Towards achieving universal health coverage in Nigeria
As high out-of-pocket payment dominates Nigeria’s healthcare spending and with low priority accorded to health by state and local governments, Nigeria’s quest to attain universal health coverage by 2015 is bleak.
The present absence of financial protection has led most Nigerians to depend on out-of-pocket payment for healthcare financing with insurance penetration, which is a measure of the relationship between premiums earned and the nation’s Gross Domestic Product, put at less than 6 percent, according to industry experts.
Universal health coverage is difficult to achieve if out-of-pocket payment is greater than 30 percent of total health expenditure. Experts explain that achieving universal health coverage would be hard to attain without expanding the fiscal space (through increasing domestic tax revenues, expanding tax base, developing social health insurance, and getting debt relief
Investigations reveal that inequalities in health service exist between rural and urban areas, as well as across income groups with these poor outcomes resulting to weakness in the health sector, particularly in primary healthcare services.
Analysts believe that there is need to expand contributions from large profitable companies by up-scaling and pooling together resources, more than what they are doing currently. Tax from mobile phone operators to fund healthcare is one that can be considered. Gabon imposes 10 percent tax on mobile phone operators for use in healthcare of low-income groups.
Other innovations include tobacco and alcohol exercise tax which is operational in Philippines, Thailand and Indonesia, excise tax on foods that contribute to an unhealthy diet, additional levy on top of existing VAT rate as is in the case with countries like Chile.
Some issues to consider in evaluating each innovative method include administrative costs, magnitude of the potential revenue, political acceptability and whether such funds should go into Consolidated Government Revenues or be earmarked.
In pursuance of universal health coverage for all, stakeholders in the health sector have called for the strengthening of capacities of public health infrastructure to provide effective, safe and quality health services, raising sufficient resources for health – from domestic and external sources, promoting efficiency of national health services to optimise resources and maximise results and remove financial risks and barriers to access through compulsory prepayment – payment before need for healthcare arises.
Even with the recent re-accreditation of HMOs into national, zonal and state HMOs with paid-up share capital of N400 million, N200 million and N100 million respectively, the quest by Nigeria to attain universal health coverage by 2015 remains bleak if the current NHIS Act 35 of 1999 is not amended.
The current Act establishing the National Health Insurance Scheme (NHIS) does not compel employers to register their employees under the scheme. A onstitutional amendment of the NHIS Act will compel states and local governments to pay subsidy and bridge existing funding gaps that would ensure and enable more Nigerians access quality healthcare under the health insurance scheme.
It can be recalled that the NHIS scheme was designed to facilitate fair financing of health care costs through pooling and judicious utilization of financial risk protection and cost-burden sharing for people, against high cost of health care through prepayment systems. Across the world, there is a compulsion by citizens to embrace health insurance and for those who cannot afford to pay for the insurance.
A proper amendment to the Act will spell out what each tier of government –local, state and federal government- is to pay for those who cannot afford such healthcare insurance platform.This will go a long way in revolutionizing the healthcare system.