aminu Magashi who offered further explanation, said strengthening coordination between all players was key to improving the implementation status of RMNCAEH+N plan in Nigeria.

He thus sought sup-port for establishment of RMNCAEH+N advocacy kits at the states, and urged partners to share existing policy documents to states for guidance. Magashi who declared the AHBN would engage the department of family health to develop a scorecard showing progress made, existing gaps and challenges frustrating full implementation of RMNCAEH+N plan in Nigeria. “We will develop a scorecard that will promote accountability, transparency, monitor progress and also have some clear recommendations for action. It will help to understand coordination, strengthen demand creation, and also improve services like family planning commitments.

At the same time, we are looking at the role of the media in demand creation so more women can access services of family planning, maternal health, postnatal care, access to childhood immunisation and COVID-19 vaccination.” Besides the delay in implementation, there has been an agitation by young people over the government’s failure in including them in the conceptualisation of the RMNCAEH+N Plan as well as other interventions and programmes where young people are captured as beneficiaries.

Chair of the Pact, Ekanem Itori wasted no minute in expressing his displeasure over such attitude, saying: “For the RMNCAEH+N Plan, it’s probably new to the people at this meeting; so it only shows that there was a poor engagement of youths when they were even developing the plan and I think it is not far-fetched from every programme that we’ve been running. “We have been asking the government that in every programme, in every intervention not when you are implementing but actually when you are developing the idea, the concept of the whole intervention, you need to actually include youths.

For the RMNCAEH+N Plan it only shows that yes, there was poor engagement of youth-led organisations.” Also supporting the position of the young people and demand for inclusion, Health Advocate and Chief Executive Officer, Vaccine Network for Disease Control (VNDC), Chika Offor who expressed displeasure over the exclusion of young people and people living with disabilities in the designing and execution of the RMNCAEH+N Plan, expressed worry that the interests of these groups not included in the planning phase was at risk of not being adequately captured, leading to waste of scarce resources. “Every group is important and that is the key so it is very important that gender, people living with disabilities, the vulnerable groups and the youths are included.

The youths are very important. “People sometimes pay lip service to youth inclusion and that is very painful, you know. Because many youths have several powerful ideas that if you are able to listen and fine tune, you will come up with very robust strategies that will support UHC.”

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