The Good, Bad News About Universal Healthcare Coverage in Nigeria

Makka Ugbabe

Serah Makka-Ugbabe

Whenever one is presented with the question, “Do you want the good news or bad news first”, do you know about 75 per cent of people want the bad news first? Today, we will deviate from the norm and start with a bit of good news. Seven years ago, Nigeria endorsed a declaration in support of Universal Health Coverage. She stood before the United Nations and promised that Nigeria would provide access to quality affordable healthcare as an essential priority for Nigerians.

This means every Nigerian should be able to get healthcare from public health facilities that meets their medical needs at a price that does not destabilize their finances. The bad news is that Nigeria has not held up to its promise for quality, affordable healthcare and the country’s health picture is still bleak. Here are some of the sad truths:

Nigeria has the highest burden of malaria globally which remains the top cause of child illness and death. Nigeria has the fourth largest number of people living with HIV globally.

Nigeria is the fourth worst place to give birth in the world, accounting for over 10 per cent of all maternal deaths in the world.

Nigeria is the eight worst place to be a child under one year old as the risk of death is high. Nigerians currently spend US$1 billion on medical tourism annually, removing much-needed funds from the local health sector.

Fortunately, this UHC Day finds Nigeria on the cusp of delivering on the promise of access to affordable healthcare. In 2018, Nigeria finally committed actual money for free basic healthcare services through Huwe, a programme launched by President Buhari in 2019. It is a joint contribution from the federal government and state government which involves collaboration with the Federal Ministry of Health, National Health Insurance Scheme (NHIS), National Primary Healthcare Development Agency (NPHCDA), state commissioners for health and state health insurance schemes (SHIS) as well as state primary health care development agency (SPHCDA). What all these acronyms and actors translate into is the promise of free health services that the most vulnerable Nigerians need in order to thrive.
This means if Huwe is properly implemented, you would be guaranteed to receive free treatment covering a range of ailments under the “minimum package of health services” at participating Primary Health Centres (PHC) around the country. This includes free treatment for malaria, anemia and vaccines for your children under 5 years. It even covers free delivery and labour.

Huwe is a building block to Universal Healthcare. If Nigeria is able to deliver on Huwe, we develop the foundation on which we can build Universal Health Coverage for all Nigerians. If it works, Nigerians would feel the positive, life-saving impact of a government program in their everyday lives.

Sadly, inertia threatens our good news. This goal will not be achieved without the diligence and vigilance of every Nigerian. Since the Fund was established in 2014, it took four years before there was actual money for it. In 2018, the 8th Assembly, which deserves our accolades for achieving this, ensured that the Fund got some allocation in the 2018 Budget Bill. When it was passed into law, the 2018 budget had an allocation of about $123 million (N55.15 billion). Like a slow moving river, 50% of the 2018 funds have been disbursed from the Federal Government to State Accounts. These funds should then be transferred to the PHC so you and I can get the free services.

But here is where we have been stuck. If you go to your primary healthcare center today, you will not receive any free Huwe services. This time money is not the problem, Huwe has funds. Coordination seems to be at the heart of the problem. The federal government and state governments need to quickly align around the problem areas e.g. the Operational manual, alignment to the National Health Act, etc. The truth is Nigerians don’t care about details of coordination. They care about receiving real services. They care about an accountable disbursement of funds. They care about quality healthcare. Huwe has the potential to provide all these.

So, what can an average Nigerian do to expedite these services? Ask questions. Ask your Governor about Huwe. Ask the Minister of Health about Huwe. Ask the Senate Committee on Health about Huwe. If you and I don’t put pressure of the principals in charge of delivering these services, it will die a quiet death and be buried in the graveyard of other government programs.

The dream for Universal Health Coverage is closer than ever. The final and perhaps most important good news is that you and I are not passive observers at the hands of an all-powerful government. The government needs you to put the pressure to do what they already intend to do. Only then can we truly get quality and affordable healthcare.

…Makka-Ugbabe is the Country Director for ONE Campaign, an international nonprofit working to reduce poverty and accelerate healthcare provision in Africa