Universal health access as bedrock of social security

Given the criticisms that have trailed the implementation of Universal Health Coverage (UHC) and health insurance for all Nigerians, the federal government has taken a step further with the inauguration of the Presidential Summit on Universal Coverage, Paul Obi writes

Of all health care programmes by the Nigerian government for effective and quality health care services, the quest for health insurance and ensuring that the country meets its target on universal health coverage has remained just a paper work. President of the Nigerian Medical Association (NMA), Dr. Osahon Enabulele has attested to this gap. In many advanced and developing countries, health insurance comes hand-in-hand with universal coverage and gives access to affordable health as the bedrock of social security. Though absolute free health care service is a tall order, health insurance where government carries a part of the financial burden remains the preferred.

In Nigeria, beyond the inadequacies of provision of better and efficient health care for all citizens, more than 70% of the financial burden in accessing health care services is borne by the citizenry. This trend remains the biggest obstacle to Nigeria attaining any of the health-related Millennium Development Goals (MDGs). Nigeria's effort at synergising universal healthcare coverage is even coming late; coming nearly a decade after the World Health Assembly (WHA) in its 58th session mandated states to "develop their health systems so that all people have access to services and do not suffer financial hardship paying for them."

But stakeholders in the health had argued then that Nigeria's quest for affordable health system through universal health coverage and health insurance was still only on paper. That it lacks full commitment from the government to ensure Nigerians have access to better health care system. While the commenced the process with the establishment of the National Health Insurance Scheme (NHIS), activities at the agency remained moribund until recently. Notwithstanding, close watchers of the agency were also not satisfied with steps to ensure that about 70% of Nigerians are covered. Till date, less than 15% of Nigerians are covered by the scheme.

To put teeth to action, the federal government has tended to respond to the yearnings of citizens in the area of universal health coverage vis-à-vis health insurance scheme funding. To accelerate the process, President Goodluck Jonathan quickly appointed Dr. Femi Thomas as the Executive Secretary of NHIS, after several months of waiting for the vacancy to be filled. Hence, the government followed with the convening of a presidential summit on universal health coverage for Nigerians. The presidential summit was primarily convened to tackle critical aspects of the programme that have not been effectively addressed. Thus, what should constitute the interventions at the national, states and local levels of the various strata of governments?

Here, there exists a consensus among stakeholders in the health sector that the focal point of health for all should be the one that deals with efficient and effective availability of health services, with regards to package of care, coverage financial affordability and access, risk protection for vulnerable groups, and ensuring that all Nigerians are beneficiaries.

At the presidential summit proper on Universal Health Coverage (UHC) at the Presidential Villa, Abuja, President Jonathan represented by the Vice President, Namadi Sambo harped on the need to diversify the means of funding health insurance in the country. Jonathan told the gathering that, "Universal Health Coverage (UHC) is a collective challenge and a collective responsibility; one that federal, state, and local governments, as well as the organised private and informal sectors, must act together in concert, to overcome. Every Nigerian, who earns an income, has an obligation to contribute to his/her health care, and we all owe it to those who do not have the means, to provide for themselves.

"We are, therefore, hosting this Summit to establish a unified front, and accelerate progress towards Universal Health Coverage that meets the needs of our people. We are determined to elevate Universal Health Coverage to a national movement with substantial participation by local and international stakeholders, supported by government and the private sector at all levels.

"We need to keep abreast with other countries in our development bracket in social health insurance. Health insurance must become a part of social culture and our people have to be encouraged to imbibe the benefits of affordable, regular contributions to achieving guaranteed and sustainable long term health services." He opined that government has "progressively improved healthcare financing and priority interventions. Social Health insurance is also gaining ground. Participating hospitals can attest to the increase in their patients and revenue pools as a result of health insurance."

While explicitly providing the guidelines how the taxes would be arrived at, Minister of Health, Prof. Onyebuchi Chukwu, said; "at the current mobile penetration rates of over 100 million active lines as published by the NC, a N1 additional charge per minute, for 15 minutes a day, for 50 million callers and N1 per text messages per day, for 25 million users, will yield more than N280 billion per annum." Chukwu observed that the universal health coverage levy of N200 per local economy ticket, N1000 per local business class ticket, $10 per international economy ticket and $50 per business and first class international ticket, will generate about N45 billion." The minister went further to explain that, "special health taxes on goods with harmful health effects, will also generate additional resources" for the proper funding of the nation's health care system. Chukwu further added that "universal health coverage will 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."

World Health Organisation (WHO) Country Director to Nigeria, Dr Gama Vaz gave account of the current situation globally regarding universal health coverage. According to Vaz, "it is well acknowledged that each year over 100 million people in the world are pushed into poverty and another 150 million are left to suffer financial hardship, just because of the way our health services delivery systems function presently." He went to explain that "out of pocket (e.g. users fees) levied at the time when people need services, not only inhibit the poor and disadvantaged from seeking health care, but are also a major cause of impoverishment for many who obtain it." On Nigeria, Vas told the teeming government officials and policy makers that "WHO strongly believed that Nigeria and will achieve UHC. However, UHC in isolation is no guarantee of efficient and effective care. In addition to political will, universal health coverage requires sufficient number of well-trained and motivated staff with adequate resources for promotion, prevention, diagnosis, treatment and professional development, and to thrive a culture of good governance and aspirational attitudes." UNFPA Representative, Rati Ndhiovu applauded Nigeria's resolve to fully implement universal health coverage, adding that, government must harness the benefits associated with multi-sectoral partners, health insurance financing options, benefits packages, human resources for health, medicines, availability of life-saving commodities among others.

In his presentation, former Minister of Health, Prof. Eyitayo Lambo maintained that "compulsory social health insurance for the formal sector employees plus provision of subsidies to the vulnerable and people outside the formal sector will offer adequate financial protection and enhance greater equity in access to as well as in financing health services in Nigeria." He said, 'moving towards UHC goes beyond financing; it involves other aspects of the health system in order to ensure availability and access to quality health services.

At a session chaired by former Minister of Information, Mr. Frank Nweke, the Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr. Ado Muhammad explained that a synergy is required in ensuring that UHC lies squarely on primary health care. Muhammad told the audience, having developed the primary health care systems with the new midwifery programme; the agency is ready to provide the enabling platform to accelerate the full take off of UHC.

Executive Secretary of NHIS, Dr Thomas on his part highlighted the importance of finance in implementing the programme. According him, Nigeria needs about N1 trillion to ensure that every Nigerian is covered.




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