As the World marks the 2019 Universal Health Coverage Day, Nigeria’s health situation calls for reflection, scrutiny and commitment to doing different things and doing things differently. The UHC Day celebration came few weeks after the release of 2018 National Demographic and Health Survey (NDHS) report. The survey shows under performance of the country’s health system on a number of important indicators. As a case in point, the report shows an increasing trend of under five deaths and no significant improvement in access to many basic health services compared with previous reports of the survey. The observed decline in maternal mortality ratio was marginal and not statistically significant. The Universal Health Coverage means every citizen should have access to needed preventive, promotive and curative health care of sufficient quality without suffering financial hardship. The Nigeria’s health scorecard as shown by the NDHS report is a reminder that the country has a significant distance to cover on the journey of Universal Health Coverage. UHC crusade is being fueled locally and internationally by the global consensus that health is both an end and means to other ends including economic growth and poverty reduction. Globally, more than hundred million people are pushed below poverty line every year by health care cost especially in the low- and middle-income countries that lack effective financial protection mechanisms. Therefore, the present administration’s quest to lift 100 million out of poverty is threatened by suboptimal access to quality health care and extremely low coverage of financial protection mechanisms like health insurance. Adequate investment in health care also has implications for employment creation and enhanced productivity of the workforce which in turn can catalyze the country’s economic growth. Therefore, spending on health should not be seen as mere expenditure but a fundamental investment in nation’s economy and human capital development.
The release of the NDHS report, however, coincides with take-off of an important policy thrust and a potential game changer for Nigeria health system performance. The Basic Health Care Provision Fund which is an earmarked fund from the Federal Government’ Consolidated Revenue Fund (CRF) aimed at providing Basic Minimum Package of Health Services to all Nigerians became a reality this year with release of funds to the agencies saddled with responsibilities of its implementation. For the first time in many years, government funds reached health facilities for provision of basic health services. While this landmark stride is highly commendable, we need concerted efforts from stakeholders to ensure that intended beneficiaries receive adequate and good quality care without suffering financial hardship. We should not relent in efforts geared towards encouraging government to implement other important health policy thrusts that have implication for the country’s UHC quest. While different countries that have made significant progress on their UHC journey chose different context-appropriate pathways, there are some commonalities among these countries which are now globally recognized as essential ingredients for achieving UHC. First, all countries that have achieved UHC and those on trajectory of achieving it have demonstrated political commitment at highest level which translates to improved funding for health. While most of these countries spend minimum of 5% of their Gross Domestic Product (GDP) on health, Nigeria’s public health spending is less than 1% of the country’s GDP. Another essential ingredient for achieving UHC is mandatory prepayment scheme and financial provision for citizen that are unable to contribute to the scheme.
The ongoing effort to reposition the National Health Insurance Scheme (NHIS) to expand health insurance coverage to the teeming population of Nigeria and enshrine best practices is highly commendable. However, necessary legal framework, institutional and operational retooling must be given adequate attention. In the same vein, the State Social Health Insurance Schemes that are established in almost all the states and FCT is a step in the right direction, these schemes most be adequately funded by respective state governments in order to make significant progress to country’s UHC quest. While optimal funding for health is a prerequisite for making progress toward UHC, more money for health must be complemented by improved efficiency of resource utilization. Health sectors stakeholders at all level should pay attention to sources of inefficiency in the Nigeria health system and act swiftly toward blocking leakages and adopt policy options that will minimize wastages. The fact that many countries spend far less per capita on health than Nigeria and achieve better health outcomes further brings to the fore the importance of enhanced efficiency of health spending. As this year’s theme for UHC Day is ‘keep the promise’ we should not forget that the promise of the current administration is next level of health care access and all stakeholders should rally round the government to make it possible. Raising the accountability bar at all levels is particularly important to ensure that the policy makers, legislators, health care providers and other stakeholders are alive to their responsibilities in order to keep the promise of next level of health care access. Achieving UHC in Nigeria is not only a national imperative but its also an impetus for accelerating progress in the whole of Africa.
Dr. Gafar Alawode
Country Director, Health Policy Plus.