Is universal health coverage every Nigerian’s right?

Universal health coverage would prevent millions worldwide from facing financial disaster. In this report by SADE OGUNTOLA, experts examine challenges against access to essential health services.

In Nigeria, when a person falls ill, he either walks straight to the hospital to purchase treatment out of his pocket or prays to his creator for healing. If none of these happen and he has no money either because he is poor, unemployed or the ailment cost more than the money he has, he simply dies.

Unfortunately, about 73 per cent of Nigerians, especially the poor are presently taking this risk on their health. This has in no small measure increased the country’s mortality rate, reduced life expectancy, and its myriads of poor healthcare statistics.

Nigeria has the highest burden of malaria globally, with about 40 per cent of global malaria deaths occurring in the country and Democratic Republic of Congo alone.

Also, Nigeria is rated as the second worst country with maternal and child deaths globally, second to India. According to World Health Organisation, a woman’s chance of dying from pregnancy or childbirth in Nigeria stands at one to ratio 13.

The scope for improving the human condition is therefore great and the action required is urgent. Fortunately, All UN member states have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals.

This year’s World Health Day theme is “Universal Health Coverage (UHC), Everywhere, Everyone”. Universal Health Coverage enables everyone to access the services that address the most important causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their future and often, those of their children.

President, Pharmaceutical Society of Nigeria (PSN), Ahmed I. Yakasai, said robust financing structures is key to strengthening health systems to ensure universal health coverage is achieved.

“When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness.

“Pooling funds from compulsory funding sources (such as mandatory insurance contributions) can spread the financial risks of illness across a population.

“Improving health service coverage and health outcomes depend on the availability, accessibility, and capacity of health workers to deliver quality people-centred integrated care.

“Investments in the primary health care workforce are most needed and cost-effective in improving equity in access to essential health care services. Good governance, sound systems of procurement and supply of medicines and health technologies and well-functioning health information systems are other critical elements.”

Yakasai therefore called on federal and state governments to increase their budget on health to at least over 10 per cent to ensure that universal health coverage could happen.

Professor Michael  Asuzu, a public health and community medicine, expert at the College of Medicine, University of Ibadan, said providing healthcare and achieving health care for all will also require a national health services that is based on a proper primary health care system that is properly linked up with and supported by all the higher levels of the three-tier health system in a two-way referral system.

That Nigeria has health indices that are far lower than those of even poorer and/or even war-torn countries, despite having far more health workers of all categories per capita than most African countries, he said indicate that some basic things in the health system are not gotten right.

Professor Asuzu declared: “On the contrary, what we will need now will be more of understanding of some basic principles and practices that exist or are used by these other countries, as best practices, in these regards; and so, to apply them to our own situation.”

Chief Executive Officer, Food Basket International, Dr Funmi Akinyele, added that interventions to ensure health for all that leave out nutrition components will fail.

According to her, “different aspects of nutrition need to be include in ensuring universal health care. For instance, there should be nutrition corners in all health facilities. Part of the problem is some people know what to eat or they just cook it wrongly.

“Malnutrition is a big problem in Nigeria, so we need to look at nutrition holistically. It is not enough to put things in place to cure people, because, without nutrition, we will not get there. Nutrition is both preventive and curative, but if we spend more time on the preventive, we will need less on the curative.

“Hygiene is an essential part of nutrition. If we are able to focus on hygiene, personal sanitation, and environmental sanitation a lot of diseases will be prevented.”

Dr Kayode Obembe, a former Nigerian Medical Association president, described universal health coverage as the right of every Nigerian that must be enforced.

According to him, instead of using the provisions to better the lots of Nigerians with regards to health, the government has insisted that health is on the concurrent legislative list, making states and local governments to enact laws apart from the federal.

Dr Obembe noted that this clause has usually been used to the detriment of Nigerians.

Also, World Health Organisation Regional Director for Africa, Matshidiso Moeti said Nigeria and other African countries must strive to improve health governance and information systems to ensure better regulation, planning, and accountability to their communities and partners.

She said to achieve the feat, adequate and sustained investment in health is necessary for ensuring equitable access to health services.

“Member States should address the persistent challenge of the inadequate health workforce. Ethiopia exemplifies how investment in health workers, and specifically community health workers, contribute to improved delivery of essential health services.

“UHC means ensuring that everyone – no matter where they live or who they are – can access essential quality health services without facing financial hardship. It is a powerful equaliser that ensures Health for All, enhances health security, reduces poverty and promotes gender equality,” she said.

Minister of State for Health, Dr Osagie Ehanire, however, assures that “Health for All” was the Federal Ministry of Health slogan.

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Ehanire said Federal Ministry of Health, through National Health Insurance Scheme set the mandate to achieve UHC by 2025, adding that the Federal Government had recognised the importance of UHC in National Health System as part of social protection architecture aimed at ensuring that Nigerians got quality health service when and where they needed it without suffering financial hardship.

He said: “Government is working to provide physical access to health care with the revitalisation of one functional Primary Health Care Centre in every political ward to serve citizens, even when they do not immediately have money to pay.

“This helps to preserve human capital and contributes to productivity and socioeconomic development, while supporting equity, especially among rural dwellers and the urban poor, leaving no one behind.”

He added: “Operationalisation of the Act, as a step toward UHC, is expected to support physical and financial access to healthcare by aiding and revamping of neighbourhood PHC Centres and solving challenges of human resource for health.”