IMPACT OF NATIONAL HEALTH INSURANCE SCHEME (NHIS) AND MANAGED CARE ON NIGERIA HEALTH INDICES

Keynote Address by Dr Ben Anyene at Annual General meeting/Scientific Conference of Health Care Providers Association of Nigeria on November 29, 2011

“There is hereby established a scheme to be known as the National Health Insurance Scheme (in this Decree referred to as "the Scheme") for the purpose of providing health insurance which shall entitle insured persons and their dependants the benefit of prescribed good quality and cost effective health services as set out in this Decree.”
In Nigeria, the provision of quality, accessible and affordable healthcare remains an important issue (Agba et al.2010). There is no denying the fact that Nigeria’s healthcare index is very poor, and that the people are suffering. Today, Nigeria has one of the highest maternal morbidity and infant mortality rates in the world.
The Encyclopaedia Britannica Concise Dictionary defines health insurance thus: System for the advance financing of medical expenses through contributions or taxes paid into a common fund to pay for all or part of health services specified in an insurance policy or law. The key elements are advance payment of premiums or taxes, pooling of funds, and eligibility for benefits on the basis of contributions or employment without an income or assets test. Health insurance may apply to a limited or comprehensive range of medical services and may provide for full or partial payment of the costs of specific services. Benefits may consist of the right to certain medical services or reimbursement of the insured for specified medical costs. Private health insurance is organized and administered by an insurance company or other private agency; the government runs public health insurance. Both forms of health insurance are to be distinguished from socialized medicine and government medical-care programs, in which doctors are employed directly or indirectly by the government, which also owns the health-care facilities (e.g., Britain’s National Health Service). 

Thus Health Insurance can be defined as a contract between an insurance provider (e.g. an insurance company or a government) and an individual or his sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g. annually, monthly) or lifelong in the case of private sector insurance, or be even mandatory for all citizens in the case of national health plans. It involves resource mobilization (generation and collection), pooling and allocation and purchasing. A health insurance scheme should provide quality, equitable, accessible, affordable, and efficient care; it should assure a significant reduction in out of pocket expenditure and it should provide universal coverage. It should also provide a comprehensive good quality and cost effective health services to entitled and insured persons and their dependents in the formal sector, self-employed, rural communities, the poor and the vulnerable groups the benefit of prescribed (Agba 2010).

In order to address a number of problems plaguing the health system in Nigeria and to improve service access and coverage, the National Health Insurance Scheme (NHIS) was promulgated in 1999 (Decree 35 1999 now Act 35 of 1999) by the Military regime of Abdusalam Abubakar and launched in 2005 by the Obasanjo Administration (1999 – 2007). Although, the idea was conceived in 1962 (Halevi Committee’s Lagos Health Bill) it was only executed forty three years after because of lack of political will to actualize the dream by successive (military and civilian) governments (Falegan, 2008).
The objectives are:

• To ensure that every Nigerian has access to good health care services
• To protect families from the financial hardship of huge medical bills
• To limit the rise in the cost of health care services
• To ensure equitable distribution of health care costs among different income groups
• To maintain high standards of health care delivery services within the Scheme
• To ensure efficiency in health care services
• To improve and harness private sector participation in the provision of health care services
• To ensure equitable distribution of health facilities within the Federation
• To ensure appropriate patronage of all levels of health care
• To ensure the availability of funds to the health sector for improved services

Managed care as the name implies refers to systems for organizing doctors, hospitals and other providers into groups to enhance the quality of health care services and assure that they are delivered in a cost-efficient manner. Managed care organizations coordinate all aspects of the delivery system in order to manage all the costs in the system (Awosika 2005). Rather than bill patients on a fee-for-services basis, managed care systems set pre-arranged fee structures and utilization review procedures, agreed upon by contract between health care providers and the managed care organization (Awosika 2005). Thus managed care helps in actualizing the purpose of NHIS.
Thus it is the believed that the purpose of NHIS will be achieved through the NHIS benefit packages itemized below that are delivered through managed care:

• Curative care by a provider
• Out-patient diagnostic and treatment services
• Short-term rehabilitation and physician therapy
• Paediatric and adult immunization services
• Family planning
• Ante-natal and post-natal care
• Eye examination but not the provision of spectacles
• Consultation with specialists
• Hospital care in a public or private hospital in a standard ward during a stated duration of stay for physical or mental disorders.
• Emergencies in and out of the HMO service area
• Detoxification and treatment of substance abuse.
• Diagnostic and therapeutic radiology services
• Primary Dental care as defined- pain control, extractions, amalgam fillings, etc.

All benefit packages under the Scheme shall be provided or made available in Nigeria only (Awosika, 2005). Participation in the scheme is optional except for workers in the private and public sectors who are expected to contribute 5 percent of their basic salary to the scheme while their employers pay 10 percent for each worker. This entitles a contributor, a spouse and four children to access Medicare from any approved service provider. As at February 2009, the scheme has registered over 4 million federal civil servants and their dependants (Agba 2010). 

We will examine the impact of the NHIS and Managed care organizations in Nigeria based on the objectives which underlie their existence

• Ensure that every Nigeria has access to good health services

Access to Health insurance provides a good proxy for measuring access to health services. The NHIS has been able to enroll up to 3% of Nigerians under the formal sector health insurance programme (Kujenya, 2009). About 1% has also been covered in the private sector by the Health Maintenance organizations. There are concerns that this figure is low, but it represents a step towards the right direction of providing health insurance coverage for all Nigerians.
There has not been remarkable improvement in national health indices if the MDGs are used as a guide. Moreover the little improvements seen are localized and often are directly attributable to intervention programs and projects designed, funded and implemented by non-public actors it the health sector.
It is universally accepted that improved national health indices can only be possible if the health services delivered are acceptable, available, accessible, accountable and affordable. For this to happen, a strengthened and evidence-driven health system must be in place. The six core functions of the health system are Stewardship/Governance, Human Resources for Health (HRH), Health Financing, HMIS, Medical Technology/Supply and Service Delivery. An NHIS needs this platform to deliver the expected results. Thus it should be helpful to interrogate the performance of these core functions. Beneficiaries have been limited to employees of the Federal Government and large corporations.

• Control/reduce arbitrary increase in the cost of health care services in Nigeria.

The NHIS reimbursement system managed by health maintenance organizations uses a capitation system for primary care and a fee for service schedule for referral care. The whole idea is to achieve the objective of controlling cost of services. So far, these have worked though the challenges limiting its effectiveness are quite numerous. There is a tendency for reduction of quality of care by providers to stay within a specified cost level. Thus, even though one achieves cost control, quality also gets impacted. We need to start monitoring service delivery in our health facilities. In many developed countries, performance monitoring is routine rather than ad-hoc. We can only talk about the effectiveness of cost control efforts when we know that service quality has not been negatively impacted on.

• Protect families from high cost of medical bills

It can be said that families who are already covered by the scheme and by the private sector insurance programmes already receive a reasonable level of protection from the high cost of medical bills. The challenge here is still the fact that less than 1 in 20 Nigerian families are included in this. Again, some illnesses such as renal conditions, HIV/AIDS are not included and do lead many households into poverty. Expansion of health insurance in Nigeria should help address these challenges in other to improve the ability of households to cope with illness events. This will also not be done in isolation from the overall challenges being faced in Nigeria with the cost of doing business. Most times medical bills are high because prices of goods and services are high. National investments in the power sector and transportation are critical to reduction in cost of doing business. While we hope that governments interventions in these areas will be appropriately implemented, it must be said that NHIS and HMOs need to work together to expand coverage and increase cross subsidization across sectors where possible so that the wealthier members of the society help protect the poorer ones from facing high costs for health care.  Nonetheless, the implementation of these programs shows that it is possible to achieve the objective of distributing service costs across income groups.

• Ensure equity in the distribution of healthcare service cost across income groups

While the ongoing NHIS formal sector programme has provided some level of equity in distribution of service costs amongst enrollees, its MDG programme has helped to the exemption from payment for some of those who cannot pay for maternal and child health services in the areas where this has been provided. However, as noted earlier, the population of Nigeria benefitting from this is quite low. Given this limitation, most people continue to pay for health care directly out of pocket, and this has significant access implications (Nnamuchi, 2007). Out of pocket expenditure still accounts for 70% of health care financing in Nigeria, thus making health care services economically inaccessible especially to the populations in greatest need. Considering that 70.8% of Nigerians live below the poverty line, on less than $1/day and are therefore not in a position to afford the high cost of health care it means that millions are left without any form of coverage thereby leading to the downward spiral of Nigeria’s key health indicators (Nnamuchi, 2007). This is not the case in Ghana where the NHIS has succeeded in extending health insurance coverage to 45% of the Ghanaian population by the end of 2008, a level of coverage unprecedented in the region (UNICEF, 2009). More so Gyapong et al. 2007 while evaluating the effect of NHIS in Ghana indicates that:

• The insured more likely to seek formal health care than uninsured.
• Insured inpatients were significantly more likely than uninsured patients to receive an x-ray.
• Insured patients were largely able to afford their care.’
• Uninsured patients did not have sufficient cash reserves to pay their bills.
• Insured women were significantly more likely to deliver by caesarean.
• Insured paid significantly less for delivery of care than did uninsured women.
• Maintain high standard of healthcare delivery services to beneficiaries and ensure efficiency in health care services

Amongst beneficiaries, there are varied opinions about the standard of health delivery services. However, the NHIS and the Managed care organizations seem to be delivering what is possible given the enormous challenges within the health sector.
Indeed the country suffers from perennial shortage of modern medical equipment such as X-ray machines, computerized testing equipment and sophisticated scanners (Johnson & Stoskopt,2009). And where these equipments are available repairs/services are always a problem due to corruption (Oba 2009). Globalization has also facilitated the growth of a flexible and mobile labour market. Shortages of medical doctors and nurses in the developed and economically better off counties, whose governments are keen to maintain adequate health services for their people, have encouraged the migration of an already disgruntled workforce to fill these shortages attracted by so called “pull factors” (Gyapong et al. 2007). Implementation of better performance monitoring of health facilities and workers as well as measurement of consumer satisfaction will help provide information about quality of services to enable planning. Health insurance funds are used in many developed funds to drive efficiency improvements, and this can be done in Nigeria as well.

• To improve and harness private sector participation in the provision of health care services

The private sector has increasingly become part of health care delivery in Nigeria. While public providers are used for health service delivery, private providers have served the important purpose of providing care especially in urban areas. More Health Maintenance organizations have also emerged to provide services for enrollees covered by the scheme. Despite these successes, the private sector has had minimal involvement in provision of health insurance in rural areas where majority of Nigerians live. The paucity of this private sector activities in such areas have to be bridged through better collaborative activities amongst all stakeholders to help achieve the objectives of the NHIS.

• Ensure equitable distribution of healthcare facilities within the country

Accessibility remains problematic, with most of the health facilities concentrated in urban areas, far removed from rural areas where majority of the population lives and where the need is more urgent. Public hospitals are grossly under-equipped while private hospitals provide cash and carry services. Self-medication is on the increase. Governments at all levels provide little support for the medical sector (Abati undated). The number of doctors in Lagos alone is more that the number in all the northern states put together. This implies that even workers and the self employed who have access to the NHIS do not get the best treatment because of lack of adequate medical facilities and personnel. According to WHO (2007a), lack of adequate medical personnel in clinics, primary care centers, general and tertiary hospitals is limiting the effectiveness of NHIS in Nigeria.
The quantum of fund expended on NHIS, (about 23 billion naira) has been disbursed to 7850 accredited health facilities nationwide (Kujenya, 2009). The poor distribution of health facilities means that this fund has been focused mainly on the richer population groups and raised equity challenges. It is important that decision makers begin to look into ways of using the funds to stimulate the public and private sector to improve availability and quality of health services especially in the rural areas.

• To ensure appropriate patronage of all levels of health care

The implementation of health insurance in Nigeria has supported use of private facilities for primary care, as well as use of secondary and tertiary facilities for primary to tertiary level care. In addition, the MDG MCH programme focused on use of public primary level facilities for provision of services to pregnant women and children. Apart from the challenge of scaling up these services, there are concerns which are recognized. There is a need to improve and use public primary facilities as providers of primary care especially in the rural areas. There have also been concerns about the appropriateness of use of tertiary facilities to deliver primary care. At the moment, up to 60% of Nigeria’s health expenditure is made at the tertiary facilities which actually take care of less that 25% of the health problems of Nigerians. These issues need to be understood, and dealt with to improve patronage of all levels of care and those managing health insurance should develop strategies that will ensure the available funds are deployed in ways that stimulate use of these facilities. 

• Maintain and ensure adequate flow of funds for the smooth running of the scheme and the health sector in general.

Adequate funding however remains a major problem to the scheme, the percentage of government allocation to health sector has always been about 2% to 3.5% of the national budget which is far below the Abuja declaration target of 15% of government budgets to be directed to the health sector (WHO,2007a; Odubanjo et al. 2009; Agba et al. 2010). The federal government has continued to pay the employer contributions for its employees. This was a major step for health insurance to expand in 2005. The MDG funds have also contributed to the pool for the maternal and child programme for which states were required to make counterpart fund payments. The provisions in the National Health Bill which we still hope will be signed by the president will further enhance the funds available for providing services. However, workers are yet to start making contributions and it is still unclear how well funds from those in the informal sector can be collected. These provide significant challenges for technocrats and politicians alike, who must develop feasible and acceptable strategies to harness such domestic funds. While health insurance systems seek to convert out of pocket payments to prepayment schemes, having the scheme end up as a free one operating only with government contributions will not lead to the desired goal of having adequate funds.
Moving forward

• There are challenges that must be sorted out if at all the goal of covering all Nigerians by 2015 is to be met. States need to cover their workers. Government needs to cover people who are unable to pay premiums. Those in the informal sector and rural areas need to be covered as well and it will be good to have a reinsurance mechanism for NHIS/Managed Care for them to strengthen their pools. Again, workers have to start making contributions. The agencies involved in insurance have to play the roles they should – regulation, monitoring for quality improvement, improvement in preventive care, efficient purchasing of services, and effective health service delivery. The dichotomies between the isolated tertiary, secondary and primary systems need to be bridged through effective referral structures. Industrial actions need to be controlled to make public facilities appealing to potential enrolees. These challenges need a collective positive response with effective civil society action including from professional groups such as your association. Making the changes will require research to generate evidence about why people are unwilling to join or contribute, effective advocacy using research evidence, and the selfless will of decision makers and policy implementers to use such evidence to guide decisions towards expanding coverage.
• The demand side is poorly understood and articulated. There is a need to promote the scheme to the nooks and crannies of Nigeria through a community based strategy that will engage a mass mobilization of Nigerians to participate in the scheme (Chikwe 2011).
• There will be a need to better organize the providers of health care to ensure more efficient use of funds and appropriate referral system. Furthermore, in underserved areas, adequate and well trained medical personnel’s should be employed to man the various hospitals, clinics, labs and health care centres  for facilities used by both current and potential beneficiaries. In-service training should be organized to boost the knowledge of the existing staff in the health sector and there is an opportunity to use staff such as Community health workers in many areas where highly trained staff are not available.
• The minimum standard for the service providers must be clearly defined by the government followed by proper supervision by the supervisory agencies. This should be followed by appropriate monitoring and regulatory activities.
• Health workers need to be motivated to contain the spate of brain drain. Evidence has show that migration of health workers to the developed countries is also a major challenge to the health system. There is also movement of health workers within countries, from public to private sectors, rural to urban, primary care settings to tertiary care institutions and even out of health profession to other professions. This may be so because, the skills of these health professionals may be either under-utilised due to lack of modern equipment, or incentives available in the urban or private sectors may not be available in the rural or public sectors. Migration exacerbates the shortage within the sector and increases the workload for the remaining workforce (Gyapong et al. 2007).
• Governments at all levels must assign more funds to the growth of the health sector in line with global best practices. Special attention must be paid to health training institutions to ensure quality training of medical personnel and other health workers in ways relevant to our own society. Government infrastructure in rural areas should be used and incentives created for all health professionals practicing in the rural settings (Omoruan et al. 2009).
• Data management should an integral part of the scheme rather being seen as an adhoc stopgap.
• The NATIONAL HEALTH BILL provides for a national health system. It provides the legal framework for Equity, Efficiency, Access, Quality, and Sustainability; all characteristics necessary for NHIS to perform to its potential. Its implementation would help the health sector and in particular NHIS to effectively contribute to the human capital development component of the   Transformation Agenda of the current government.

Conclusion
NHIS and Managed care organizations in Nigeria have been able to provide health insurance cover to Nigerians though the expected goal of Universal coverage still seems distant. Overall, their impact on Nigeria’a health indices is not known because of the low coverage and absence of empirical evidence on this. If properly managed with the support of all stakeholders and the willingness of implementers to use evidence to institute reforms, the scheme can impact positively on all the sectors of the economy, since it takes good health to be productive. Where to begin will be the genuine commitment by all through programmed and targeted health system actions to fix the health sector.

Thank you.

Dr. Ben Anyene
Chairman
Board of Trustees HERFON

BOT Members: Dr. Ben Anyene (Chairman), Hajia Maimuna .M. Bala, Dr. Halima Adamu, Mr. Sam. Ndah Isaiah, Prof Joseph Oluwasanmi, Dr Daniel Gana, Dr. Shehu Sule, Chief (Dr) (Mrs) Monica Iyombe (JP),     Chidi Marume, Dr Jide Idris

The current publication Review Advisory Committee members are

1. Prof. Adetokunbo Lucas - Chairman RAC

Adjunct Professor Harvard School of Public Health, USA

1. Prof. OO Akinkugbe, CON - Co-Chairman RAC

Ibadan Hypertension Centre Iyaganku Reservation Area, GRA, Ibadan, Nigeria

1. Dr. AG Abdulrahman - Technical Editor

Dept. of Surgery University of Ilorin Teaching Hospital, Ilorin, Kwara State

1. Prof A F Biola Mabadeje - Member

Dept. of Pharmacology & Medicine College of Medicine, University of Lagos, Idi-Araba, Lagos

1. Prof. CU Abengowe, OON - Member

Department of Medicine National Hospital, Central Area, Abuja

1. Prof G C Onyemelukwe, MON - Member

Dept. of Medicine (Immunology), Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State

1. Dr. Aderonke Olumide – Member

Dept. of Community Medicine,
College of  Medicine, University of Ibadan, Ibadan

1. Prof O K Alausa – Member

Deputy Vice Chancellor, (Academic) Olabisi Onabanjo University Ago-Iwoye, Ogun State

1. Prof. Christopher N. Obionu - Member

Dept. of Community Medicine, University of Nigeria Teaching Hospital, Enugu

1. Dr. Ibrahim Taofeeq - Member

       Department of Community Medicine, Usman Danfodiyo University, Sokoto

1. Dr. Nnebe Agumadu (Nee Omalu) – Member

Department of Paediatrics, University of Abuja, Nigeria

1. Dr. Ibrahim Oloriegbe – Member

 Former Executive Secretary (HERFON) Abuja, Nigeria

1. Dr. Issa Baba – Member

 Department of Behavioral Science University of Ilorin, Ilorin

1. Jane Miller – Member

 Senior Health Advisor DFID Nigeria, Abuja
   15. Dr M Anibueze – Member
     Director of Public Health Federal Ministry of Health, Abuja

16.Dr Francis T. Aminu – Member
Country Coordinator/ National Program Manager Micronutrient Initiative Abuja, Nigeria

The current edition NHR 2010 which is on “Non-Communicable Diseases in Nigeria: The Emerging Epidemics” addresses the progress made in controlling these diseases to date. It also highlights the policy implications of the upward trends in incidence for Diabetes, Cancer, Asthma, Obesity, Cardiovascular disease, Strokes, Road Traffic Accidents, Domestic Violence, Psychiatric Disorders, etc. It will serve as a guide for eliminating them as problems of public health importance. The publication is in sync with the UN declaration of 2011 as ‘The year of Health’ with emphasis on Non-Communicable Diseases, at the September 20th UN General Assembly just concluded in New York, USA.
The publication emphasizes the critical importance of changes in lifestyle in controlling non-communicable diseases. It also demonstrates the value of therapeutic services. The issue is not making a choice between prevention and therapy but organizing all the services to achieve optimal effect in reducing morbidity and mortality from NCDs.
For example, a well-equipped cancer treatment centre in a tertiary hospital should be complemented by a broad programme of cancer prevention and services aimed at early diagnosis otherwise such a unit will expend most of its resources in treating a large number of patients presented with end-stage diseases. Similarly, modern treatment of heart diseases, both medical and surgical, would benefit from a community-based action aimed at reducing risk factors such as obesity and a sedentary lifestyle. What is called for are balanced investments in various units of the health services striving to achieve coordinated interventions from community-based primary care to sophisticated high technology care at specialist, teaching and tertiary hospitals.
Epidemiological and demographic transitions
Nigeria is undergoing an epidemiological as well as a demographic transition. In developed countries, the rise in the disease burden from cancers, cardiovascular diseases, diabetes and other NCDs follow the decline in occurrence of communicable diseases. As in some developing countries, the incidence of NCDs is steadily increasing whilst the nation
is still contending with a heavy burden of diseases due to communicable diseases as well as peri-natal deaths. Furthermore, the recurrence of tuberculosis and endemicity of malaria, the threat posed by new diseases like HIV/AIDS, bird-flu and even more recently swine influenza, highlights the continuing importance of infectious diseases. Thus, the pattern of the epidemiological transition in Nigeria shows a combined burden of both communicable and NCDs but the information about the frequency and distribution of NCDs is rather sketchy. Nigeria has also benefited from the Global Child and Maternal Survival Programmes that are expected to result in a marked drop in child and maternal mortalities. This expected change in child and maternal mortalities together with a fall in the birth rate will inevitably result in increasing life expectancy; and more elderly people in the population constitutes the demographic transition in developed countries and Nigeria is beginning to experience it.

In Nigeria, there is awareness of the increasing importance of NCDs but less awareness on its implications to individual well-being, national development and security. Under the leadership of Professor O O Akinkugbe, the National Expert Committee on NCDs, in a report of a national survey in 1997 drew attention to the threat of diabetes, hypertension, hypercholesterolemia, anaemia, and sickle cell diseases. The wide variations in the prevalence of diabetes showed that the problem is rapidly evolving, affecting most severely urban communities with relatively low frequency in rural communities. The urban-rural difference is a clear warning of future trends because of the current rapid urbanisation in Nigeria. The report also showed a significant prevalence of high blood pressure largely undiagnosed and untreated, constituting a major risk factor for the occurrence of heart failure, strokes and renal failure.

Our fragile health system is already overwhelmed with the burden of Communicable Diseases like HIV, TB, Malaria, Hepatitis, Cholera, Polio, Measles, Dysentery, etc. The irony of the situation is that these ailments once identified, can be eliminated and relative immunity acquired. This is not the case with the major Non-Communicable Diseases. Diabetes, Hypertension, Seizures, Psychiatric disorders, for example are life-long battles, necessitating considerable health expenditure, time costs and loss of productivity.
The rising trends are a threat to our National development as an emerging economy. The U.S. spent 76.6 billion dollars in 2010 on direct and indirect costs related to care for Cardio-vascular diseases alone (American Heart Association, 2010). This is more than two times the annual National Budget plus the annual budgets of the 36 States of the Federation and FCT.
The average individual annual expenditure by a Diabetic patient in 2007 was USD 11,800 (American Diabetes Association) about N2million. There are only a handful of people in Nigeria that can afford to pay about N2million yearly just for one ailment. Patients with these diseases usually develop complications and other co-existing conditions, further exacerbating the levels of incapacitation. The impact on the workforce in the next two decades will be far reaching.
The solution is prevention. Several of these are brought on by harmful lifestyle choices, many influenced by Western culture and rapid urbanization. Healthy Workplace initiatives can be encouraged by giving corporate employers incentives. Behaviour can be influenced through personal taxation. It has worked in the U.S. with cigarettes being taxed heavily and led to higher rates of cessation for financial reasons. For other ailments, early detection is the key. Our current disease surveillance systems are weak and screening services, for example for Cancer, are limited.
If we start now, we can raise a heightened level of awareness around lifestyle choices, regular screening, disease surveillance and pre-emptive management. It will be far less devastating economically and physically, than waiting for the full blown manifestation of the epidemic before we act and/or react.
As part HERFON’s contribution to stimulation of national conversations and taken actions towards the control of epidemics of Non-Communicable Diseases (NCD) which are already here in Nigeria the Book will be presented to the Nigeria public on Thursday October 13, 2011 under the distinguished Chairmanship of Mr Folusho Phillips the President Nigeria Economic Summit Group (NESG). The Special Guest of Honour is The Honourable Minister of Health and the Chief presenter is Aliko Dangote. We are expecting the presence of who is who in the country - from people in government at all levels to the people in the private sector and international development partners. The venue is Nicon Luxury Hotel, Shehu Shagari Way, Garki, Abuja. Time is 10am.
We invite the general public to avail themselves of the opportunity for updating on the dangers of the NCDs. We make special appeal to the media, health correspondents and editors in particular to assist in educating and informing the general public about the new emerging epidemics – NCDs – the effects, prevention and management of the diseases.
HERFON shall continue to be in the forefront of generating evidence, building capacities, fostering partnerships to inform and drive her advocacy for better health for all Nigerians.

BOT Members: Dr. Ben Anyene (Chairman), Hajia Maimuna .M. Bala, Dr. Halima Adamu, Mr. Sam. Ndah Isaiah, Prof Joseph Oluwasanmi, Dr Daniel Gana, Dr. Shehu Sule, Chief (Dr) (Mrs) Monica Iyombe (JP),     Chidi Marume, Dr Jide Idris

BOT Members: Dr. Ben Anyene (Chairman), Hajia Maimuna .M. Bala, Dr. Halima Adamu, Mr. Sam. Ndah Isaiah, Prof Joseph Oluwasanmi, Dr Daniel Gana, Dr. Shehu Sule, Chief (Dr) (Mrs) Monica Iyombe (JP),     Chidi Marume, Dr Jide Idris