Dr Emmanuel Abanida is the executive secretary of the Health Reform Foundation of Nigeria (HERFON). He speaks to ADAM ALQALI about the quest to achieve Universal Health Coverage (UHC) in Nigeria
As one of the prominent activists advocating for the successful realization of Universal Health Coverage (UHC) in Nigeria, what does the campaign for UHC aspire to achieve?
Universal Health Coverage (UHC) is a global aspiration and a subset of Goal 3 of the Sustainable Development Goals (SDGs) which is supposed to be achieved by 2030; it is seeking to ensure everyone have access to healthcare including those that are at financial risk and therefore ordinarily will not have such access.
So, UHC is contextually about creating equity in access to healthcare services so that no one dies as a result of their inability to access healthcare. Technically speaking, UHC is the process of ensuring quality healthcare is made available to everyone and at a cost that is affordable such that no one is deprived of the opportunity to access healthcare as a result of either lack of financial access or physical access, in terms of distance.
Nigeria has already keyed into the UHC and the essence is that at the end of the day, people are able to access to maternal, child and family health and you don’t have people dying as a result of malnutrition, infectious and non-communicable diseases as well as psychosocial disorders.
How would achieving Universal Health Coverage help Nigeria achieve socioeconomic development?
Achieving the aspirations of Universal Health Coverage in Nigeria means that we have a healthy population and hence we have achieved increase in productivity, and reduced families’ out of pocket expenses on medical care; this also means our children are healthier and therefore perform better, educationally.
UHC is very holistic and no country attains economic development without achieving UHC, hence health is at the heart of the goals of the UNDP, WHO, SDGs and African Peer Review Mechanism. And lack of UHC means families will have to incur a lot of out of pocket expenses which has negative effects on them, economically. That is to say achieving a healthy nation also means achieving a healthy economy.
What can you say are the major hindrances to achieving UHC in Nigeria?
Achieving UHC in Nigeria has been a tough issue and the challenges are multi-dimensional, even though people will naturally want to point accusing fingers at the government; it is to do with irresponsibility on the part of the government and the citizens, as well. On the part of the government, the biggest hindrance to achieving UHC has to do with lack of commitment and failure to take responsibility and ownership for healthcare service delivery by the government.
It is not enough to convene conferences and make statements about UHC in newspapers, instead it is about the level of commitment that is being invested; even though the government seems to be trying its best the truth is that the best is still not enough. Let’s look at certain financial commitments that are basic requirements in the quest to achieve UHC, for example, the 15% allocation to the public health sector, according to the [2001] Abuja Declaration – Nigeria has never done even 10%.
Again, there is the much talked about Basic Health Care Provision Fund (BHCPF) which is enshrined in part 1, section 11 of the 2014 National Health Act. Although the Fund is meant to be funded from the following sources: 1% of the Consolidated Revenue Fund (CRF) of the Federation, donors and any other sources, yet since the Act came into being in 2014 Nigeria has never committed even the 1% of the CRF to public health.
Although the 1% of CRF will not adequately cater for our healthcare funding requirements, it will be a sign of commitment that is expected to have a catalytic multiplier effect such that other funding can come into the country from donor partners, to complement it. I am aware of many partners who are reluctant to come in and drive the process because they can’t see the government’s commitment, in terms of allocating the 1% of CRF to the public health sector.
The government needs to understand that although agriculture and roads are a priority, health is a priority of priorities; a sick man cannot go to the farm and neither can he drive on the road. Another challenge has to do with Human Resources for Health (HRH), to achieve UHC we need at least 450 to 500 healthcare workers per 100,000 Nigerians. At the moment, we don’t have up to 50 healthcare workers per 100,000 Nigerians.
Close to 80% of the HRH gap in Sub Saharan Africa is in Nigeria, with this huge gap Nigeria cannot achieve UHC which means both financial and human resources are lacking. In 2013, paradoxically, Nigeria rebased its economy and said it had graduated from a low income to a medium income economy, which means we are okay!
As such, although there might be marginal increase in our budget for health, in reality our spending on public health keeps going down, if you look at the exchange rate. So, GAVI and other partners are moving out of Nigeria since we said we are a now a big economy, bigger than South Africa. What is bigness in just name? South Africa is spending close to 4 times what Nigeria is spending on public health.
As we speak, South Africa doesn’t depend on UNICEF for vaccines; they produce every vaccine and the government takes responsibility. That must also happen in Nigeria without which we cannot achieve anything.
And talking about the people’s responsibility, Nigerians are lackadaisical in nature hence although there is a service compact between government and the people which makes it compulsory for the government to provide these services, if it doesn’t, the people must demand for such services. However, Nigerians are not interested in demanding for the services, which is a basic responsibility. There are two sides to services: services provision and delivery as well as demand creation, so not demanding for services is a big lacuna in achieving UHC.
What do you think all stakeholders including government, civil society, citizens groups and others must do collectively to achieve UHC in Nigeria?
Firstly, the government must assume leadership because it has bigger resources, and what other stakeholders can do is find a way of supporting and stimulating the government, by positively agitating to the government including enlightening and carrying out advocacies to relevant government agencies.
The government cannot do it alone, hence achieving UHC requires mass mobilization yet the leadership must come from the government since there is a limit to what civil society can do. No matter what the civil society does, if the government doesn’t assume leadership nothing will happen.
