Advocating social justice in healthcare delivery in Nigeria

Health is a fundamental human right and the attainment of the highest possible level of health is a most important worldwide social goal. The provision of quality, accessible and affordable healthcare therefore remains an important issue globally. However, there is no denying the fact that Nigeria’s healthcare index is very poor, and that the people are suffering as the healthcare policies and programmes in the country are implemented in a way that those at the lower socio-economic strata of society suffer exclusion. Consequently, the healthcare delivery system in Nigeria is largely hinged on an individual’s ability to pay rather than on needs.

The definition of social justice revolves around the concept of equality and human rights. It pertains to the opportunities, privileges, and wealth of people around the world. Social justice examines how these rights are manifested in the lives of individuals. It also aims to redress inequalities based on gender, age, and other characteristics. While discrimination affects social justice on a global level, many leaders strive for human rights and equality for individuals. Social justice in health care translates to the delivery of high-quality care to all individuals. Achieving social justice is critical in health care to ensure that all individuals can maintain their highest level of health and wellness.

As it pertains to healthcare delivery, social justice is the view that everyone deserves equal rights and opportunities — this includes the right to good health. Yet today, there are inequities in health that are avoidable, unnecessary and unjust. These inequities are the result of policies and practices that create an unequal distribution of money, power and resources among communities based on race, class, gender, place and other factors. To assure that everyone has the opportunity to attain their highest level of health, we must address the social determinants of health and equity.

The extent of health inequalities is typically proportionate to the level of disadvantage, with populations experiencing poverty and social exclusion having fewer opportunities for health than those in more privileged positions. Health is socially determined. The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. The distribution of power, money and resources at global, national and local levels, which are themselves influenced by policy choices shape these circumstances.

Health systems can feed into and reinforce existing social and health inequalities. Therefore, health inequalities in Nigeria manifest among the poor, the unemployed, and people living in rural areas where health facilities are either unavailable or not functioning, among others.

There are severe budgetary constraints and uneven distribution of resources among the urban and rural areas with the rural areas mostly affected by inequitable budgetary health expenditure allocation. In fact, Nigeria’s health financial arrangement has shifted from health provisioning by government as a normal good towards a competitive market where greater proportion of health services are provided by ability to pay through out of pocket expenses. Furthermore, excessive reliance on the ability to pay through out-of-pocket payment reduces health care consumption, exacerbates the inequitable access to quality care, and exposes households to the financial risk of expensive illness.

Also, access to medical care in Nigeria is a class issue. While some can afford the best centres’ within Nigeria, including elaborate private hospitals, many more can only afford General Hospitals. Others attend the informal medical sources. In some places, when available, medical treatment is being received in an archaic and underfunded hospital infrastructural system where health care personnel work under prehistoric hospital conditions coupled with lack of proper diagnostic facilities.

In view of the various factors contributing to health inequality in Nigeria coupled with its potential danger on the socio-economic development of the country, it is recommended that governments at all levels as a matter of urgency address all form inequalities that contribute to poor health outcomes and utilization among the population. Equity in utilization means that health services and resources should be used according to need, not by people’s ability to pay. Poorer people can be disproportionately restricted from using services because of their cost. When this occurs, both utilization and out-of-pocket payments by richer people comprise a greater share of the total. In this case, household survey data on health spending will appear to be more equitable than if the poor and the rich used the services equally and paid the same amounts.

Therefore, it is recommended that governments at all levels in Nigeria should demonstrate good governance coupled with transparency, accountability and inclusiveness in the management of health resources.

The existing health insurance (NHIS) should as a matter of urgency be made all inclusive in line with the new National Health Insurance Authority Act 2022. The new law is one big step towards Universal Health Coverage in Nigeria because through the Act health insurance is now mandatory for all Nigerians. This could mean that over 70% of Nigerians who pay for health out of pocket, many of whom are thrown into poverty as a result could benefit from national level mandatory health insurance.

Again, health systems can advocate for protecting population health by investing in policies and practices that keep people employed; help those who become unemployed to cope with the negative effects, and get unemployed people back into work as soon as possible.

Effective provision of health campaigns and education for every Nigerian will go a long way in promoting equity in the delivery of health care services in the country. The role of mass media and civil societies will help in achieving this, as it will sensitize the public on the need for the government to cater for their health demands.

If health care services delivery is to be more equitable in Nigeria, then leaders and health care providers need to embrace the basic principle of ensuring the empowerment of poor clients to have a more central role in health system design and operation. Thus, equity in health systems is premised on both technical adequacies (e.g. the objective comparability of needs and services) and socio-moral perspectives (e.g. the opportunity to access services and the consequences for consumers of the services).

Okeke is a programme officer with the Centre for Social Justice (CSJ) Nigeria.