IOD NIGERIA COUNCIL VISITS NIPSS, SPEAKS ON FUNDING UNIVERSAL HEALTHCARE IN NIGERIA
The Chairman & President of Council of IoD Nigeria, Chief Chris Okunowo, F.IoD led members of the Governing Council to pay a visit to the National Institute for Policy & Strategic Studies, Kuru, near Jos.
The visit, which took place on October 18, 2019 was intended to formally pay a courtesy call on the Director General/CEO of the Institute, Prof. Habu S. Galadima on his appointment as DG/CEO of the Institute. Another key objective of the visit was for the Institute to deliver a lecture to the Senior Executive Course 41 Participants at the Institute.
In the paper, presented on behalf of the Institute by Dr. Ebun Sonaiya, F.IoD, Chairman of Governing Board of IoD Centre for Corporate Governance, he noted that the reason for the lecture at the Institute was on account of the fact that the Institute serves as a high level centre of reflection, research, and dialogue where academics of intellectual excellence, policy initiators and executors and other citizens with high level of practical experience and wisdom drawn from different sectors of national life in Nigeria are expected to meet to reflect and exchange ideas on the great issues of society, particularly as they relate to Nigeria and Africa, in the context of the dynamics of a constantly changing world.
With respect to the origin of health insurance, he opined that health insurance arose from the uncertainty and potential for financial ruin of ill health. People tend to be risk averse and are, therefore, willing to forego part of their income to purchase the assurance that they will be protected from catastrophic health expenditure. Health insurance operates on the basis of the willingness of individuals with similar aspirations (protection from the risk of impoverishment by illness) but varying probabilities of ill health to contribute funds (premiums) to a pool. The larger the pool, the more sustainable, while steps are taken to mitigate causes of insurance market failures.
Talking about funding mechanisms and models of universal health care, he compared and analysed health data and human development indices of some countries, ranging from Sweden, Cuba, United Arab Emirates (UAE), Jordan, Singapore and Pakistan, and noted that Nigeria is lagging behind all, while adding that Nigeria is ranked 19th of some 19 African countries based on Human Development Index. He added that Nigeria’s estimated population is 198 million, with fear that the recent prediction that placed the country’s population at 264 million by 2030 and 410 million by 2050 might be disastrous, if commensurate resources are not provided to address the population.
With reference to the UN report on Nigeria’s Sustainable Development Goal (SDG), he said that a new report by the World Poverty Clock shows Nigeria has overtaken India as the country with the most extreme poor people in the world. India has a population seven times larger than Nigeria’s. The struggle to lift more citizens out of extreme poverty is an indictment on successive Nigerian governments which have mismanaged the country’s vast oil riches through incompetence and corruption.
He added that 86.9 million Nigerians now living in extreme poverty represents nearly 50% of its estimated 180 million population. As Nigeria faces a major population boom—it will become the world’s third-largest country by 2050—it’s a problem that will likely worsen. But having large swathes of people still living in extreme poverty is an Africa-wide problem. He noted that of those countries in top ten, only Ethiopia is on track to meet the United Nations’ SDG of ending extreme poverty by 2030. Outside the top ten, only Ghana and Mauritania are also on track with the SDG target. Indeed, of the 15 countries across the world where extreme poverty is rising per World Poverty Clock data, 13 are currently in Africa.
In terms of universal health coverage and healthcare financing, he referred as a situation whereby all people and communities can use: Promotive, Preventive, Curative, Rehabilitative and Palliative health services that they need, which must be of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship. He added that this definition of UHC embodies three related objectives:
* Equity in access to health services - everyone who needs services should get them, not only those who can pay for them;
* The quality of health services should be good enough to improve the health of those receiving services; and
* People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm.
With respect to the trend and practices in Nigeria, he observed the following:
* The Nigerian health system is very broad and heterogeneous generally public and private, comprising of;
public, private for-profit, community-based organisation (CBO), faith-based organisation (FBO), and traditional healthcare providers (FMOH, 2009).
* Health care resource allocation in Nigeria is skewed in favor of secondary and tertiary care as against primary care PHC. This situation is both inefficient and promotes inequities.
* Distribution of the health workforce in Nigeria is also skewed in favor of secondary and tertiary facilities located in urban areas as incentives for health workers to accept rural postings are often non-existent or poorly applied.
* Overprovision in some areas while other areas are not covered. The absence of social security for vulnerable groups, regressive taxation, poor planning and targeting of public funding for health, corruption, and lack of coordination across the three tiers of government all contribute to health inequities.
* Government expenditure on health as a percentage of total government expenditure was an average of 7.2% from 2008 to 2012. In the same period, external resources for health as a percentage of total expenditure were 5.3%. With private prepaid plans as a percentage of private expenditure on health at only 3%, private out-of-pocket expenditure as a percentage of total expenditure on health amounted to nearly 70% in 2012.
As part of measures towards addressing the issues, he advised that there is the need for urgent action that would result in population control in the country. Cultural and religious beliefs which had, hitherto, discouraged the use of contraceptives and other family planning methods must be challenged by government and be responsible in providing individuals, couples and parents with adequate information, education, resources and services that would enable them make informed decisions as regards family planning.
On options for raising more domestic funds for health, he proposed the following as critical to health care delivery:
* Increase the priority given to health in government budget allocations: Increase the priority given to health in government budget allocations - 45 countries currently devote less than 8% of their total spending to health, and 14 countries devote less than 5%; Taken as a group, the 49 low-income countries could raise an additional US$ 15 billion per year for health from domestic sources by increasing health’s share of total government spending to 15%.
* Raise revenue for health more efficiently – e.g. increase the total availability of resources (strong tax base)
* Reduce heavy reliance on direct OOP: .
* Reduce and eliminate inefficient use of resources:
* Free or subsidized services (e.g. through exemptions or vouchers) for specific groups of people (i.e. the poor) or for specific health conditions (i.e. child or maternal care)
* Subsidized or free insurance contributions for the poor and vulnerable
* Cash payments to cover for expense on transport costs for the poor.
In his conclusion, he advised that regardless of the stages of development, Nigeria can adopt new measures, adapt and improve her financing systems to maintain or progress towards universal coverage. He added that Nigeria and the global community can do more to raise needed funds and strengthen national financing institutions and capacities in various countries to attain universal coverage by doing the following:
* Work towards achieving Universal Health Coverage (UHC) as well as the Sustainable Development Goal (SDG) targets especially through the strengthening of our Primary Health Care System as well as the secondary and tertiary subsystems in Nigeria.
* Sign: the National Health Act (2014), the development of the National Health Policy (2016) and the Second National Strategic Health Development Plan (2018-2022) to operationalise the Policy as well as the rolling out of the implementation of the Basic Health Care Provision Fund, among others in Nigeria.
* Stop introducing more global initiatives with more secretariats at the international level.
* Buy into the countries national health plans and channel funds to countries in ways that build domestic financing capacities and institutions, rather than bypassing weak systems – e.g. fund Sector Wide Approaches, General Budget Support, etc.
Dr. Sonaiya, in his introduction, noted that the reason for the lecture at the Institute was on account of the fact that the Institute serves as a high level centre of reflection, research, and dialogue where academics of intellectual excellence, policy initiators and executors and other citizens with high level of practical experience and wisdom drawn from different sectors of national life in Nigeria are expected to meet to reflect and exchange ideas on the great issues of society, particularly as they relate to Nigeria and Africa, in the context of the dynamics of a constantly changing world.