THISDAY and the Journey to Universal Health Coverage in Nigeria


Universal Health Coverage enshrined in the Nigerian constitution gives the government the statutory role of ensuring all citizens have access to affordable and qualitative healthcare. But 73 percent of Nigerians still pay out of pocket for their healthcare. The launch of the Basic Healthcare Provision Fund by the Minister of Health, Professor Isaac Adewole and the Director General of the World Health Organisation, Dr. Tedros Adhanom Ghebreyesus at the 2nd THISDAY Healthcare Policy Dialogue holding this Thursday, April 12th in Abuja, hopes to change the narrative. Martins Ifijeh writes

In Nigeria, when a citizen 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 is broke, or having a delayed salary, or is unemployed, or no one to lend him money, or the ailment cost more than the money he has, he simply dies. It is that simple in this part of the continent.

About 73 per cent of Nigerians are presently taking this risk on their health, especially poor Nigerians who comprise of the major chunk of the country’s population. This therefore has in no small measure increased the country’s mortality rate, reduce life expectancy, and the myriads of poor healthcare statistics which the country is known for.

No wonder when health indices are discussed on global stages on a country-by-country basis, Nigeria often emerges one of the countries with the worst indices among key global health issues. The country sits comfortably among the 10 worst countries in the world with disease burdens.
On specifics, 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. Not only that 90 per cent of Nigerians are at risk of it, it kills over 300,000 of them yearly, with 11 per cent of maternal deaths linked to it.

Also, Nigeria is rated as the second worst country with maternal and child deaths globally, just second to India. About 15 per cent of global maternal deaths occur in Nigeria alone, and the deaths of newborn babies in the country represent a quarter of the total number of deaths of children under five worldwide. In fact, a woman’s chance of dying from pregnancy or childbirth in Nigeria stands at one ratio 13, if indices from the World Health Organisation (WHO) are referenced.
Among other areas, Nigeria is the second worst recipient of malnutrition burden globally, just second to India.

Several countries with similar poor health indices decades ago have prioritised their healthcare financing through implementations of universal health coverage for their citizens. For instance, countries like Turkey, Mexico, Thailand, Kenya, Ghana, among others are currently doing well in healthcare coverage for their citizens.

Turkey successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. With what it has achieved in the last two decades, it is almost unbelievable that Turkey began its journey in 2003 with the implementation of the Health Transformation Program (HTP) designed around the Basic Health Law.

This led to changes in health system functions which were implemented systematically over a 10-year period. Needless to mention that fifteen years after it has achieved UHC through the HTP, improved population health and wellbeing now provides remarkable possibilities for increases in economic growth.
The Nigerian government, as part of efforts to address its own healthcare issues, enacted the National Health Act in 2014, which the present government of President Muhammadu Buhari is now ready to operationalize through the Basic Health Care Provision Fund (BHCPF).

The BHCPF is a fund allocation to cater for the basic health needs of all Nigerians, with a minimum of one per cent provision by government as stipulated in the 2014 National Health Act. If included in the 2018 national budget, the BHCPF will amount to at least N45 billion for the year.

It is also in tackling the universal health coverage issue in the country that THISDAY Newspapers is holding the second edition of its Healthcare Policy Dialogue series, tagged: ‘Journey to Universal Health Coverage in Nigeria’, where stakeholders in the health sector and policy makers will chat a way forward for a UHC model for the country.
The Federal Government, through the Minister of Health, Prof. Isaac Adewole, who is the Chief Host of the policy dialogue, will use the occasion to launch the logo of the BHCPF and the beneficiary identification card as stipulated in the National Health Act.

This could not be happening at a better time with news emerging from the National Assembly that it has appropriated a minimum of forty five billion naira appropriation for the implementation of the Basic Healthcare Provision Fund in the 2018 appropriation act.

With this quantum of resources by the National Assembly, Nigeria may as well be on its way to join other countries that have made giant strides in achieving UHC.

In a chat with THISDAY, the Chairman, Senate Committee on Health, Senator Lanre Tejuoso said the National Assembly is about concluding the passage of the 2018 national budget, but that if it doesn’t reflect the one per cent of the consolidated revenue fund for health, the country would be sending a wrong signal to development partners.

“If we don’t do this, it means we are not encouraging development partners that have spent more than that over the past years. We cannot surrender our health financing to foreign friends,” he added.
He said the implementation for 2018 would mean a minimum of about N45 billion would be set aside in this year’s national budget for BHCPF.

According to him, this is why the health summit, organised by THISDAY Newspapers is coming at the right time since the passage of the national budget is around the corner, adding that the event would afford policy makers and healthcare stakeholders the opportunity to chat a way forward for universal health coverage for the citizens.

Tejuoso said the leadership of the National Assembly led by Senate President Bukola Saraki who is a medical doctor, has insisted that the committees on Appropriation protect the budget line for the BHCPF in the 2018 budget.

This will be a game-changer for Nigeria since the government has invested so little resources in health over the last two decades compared to countries of similar economic status.
Benjamin Loevinsohn of the World Bank told THISDAY that only 10 per cent of the poorest Nigerian children are immunized using Penta3 as compared to 28 per cent in Chad and 52 per cent in Niger.
Remarkably, despite having a lower Gross Domestic Product per capita than Nigeria, Ghana and Kenya spend considerably more on publicly funded healthcare.

The THISDAY high level policy dialogue will hold Thursday 12th April at the Congress Hall, Transcorp Hilton Hotel, Abuja by 10am. It will be headlined by the Director General of the World Health Organisation (WHO), Tedros Adhanom Ghabreyaesus and Prof. Adewole

The first edition, with the theme: ‘Healthcare Financing in Nigeria’, was held Tuesday March 6th 2018 in Abuja, and it recorded a huge success as it drew quality participation and came up with some far reaching conclusions that are currently being discussed at the highest level of government in the country.

This second edition, which draws on the success of the first, is particularly relevant as Nigeria sets into motion its Universal Health Coverage aspirations with the launch of the BHCPF under the administration of President Muhammadu Buhari.

This high level policy dialogue will bring together policy makers, including members of the Federal Executive Council, parliamentarians, development partners, including bi-and multilateral institutions, entire senior leadership of the WHO, healthcare practitioners, civil society organisations, private sector leaders, media think-tanks, academia, institutions involved in financing and delivering healthcare –banks, HMOs, MFIs & insurance companies, and members of the public.

The WHO DG will be accompanied to the event by the entire senior leadership of the WHO, including the African Regional Director of WHO, Dr. Matshidiso Rebecca Moeti (the first woman to hold such position).

Ghabreyaesus will use the occasion to launch the logo and beneficiary identification card for the Basic Health Care Provision Fund of the National Health Act.
He will also be hosted at a high-level experience sharing event by the Nigerian government as the country has set in motion its universal health coverage aspirations with the launching of the Basic Healthcare Provision Fund of the National Health Act under the administration of President Muhammadu Buhari.

Other speakers at the THISDAY Summit include Country Director, World Bank Nigeria, Rachid Benmassoud, Chairman, Zenith Bank, Jim Ovia, Minister of State for Health, Osagie Ehanire, Representative of Bill & Melinda Gates Foundation, Paulin Basinga, Representative of United Nations Children’s Fund (UNICEF), Mohammed Malick Fall, Minister of State for Budget and National Planning, Zainab Ahmed, Representative of United Nations Populations Fund, (UNFPA), Diene Kieta, and Senior Rep & Mission Chief, International Monetary Fund (IMF), Amine Mati.

According to a statement to announce the policy dialogue, THISDAY Board of Directors said the theme was carefully chosen because Nigerians were in dire need of Universal Health Coverage.
“Universal Health Coverage (UHC) is about ensuring that people have access to the healthcare they need without suffering financial hardship. It also helps drive better health and development outcomes. The best investment for a safer, fairer and healthier Nigeria is one where the attainment of UHC is made a moral imperative,” the Board noted.

Federal Ministry of Health has earlier noted that Nigeria is fully committed to the ideals espoused by the principles of universal health coverage, adding that a National Health Act signed into law in 2014 guarantees a Basic Minimum Package of Health Services for all Nigerians and also assures additional financing for the sector through the implementation of the Basic Healthcare Provision Fund.

Nigeria had earlier hosted a Presidential Summit in March 2014 which ended with a Declaration on Universal Health Coverage in Nigeria.
Co-organisers of the Summit are the Federal Ministry of Health, World Bank, World Health Organisation (WHO), UNICEF, UNFPA, and the United States Agency for International Development.