THISDAY and the Journey to Universal Health Coverage

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Universal health coverage enshrined in the Nigerian Constitution gives the government the statutory responsibility of ensuring all citizens have access to affordable and qualitative healthcare. But 73 per cent 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 12 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 the major chunk of the country’s population. This therefore has in no small measure increased the country’s mortality rate, reduced life expectancy, and the myriads of poor healthcare statistics which the country is known for.

No wonder when health indices are discussed at the global stage on a country-by-country basis, Nigeria often emerges one of the countries with the worst indices on key global health issues. The country sits comfortably among the 10 worst countries in the world with high incidents of disease outbreaks.

For example, Nigeria has the highest incidence of malaria globally, with about 40 per cent of global malaria deaths occurring in the country alone. Not only that 90 per cent of Nigerians are at risk of the disease, as it kills over 300,000 persons 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 a ratio of one to 13, according to the indices provided by the World Health Organisation (WHO).

Among other areas, Nigeria has the second worst incidence of malnutrition globally, just second to India.

Several countries with similar poor health indices decades ago have prioritised their healthcare financing through the implementation of Universal Health Coverage (UHC) 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 Programme (HTP) designed around the Basic Health Law.

This led to changes in the health system function which were implemented systematically over a 10-year period. Needless to mention that 15 years after it has achieved UHC through the HTP, improved population health and well-being 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 operationalise 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 N45 billion for the implementation of the Basic Health Care 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 universal health coverage.

In a chat with THISDAY, the Chairman, Senate Committee on Health, Senator Lanre Tejuoso, said the National Assembly was 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 Committee on Appropriation protects 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 immunised 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 10a.m. It will be headlined by the Director General of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus 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 Buhari.

This high level policy dialogue will bring together policy makers, including members of the Federal Executive Council, parliamentarians, development partners, including bi-and multi lateral 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 and 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).

Ghebreyesus 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 Buhari.

Other speakers at the THISDAY summit include the Country Director, World Bank Nigeria, Rachid Benmassoud, Chairman, Zenith Bank, Jim Ovia, Minister of State for Health, Osagie Ehanire, the Representative of Bill and 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 and 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 had earlier noted that Nigeria was 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 in terms of health services for all Nigerians and also assured additional financing for the sector through the implementation of the Basic Health Care Provision Fund.

Nigeria had earlier hosted a presidential summit on health financing 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 (USAID).