Considering the overwhelming global support and documented benefits of the Universal Health Coverage (UHC), in Nigeria which the Federal and State governments are implementing through a number of initiatives. AJUMA EDWINA OGIRI writes on this
The Recent presidential Summit on Universal Health Coverage (UHC), held in Abuja, which was organised by the Federal Government vowed to do everything within its powers to provide accessible health services to all Nigerians.
In the summit tagged: “UHC a vehicle for sustainable growth and development.” President Goodluck Jonathan, advised Nigerians to embrace and enroll in National Health Insurance Scheme (NHIS) in order to have access to affordable health care services.
UHC is about people having access to the health care services they need without suffering financial hardship in paying for them. It holds the key to unlocking the door for significant improvement in the health status of Nigerians.
UHC was placed on the global agenda when the 58th World Health Assembly in 2005 adopted a resolution calling on member states to develop their health systems, so that all people have access to services and do not suffer financial hardship paying for them.
This is explicitly captured in NHIS’s objective: “to ensure that every Nigerian has access to good health care services,” as contained in the NHIS act. [3] Although NHIS is the major federal government’s key financing mechanism for removing financial barriers to accessing health services, there are also other complementary financing options at the federal and state levels that also help to improve financial access to services. These programmes include health equity funds, community based health insurance, fee exemption schemes, conditional and non-conditional cash transfers, voucher schemes, etc.
Despite these efforts, the percentage of Nigerians covered by any form of pre-payment scheme has remained less than 7% of the population. Those covered are mostly civil servants and the formal private sector, leaving out the more vulnerable segments of the population who have higher disease burdens, lower incomes and are in most need of protection.
To address physical access, State Ministries of Health and the National Primary Health Care Development Agency (NPHCDA) have invested in refurbishment and construction of primary and secondary health care facilities, while the Federal Ministry of Health also dedicated most of its investments in this area to tertiary health care development.
In 2011, the Federal Ministry of Health (FMOH) estimated a total of 34,173 health facilities in Nigeria of which 88.1% are primary health care facilities, 11.7% secondary and 0.2% tertiary. This provides roughly 1 health facility for every 6,000 Nigerians, with wide variations across states, urban and rural areas. Although 60% of Nigerians receive care from private providers, public private partnerships are still weak and the role of the private sector in providing care to those in lower income groups and hard-to-reach areas is yet to be properly harnessed.
There have also been efforts to improve access to quality care, medicines and skilled human resources. The minimum package of care defined in the National Strategic Health Development Plan sought to ensure the availability of a set of high impact health interventions and services at each level of the National Health Care delivery System. The Saving One Million Lives Initiative is providing a platform to improve results/outcome based programming by helping shape strategy and improve performance management and coordination of existing health programmes.
However, despite these efforts, if Nigeria is to attain UHC as well as its goal of achieving 30% coverage with appropriate schemes for populations in the lowest 2 quintiles by 2015 as reflected in the NSHDP, the levels of coverage for access to health care services and financial risk protection need to be significantly improved at all levels.
The Minister of Health, Prof. Onyebuchi Chukwu, during a three day Presidential pre-Summit on UHC, urged a team of health experts and development partners to formulate strategies that would guarantee quality healthcare delivery for Nigerians.
Prof. Chukwu said they should be bold to suggest ideas that will “constitute a game changer, but pragmatic to know that we are here in Nigeria,” as Nigeria still faced problems of financing health for its population to ensure that patients had access to hospitals when they need it.
The minister urged the health experts to recommend the best practices from countries with successfully national health insurance schemes, adding that Nigeria needs to develop policy and regulation that will guarantee quality health care for all citizens.
“We recognize the central role of political will and commitment at all levels, in achieving UHC and have invited you to build consensus on collective actions that will fast track progress towards UHC.
“Universal Health Coverage will therefore ensure that as a country, we make the right investments in human development that will enable us reap the demographic dividend and usher in a period of economic growth similar to the pattern observed in East Asia,” he said.
In his presentation, the Chief Executive Office, Ghana National Health Insurance Agency, Mr. Sylvester Mensah, said that health infrastructure, equipment, human resources and pharmaceutical chain supply were essential for achieving qualitative health insurance system.
Mensah further added that the Ghanaian government exempted payment of premium for people above 70 years and those below 18 year, as well as pregnant women and persons living with disabilities.
Also speaking at the summit, the Health System Analyst, World Health Organization (WHO), Dr Inke Mathauer, recommended a compulsory health insurance payment for persons who are able to pay for it, adding that there is need for subsidization for the poor, and those in the informal sector.
Mathauer also said there was need for an increase in government’s health spending.
The Minister said that over the last couple of months, they have challenged technical experts to bring forward evidence-based arguments of potential options for UHC in Nigeria, adding that this was followed by extensive deliberations during the pre-summit technical workshops by critical stakeholders including commissioners for health, organised private sector, health managers and religious organisations, amongst others.
He further said that a consensus was reached that government should work with all stakeholders to make health insurance mandatory for all Nigerians, adding that “financial access is possible if health insurance is made compulsory and treated as right of all citizens.”
