Editor’s Note: This week’s Thought Leadership opinion piece comes from Dr. Uchenna Ewelike, a Senior Health Economist. He re-echo’s the importance of Universal Health Coverage in ensuring financial protection for the most vulnerable in our societies, analyses Nigeria’s journey towards Universal Health Coverage, and proffers solutions for the road ahead.
Universal Health Coverage is meant to ensure that all citizens irrespective of their socioeconomic status have access to health services without suffering financial hardship. This simply means that nobody should be made poorer because they are sick. It is uncertain when one would fall sick. This uncertainty is complicated because the sick and vulnerable are usually left at the mercy of healthcare providers if they are unable to pay for healthcare prior to falling sick.
Health is a fundamental human right as enshrined in the constitution of many nations, including the World Health Organisation’s (WHO) constitution of 1948. Ironically, this right to health is denied to many citizens whose health systems do not provide social and financial risk protection. The easiest way to restore the rights and dignity of citizens is for nations to work towards achieving Universal Health Coverage.
The drive towards Universal Health Coverage is about equity, quality and preventing people from suffering any form of financial hardship. It is about achieving goal 3.8 of Sustainable Development Goals set for all nations by the United Nation in the 2015–2030 development agenda. Therefore, state and non-state actors should understand that this is an important goal that must be pursued for development and economic prosperity.
Challenges with the push for Universal Health Coverage in Nigeria include, poor health coverage, supply side inadequacies, weak fiscal space, legislative bottlenecks, and a lack of “political will’. This has resulted in many households financing their healthcare needs through out of pocket payment expenditure. The World Health organization recommends that out-of-pocket expenditure for health should be between 20–30% of total health expenditure. Sadly, this has not been attained in Nigeria. The 2010–2016 National Health Accounts of Nigeria which tracks health care expenditure patterns clearly showed that over 76.6% of healthcare spending is out-of-pocket. Households are shouldering the burden of healthcare costs in Nigeria as against the Universal Health Coverage principle that lays emphasis on public spending. Considering the strong correlation between health and economic development, this inequity must be corrected if we must achieve the health-related SDGs in Nigeria.
Despite these challenges, it is commendable that in 2018, the government of Nigeria released N55 billion budgeted for the Basic Health Care Provision Fund ( a component of the 2014 National Health Act) It is also more reassuring with the gradual increase of the fund to N59.9 billion in the 2020 appropriation. The Basic Health Care Provision Fund (BHCPF) will be disbursed through three gateways — National Health Insurance Scheme (NHIS), National Primary Health Care Development Agency (NPHCDA), Federal Ministry of Health and the Nigerian Centre For Disease Control (NCDC). These three gateways must work collaboratively for efficiency and accountability to meet the health needs of vulnerable Nigerians.
The BHCPF cannot on its own get Nigeria to universal health coverage. Therefore, state and federal governments, policymakers, donors and other stakeholders in the health sector should also begin to push for increased domestic resource mobilisation to fund healthcare in Nigeria. Globally, there are competing health needs and huge donor fatigue. As a nation, we cannot depend on the 15% budgetary allocation to health as stated in the 2001 Abuja declaration by African heads of states but we must also ensure that these health budget estimates are actually released to finance health.
The road to Universal Health Coverage is a tedious but attainable journey; all stakeholders must work together to ensure it becomes a reality within the shortest possible time. Thailand, South Korea, Mexico, Japan, and Rwanda have demonstrated that political will is needed to achieve universal health coverage. President Muhammadu Buhari has so far demonstrated some political will in moving Nigeria to Universal Health Coverage. He should do more because Nigeria’s economic development would be hampered by a weak health system.
No nation achieves greatness with an unhealthy population. Nigeria’s 1999 constitution assures of justice and equity. Universal health coverage is a way of making this a reality. Everyone should get on board.
Dr. Uchenna Ewelike is currently the Divisional Head in the Informal Sector Department and former TA to the Overseeing Director, NHIS. He is a fellow of the Royal Society for Public Health in the United Kingdom. He holds a doctorate degree (Ph.D.) in Health Economics from University of Nigeria Enugu Campus. Dr Ewelike is a Member of the Domestic Resource Mobilization of Global Joint Learning Network for Universal Health Coverage, JLN. He is also the author of the book ‘Basics of Health Financing in a Developing Economy’ which is used in many Nigerian universities and health financing experts in the sub region.