Poor healthcare financing, challenge to effective COVID-19 pandemic response

KAZEEM BIRIOWO examines the funding of the national health-care response during the COVID-19 pandemic in Nigeria and the need for increased government health spending to strengthen local health security and universal coverage.

The Federal Government of Nigeria generated more than 100 percent of its anticipated budget for responding to the COVID-19 pandemic from the private sector and donor/philanthropist community.

These funds constituted most of the funding for the COVID-19 public health and clinical-care response. The poor preparedness of the Nigeria health sector for emergency response, least of all for a disease of the magnitude of COVID-19, necessitated using most of the pooled resources for building temporary structures, such as isolation centres, and providing clinical care.

This expenditure has done little to strengthen the general health system. The poor national COVID-19 testing coverage makes it difficult to accurately estimate the number of persons who have COVID-19 and to estimate the number who paid out-of-pocket for COVID-19 care in institutions, not in the public and private health-care centres designated by the government for COVID-19-patient care.

The combination of the National Health Insurance Scheme not providing coverage for COVID-19-related care, the huge out-of-pocket expenses patients incurred for health care, and workers’ loss of income because of the government-mandated lockdown measures to control the pandemic may have impoverished countless Nigerians. There is no accurate estimation of the possible impact of the pandemic on a household income of Nigerians.

Analysts say the many years of insufficient government investment in health have rendered the health care system unprepared to meet the demands that COVID-19 has placed on it.

Thus, even the large sums collected for the emergency response are inadequate and having been used for temporary infrastructure, are unavailable for long-term investment in the nation’s health care.

Also, poor access to insurance coverage has challenged the poor and vulnerable, who need care for COVID-19 infections and, at the same time, care for other medical problems during the pandemic.

The process for COVID-19-related commodity procurement was least responsive to the needs of those most in need of care and support. Multiple unexplored mechanisms are available for funding health care in Nigeria to ensure universal coverage and strengthen the health system.

However, experts advise that for the short-term and to enhance the COVID-19 pandemic response, domestic government spending on health as a percentage of gross domestic products must be increased.

 

Nigeria’s financing of health care during the COVID-19 pandemic

An analysis in Nigeria’s health care finance system in response to coronavirus disease in 2019 affirms that Nigeria would need $330 million to control the outbreak. The country raised more than $560.52 million, of which more than 90 percent came from the private sector and the donor or philanthropist community. The pooled COVID-19 fund is mainly being expended on temporary public health and clinical care measures, with little invested to strengthen the health system beyond the pandemic.

The huge out-of-pocket expenses and the inability of most Nigerians to earn money because of measures instituted to contain the pandemic, will likely cause many Nigerians to become economically impoverished by the COVID-19 pandemic.

COVID-19-related commodity procurement was least responsive to the needs of those most in need of care and support. The government needs to institute several fiscal policies. Immediate response to ease the financial impact of COVID-19 requires inclusion of COVID-19 management in health insurance packages and an increase in domestic government health spending.

Nigeria recorded its first COVID-19 case on February 27, 2020 and, it has recorded over 259 thousand confirmed COVID-19 cases and 3144 deaths as of July 17, 2022 according to Nigeria Centre for Disease Control (NCDC). The severity of the COVID-19 outbreak in Nigeria in terms of the number of people infected is less than that reported in Europe and North America and South Africa. A few reasons for these differences have been proffered, none of which include an effective health-systems response.

Before the COVID-19 outbreak, Nigeria’s response to disease outbreaks was rated poorly by the 2019 Global Health Security Index and World Health Organization’s Joint External Evaluation of International Health Regulation score capacities(Center for Health Security, 2019; and World Health Organization, 2017).

The country’s response to the COVID-19 pandemic has been undermined by its poor health system, which is the result of chronic low government spending on health, delay in government responses to the virus, low rates of COVID-19 testing, and poor transparency and accountability. The country’s surveillance system and contact tracing may be effective for dealing with small pockets of outbreaks but is less effective for dealing with a disease of a magnitude as large as that of COVID-19.

One of the reasons for the poor disease surveillance system is the low health-sector budgetary allocation. Delay in public-health response also contributed to the poor response.

While the World Health Organisation declared COVID-19 a public health emergency of international concern on January 30, 2020, the Presidential Task Force on COVID-19 was not set up until March 7, 2020, the closure of land and air borders was delayed until March 25, 2020 and the lockdown of states was initially limited to the three states, with evidence of rapidly advancing community transmission of COVID-19 (Lagos, Ogun, and the Federal Capital Territory) on March 28, 2020.

COVID-19 testing was initially limited to persons with severe symptoms, an ineffective containment approach for a disease in which 80 percent of those infected are asymptomatic yet with a high transmission rate of 3.5 persons to one infected person for persons who are both asymptomatic and symptomatic. As of September 1, 2020, the country has only tested 405,916 of its 206 million population.

The COVID-19 response has also been bedeviled by alleged corruption in the Nigerian health sector which has undermined efforts to cushion the effect of COVID-19.

Adequate health financing strengthens the delivery of primary health-care services in general, which then is capacitated to respond to the needs of the country during health emergencies like that of the COVID-19 pandemic.

The Minister of Health, Dr Osagie Ehanire, believes that great strides have been achieved in the containment of COVID-19 and other diseases. In a speech at the National Case Management Training on Lassa fever in Abuja, he maintained that Nigeria must not forget that the COVID-19 pandemic is not yet over and that some patients may have Lassa fever and COVID-19 at the same time and suffer complications from both of them.

“These patients need particular attention and timely decision-making is key in this regard. We have made internationally recognized giant strides as a nation, in addressing COVID-19,” he said.

He observed that Molecular laboratories now exist in all Teaching Hospitals, Federal Medical centres and specialist hospitals. In the same vein, modern Intensive Care Units, well-equipped isolation centres and Personal Protective Equipment have been made available at these centres. This government is committed to addressing Lassa Fever as well as we have addressed COVID-19 so far.

Experts, however, recommend that the government must institute measures to prevent the worsening of the current health crisis in Nigeria, which may be exacerbated by large numbers of people needing chronic medical care as a result of COVID-19 infection.

The need for hospital care likely will increase due to the deteriorating health of many chronically ill persons who received insufficient attention to their health needs at the height of the pandemic.

It is therefore imperative for governments at the national and sub national levels in Nigeria to increase their investment in the health of the Nigerian people.