Making quality focus of Nigeria’s universal health coverage
Nigeria’s government report on National Health Insurance Scheme (NHIS), says achieving universal health coverage (UHC) to provide about 198 million population with access to a collective set of comprehensive health services of adequate quality, at the same time as financial protection is achieved when direct payments made to obtain health services do not expose people to financial hardship and do not threaten living standards.
The government report also identifies that service coverage and affordability are critically important, but not sufficient, to ensure achievement of UHC. As such, it is important to improve the quality of care at the entry point into the health care system which is the Primary Health Care system.
The National Health Act 2014 set aside 1% consolidated revenue for the health sector and consequently laid the foundation for Nigeria towards achieving Universal Health Coverage.
The World Health Organisation (WHO) says the Universal Health Coverage is a political choice for countries themselves to make. A study released recently by WHO showed that 85 percent of the funding gap to achieve universal health coverage could be met by countries themselves, although up to 32 of the poorest countries will require development assistance.
Nigeria’s primary, secondary and tertiary institutes are beset by challenges, although PHC facilities are the people’s first point of contact with the health system, insufficient service delivery, overburdened clinics with long queues, and poor quality of services has resulted in many people avoiding PHC facilities and going straight to hospital outpatient departments where services are perceived to be better.
Industry watchers say for Nigeria to achieve universal health coverage to deliver substantial health, economic and political benefits across populations, healthcare provision should be considered as a human right and no one should be denied access to healthcare due to financial reasons, gender reasons, issues related to geographical barriers or any other issues which might create a barrier to healthcare access.
They further say Nigeria can set in quality at the core of universal health coverage, through improving the National Health Insurance coverage, implementation of national policy and having an ideal clinic with good infrastructure spaces, needed equipment, information and communication technology, adequate staff numbers, adequate medicines and supplies, good administrative processes, guidelines, and collaboration support to ensure the provision of quality health services to the public.
They added that government needs to encourage activities through non-governmental agency to promote advocacy, nationwide screening program in order to enhance early detection, control the upward trends and reduce the mortality rate of Non- communicable diseases.
Chibuzo Opara, Co-CEO DrugStoc Nigeria, said approaching the issues of universal healthcare is about elaborating equitable and affordable healthcare at the end of the day, adding that there should be an agreement and a commitment between citizens and decision makers on where the country places universal healthcare among other important priorities.
“In order to create a catalytic process within the system, we need to focus on tackling the issue of financial access to healthcare, holding individuals and entities accountable and measuring the impact of interventions and activities in the healthcare sector. Infrastructure challenges are still a key issue and the need to sensitise and make people aware of the inherent advantages in a healthy population, especially now that we are still a young aged country,” said Opara
As part of efforts to achieve UHC, the country has been to set of guidelines defining the basis for Administration, Disbursement, Monitoring and Financial Management (ADMFM) through the Basic Healthcare Provision Fund (BHCPF, “The Fund”)
The guidelines address urgent interventions put in place to tackle persistent and emerging causes of population mortality in Nigeria including Maternal Mortality, Perinatal Mortality and Road Traffic Injuries (RTIs)
However, guidelines processes is also to be applied, the responsibilities of various stakeholders including (but not limited to) participating healthcare providers, healthcare facilities, Federal Government parastatals such National Health Insurance Scheme (NHIS), the National Primary Care Development Agency (NPHCDA), Federal Road Safety Corps (FRSC), National Emergency Management Agency (NEMA), State Governments, Local Governments and their participating agencies including State Primary Health Care Development Agencies (SPHCDAs) and the accompanying accountability expectations contingent on these responsibilities.
The models at the moment both the NHIS and the HMOs have covered less than 5 per cent of the population which attaining universal health coverage is one of the core mandates of the scheme.
Doyin Odubajo a Public Health Expert, however expressed the view that as at today, Lagos, Abia, Kwara, Delta, Ekiti, Kano and Bauchi. Ogun, Enugu, Anambra, Ebonyi and more are reported to be at advanced stages with enabling laws of State Supported Health Insurance Schemes (SSHIS) that has been passed through National Council of Health memo approved in March 2014 by the federal government.
“Making health insurance mandatory as some states have started in the country, is expected to benefit all Nigerians and will as well serve to improve the country’s economy when more people are healthy.
“Government should be responsible for the accountability of the health providers for service delivery and it must be monitored to ensure the providers deliver quality healthcare services at the end of the day,” Odubajo said.
According to Tedros Adhanom Ghebreyesus, WHO director-general, said Universal health coverage is ultimately a political choice. It is the responsibility of every country and national government to pursue it. I personally commit to spearheading the advocacy required to secure the political support of global, regional, and national leaders
“We need to do more to enable your advocacy and activism efforts, to support of universal health coverage and to increase access to essential medicines and health commodities” said Ghebreyesus.
ANTHONIA OBOKOH