Universal health coverage and the future we desire

Ensuring the health of a people is, of course, larger than the delivery of healthcare to the ailing. The well-being of human beings is affected by the liveability of the environment, and such factors as the quality of housing, the amount of time the citizen spends in traffic commuting from home to work every day, the quality of the water he drinks, and several other factors.

Taking all this into consideration, it is right to say that the availability and accessibility of good quality healthcare services to the citizens is crucial for their wellbeing.

Currently, more than 70 per cent of the encounters Nigerians have with doctors and other healthcare providers are funded by out-of-pocket payment by the citizens.

The cruel reality with out-of-pocket expenditure is that they are outrageously high, unsustainable and inequitable and pushes Nigerians into poverty. In most cases, many people suffer and even die daily because they cannot afford the healthcare they need.

To achieve universal health coverage, health insurance must be widespread. federal, state and local authorities must increase advocacy to encourage Nigerians to channel the high out-of-pocket expenditure for health insurance.

There are enabling legal frameworks for this through mandatory health insurance at the federal level as well as across more than 31 states of the federation. More Nigerians having health insurance moves the country gradually towards universal health coverage and ensures pandemic preparedness.

Health insurance is an insurance contract taken to cover the cost of medical care. The contract can be annually, monthly or over other fixed and certain periods of time. It typically caters for health care expenditures such as medical, surgical, prescription drugs, dental and other expenses incurred by the insured.

To deliver these services, sufficient and capable health and care workers with optimal skills mix at facility, outreach and community levels are needed; they are to be evenly distributed and appropriately supported. UHC strategies enable everyone to access the services that address the most significant causes of disease and death in their society and also ensure that the quality of those services is good enough to improve the health of the people who receive them.

According to the WHO, Universal Health Coverage means that all individuals and communities receive adequate health services without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Health security refers to all the efforts made by the government and its public health institutions, in this case, the Nigeria Centre for Disease Control (NCDC) to mitigate adverse public health incidents. Clearly, the world was taking positive steps to deliver health for all by 2030 before Covid-19 fundamentally disrupted health systems, societies and economies.

To get back on track, world leaders need to take this opportunity to reset the foundations of health systems and strengthen the capacities of all countries to prevent and respond to health emergencies. Covid-19 has shown that we must act now.

At over 70 per cent, out of pocket expenditure for healthcare in Nigeria is extremely high. This is mostly motivated by poverty as people, reluctant to visit hospitals when they are ill because they could not afford to, would rather use cheaper alternatives like self-medication.

This becomes a missed opportunity to quickly detect infectious diseases that can potentially become outbreaks. Therefore, efforts geared towards getting more people to frequently access healthcare in hospitals are good for health security.

If people have health insurance coverage, which is a strategy to achieve UHC, their health seeking behaviour is more likely to improve.

This is because, when they are ill, the priority is seeking quality healthcare and not worrying about paying out of pocket. When citizens are not reluctant to seek care because they know they won’t be thrown into financial hardships, then it’s easier for health workers to detect and halt potential disease outbreaks.

Nwachukwu writes from the Centre for Social Justices (CSJ), Abuja, Nigeria

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