•Stakeholders fear Nigeria may not meet deadline
From Fred Ezeh, Abuja
Nigeria is expected to join the rest of the world to celebrate the 2024 World Universal Health Coverage (UHC) Day with the theme “Health: It’s on the government.” It’s usually a day set aside by the global leaders led by the World Health Organization (WHO) to raise global awareness on the need for improved access to affordable healthcare services for the world population.
UHC Day, celebrated on 12th December, annually, serves as a rallying point for advocates to raise their voices, and share the stories of the millions of people who seek the opportunity to access quality and affordable health care services. It also affords them the platform to loudly call on leaders to make smarter investments in healthcare and remind the world about the imperative of UHC.
WHO said the 2024 edition will focus on the role of financial protection in accelerating progress towards UHC, adding that financial protection ensures that people don’t fall into poverty because of having to pay out-of-pocket for health costs.
Indirectly, the organization is questioning the efficiency and effectiveness of various health care policies and programmes, particularly the health insurance programmes of its member-nations.
It noted that over the last 20 years, financial protection has progressively deteriorated, with about two billion people experiencing financial hardship and 1.3 billion people pushed into poverty due to health spending.
The implications are that mothers may miss out on the life-saving intervention they need for themselves or their children; people might not get diagnosed and treated for Non-Communicable Diseases (NCDs) on time, with delays in early treatment leading to severe, untreatable or life-threatening illnesses.
It stated that only healthier populations could build communities that are more resilient, productive, peaceful, and prosperous. Hence, health for all campaigns is a prerequisite to achieving the Sustainable Development Goals (SDGs). But in spite of the numerous high-level political commitments to achieve UHC by 2030, over half of the world’s populations still have no access to essential health services.
Nevertheless, UHC will remain elusive until governments adequately invest in protecting people, particularly the most vulnerable, from impoverishing health spending, hence the UHC Day, hence the calls for urgent action to put financial protection measures in place.
UHC in Nigeria
The campaign for UHC peaked in the last 10 years, with different programmes and policies being championed by the government. In 2014, the National Health Act came into effect, thus giving a strong push to the quest for UHC, beginning from the primary health care facilities.
Few years down the line, there’s growing fear and anxiety among Nigerians particularly the major players in the health care value chain, as regards the possibility of Nigeria meeting the UHC 2030 global target a few years to the 2030 deadline.
They highlighted the fact that the primary health care, which is the foundation for health care service delivery, is yet to witness or feel the impact of the government policies despite the establishment of the Basic Health Care Provision Fund (BHCPF) which was a fallout of the National Health Act.
Investigations revealed that foundation of the BHCPF was faulty; hence the periodic review of the items therein by the Ministerial Oversight Committee (MOC) of the BHCPF to ensure the effective implementation, transparency, and accountability of the fund.
The MOC oversees the BHCPF’s strategic direction, monitors fund disbursement, and ensures alignment among the four disbursement gateways, namely, NHIA, NPHCDA, NEMSAS, and NCDC The MOC ensures effective utilization of resources to improve access to quality healthcare for underserved populations, coordinate stakeholders, and promote adherence to national health policies.
At the maiden edition of the Joint Annual Review (JAR) of the health sector, stakeholders as well as local and international partners, engaged in the critical assessment of the health sector vis-a-vis the policies and programmes implemented in the last one year using the benchmark set by the Sector-Wide Approach.
Steps by health minister
It was at an event to mark last year’s UHC that the Nigeria Health Sector Renewal Investment Initiative (NHSRII) was birthed, and that was followed by the signing of the compact by the state governments and other implementing partners.
Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said the
NHSRII is a policy framework that will guide the renewal of the health system.
He further explained that the policy document would offer an opportunity to source for domestic funds to finance the health care services in Nigeria, particularly at the Primary Healthcare Centre (PHC) level, highlighting a compact agreement with great input from the state governments and development partners.
“To this end, achieving UHC is a political decision, and Nigeria is committed to that. President Ahmed Bola Tinubu has shown his commitment to that effect through his improved budgetary allocation to the health sector in the 2024 budget.
“We expect state governments to reciprocate and complement the federal government in the funding of PHCs. Tertiary hospitals are not left behind. They are also receiving the necessary attention needed to improve their services.
“But being an item in the concurrent list, the National Council on Health (NCH), which comprises of state commissioners of health, at its 64th meeting in Ekiti state in 2023, deliberated and approved the Sector-Wide Approach in line with the National Health Act of 2014, which approved the creation of Basic Health Care Provision Fund (BHCPF) and other systems to help improve the health care services.
“The implementation of the BHCPF has resulted in improved PHC services at several locations in the country. Currently, 8,000 PHCs are enlisted in the BHCPF. But our desire is to expand beneficiary PHCs to 17,000 PHCs in the next few years. This will enable more Nigerians to enjoy quality health care services at the PHCs.”
Stakeholders’ views
President, FCT Chapter of the Association of Resident Doctors (ARD-FCTA), Dr. Rahman Olayinka told Daily Sun that Nigeria is far from achieving the UHC 2030 global target because of obvious reasons.
He said: “Achieving UHC requires a strong and reliable primary health care system, which is the foundation for health care service delivery. Sadly, that has not been achieved over the years despite the investment that had come from local and international partners.
“In Nigeria, many ailments that ought to be treated at the PHCs found their way to teaching hospitals, and that’s because of lack of confidence in the PHC services. In addition to that, there’s a dearth of manpower at the PHCs and poor motivation of the health workers therein. There’s no gain saying that we are very far from achieving UHC 2030.”
The Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr. Muyi Aina, explained that the NHSRII is a policy framework that will guide the renewal of the health system.
“This is part of the ‘Renewed Hope Agenda’ of the government. Our commitment to the course is to ensure that Nigerians have access to basic health services at the PHCs across the country, which is key to achieving the UHC global target.
“We want to also reduce out-of-pocket expenditure, hence the chase for a better BHCPF and health insurance system that would provide efficient and effective health care services.
“There are over 30,000 PHCs across the country even though many of them are having different kinds of challenges, ranging from insufficient manpower, commodities, and other necessities. However, the desire of the federal government is to expand PHC accessibility in the country from one to two PHC per political ward, but that will be dependent on some factors that might include population, need, size and other factors that might make it necessary and important to do that.
“There is also the need to train additional human resources for health and make them available at the PHCs, particularly those at the remote areas,” he said.