Universal health for all: A Case Study of NHIS – Wale Irokosu
Whilst, we (YP) will love to be in power to improve the lives of Nigerians as soon as possible, we understand 2019 is a long shot. Nonetheless, we believe we can still improve the lots of Nigerians in many ways outside power. A government is only as good as its competition (opposition). Effective opposition is key to optimal government performance. We intend to keep the government on its toes in due course.
One of our low hanging fruits is policy advocacy, which loosely means that we can sell or market policies that can make life better for our compatriots. We expect that Nigerians would be better placed to ask or demand for better policies or ask pertinent questions that would make life better for them. Government would also be forced to fend us off by changing its policies for the betterment of Nigerians. We are on the centre left of the political divide. Our main ideology being equal opportunities to quality basic education, universal healthcare and social housing: critical factors for human capital development. The world is moving from extractive wealth (crude oil) to knowledge based wealth (intellectual property: google, apple and others) and human capitalist essential. Whilst, government does not have their sources to do everything for its citizens, they must not be uneducated, unhealthy and homeless, at the very least.
I will limit myself to universal healthcare today. In lay terms, access to affordable or free health care for all. It makes the difference between life and death to many people. In WHO’s definition Universal Health Coverage (UHC) means that “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”
Admittedly, I am not a medical practitioner. So, forgive me if I don’t use medical terms or deal with core medical issues. It’s all about bringing the policy available to deliver universal health coverage to your notice and engender discussions around it. Our party’s position is that the extant law and Policy is good and can deliver UHC. Indeed, it’s a low hanging fruit. However, the implementation, efficiency and corruption issue is another story entirely. We need to start asking serious questions.
Universal Health Care in Nigeria
The Nigerian Government established the Nigerian National Health Insurance Scheme in 2005 with the goal of achieving Universal Health Coverage in the country. The law was enacted in 1999. Sadly, more than a decade after, the country is still plagued by negative health indices exemplified by low life expectancy rate, inaccessibility to healthcare, rural to urban disparity in health care accessibility and affordability, prevalence of unprofessional health service providers, rising infant mortality rates and many more. Reasons for this are multi-faceted. However, the most notorious of them remains the government’s meager annual budgetary allocation to the health sector which has hovered around5-6% over the years. This is why the National Health Insurance Scheme is important for creating an avenue that ensures that qualitative health care is accessible to all.
It is a special health insurance scheme paid for from a common pool of funds contributed by participants of the scheme. For example students are expected to contribute N2, 000 per annum for health coverage, while contributions are earnings-related. For public (Federal) sector programme, the employer pays 3.5% while the employee pays 1.75% of the employee’s consolidated salary. The members of the Public Sector, Organized Private Sector, Armed forces, Police and other uniformed services, the informal sector on the other hand, covers all residents (families) of the participating communities/occupation-based groups (including retirees). The last group, the vulnerable, as the name implies, comprise the Physically Challenged Persons, Prison Inmates, and Children under Five, Pregnant Women, and Aged.
Originally established to provide health care for all Nigerians, an evaluation of the performance of the NHIS till date shows that it has no lived up to achieving the initial goal. For instance, out of over 180 million Nigerians, the scheme has barely been able to cover up to 10% of this population. More worrying is the fact that almost all of the people covered under the scheme are of the formal sector leaving those in the informal sector (the rural dwellers and the poor) grossly neglected.
To change this ugly trend, the government needs to review the NHIS Act, making the scheme mandatory, and increase government stewardship of health financing policy reform implementation.
There also needs to be an increase in the annual budgetary allocation to the health sector, as well as the establishment of a culture of transparency and accountability as the watchword in tackling revenue generation and allocation off unstop the health sector and NHIS. It also needs to ensure community and stakeholder’s participation to grow the scheme.
Furthermore, there needs to be a conscious effort to build capacity across the health system so as to ensure a performance driven system where health service providers and project managers execute their jobs efficiently. Lastly, the NHIS is be deviled with corruptions by the HMOs if reports in the news dailies are anything to go by. See, for example, http://thenationonlineng.net/banks-ex-ceos-indicted-asn720b-cash-disappe... https://www.premiumtimesng.com/health/health-news/279983-nhis-scandals-e...
Case Study of Rwanda
Ten years after African heads of states and governments pledged in Abuja, Nigeria, to allocate at least 15% of their national budgets to health, and despite expressing commitment to the pledge several times, only six African countries have achieved that target. Rwanda has particularly proven that low-income countries can move towards Universal Health Coverage, even when the vast majority of its people live in rural areas and belong to the informal sector.
Rwanda is one of only six African countries to have met the targets of the Abuja Declaration (to allocate at least 15% of national budgets to the health sector) with the highest percentage of 18.8% of its national budget to the health sector. Universal Health Coverage was achieved via Community-Based Health Insurance (CBHI) scheme which was developed to meet the needs of Rwandans outside of the formal sector, where access to and utilization of health care services had been historically very low.
According to the International Labour Organization, near universal coverage was achieved in Rwanda due to strong political commitment, a decentralized and strong network of health facilities in all districts, community participation, and the use of cultural elements to include all people. Subsidized contributions by the Community-based Health Insurance (CBHI) for the poor and vulnerable, helped to extend coverage to otherwise excluded groups. Also, the linkage between health centers, hospitals and communities was strengthened by a total of 45, 000 community health workers (CHWs) to build health care system capacity.
It is noteworthy that the Rwandan model was built on the Nigerian law and model and it’s working well. I belong to a school of thought that believes that our problem is not vision but capacity to deliver our vision. This is another example; the inefficiency, lack of commitment of government in committing funding to budget and corruption are our problems. We know what we want. It’s how to get there.
About the Author:
Wale Irokosu is the National Policy and Strategy Secretary of the Youth Party. A practicing legal practitioner. His main remit is to come up with policies and strategies to advance the cause of Youth Party.
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