Beyond Marking World Health Day

As Nigeria, last week, joined the rest of the globe to mark the 2019 World Health Day, Martins Ifijeh writes on the need to prioritise universal health coverage and improve health of citizens, if the country must move beyond just ‘marking’ the day to actually celebrating the achievements recorded in the sector

In many countries of the world, majority of citizens are forced to choose between healthcare, food and other necessities of life. When they are sick, it is either they spend the little money they have on purchase of healthcare or spend it on feeding; a scenario that has ensured those who choose healthcare go home hungry, while those who choose food at the expense of healthcare suffer the consequences of worsened disease conditions or even death. Either way, their life suffers.

Sadly, those prone to these factors are the poor and vulnerable that can do nothing about the situation, given that healthcare and other basic amenities of life shouldn’t be some of the myriads of daily challenges they should worry about when there are governments in place.

While several billions of people across the globe are no doubt living their lives this way, it is said to be more common in middle and low income countries where majority of the citizens do not have the financial strength to purchase healthcare for themselves and their families in addition to other things they need money for.

Chief among countries affected by this is Nigeria where over 87 million persons are living below two dollars per day if reports by World Poverty Clock and Brooking Institute are anything to go by. These poor Nigerians juggle their two dollars daily income between feeding their families, paying for healthcare and meeting other basics of life.

Last year, the 2018 Health Maintenance Organisations Industry Report by Agusto & Co posited that of Nigeria’s 200 million residents, only 5.1 per cent of the population enjoys health insurance where they can, along with their families walk into healthcare facilities to access healthcare without worrying about paying.

This, no doubt has played out in the different healthcare indices of the country; from poor maternal and child health, to disease outbreaks, poor human and capital development, and high mortality rates, among others – making the country one of the worst places on earth to live a healthy life.

When health indices are discussed on global stages on a country-by-country basis, Nigeria often emerges one of the countries with the worst indices among key global health issues. The country sits comfortably among the 10 worst countries in the world with disease burdens.

Burden of Malaria
On specifics, Nigeria has the highest burden of malaria globally, with about 40 per cent of global malaria deaths occurring in the country and Democratic Republic of Congo alone. Not only that 90 per cent of Nigerians are at risk of it, it kills over 300,000 of them yearly, with 11 per cent of maternal deaths linked to it.

Maternal and Child Deaths
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 one ratio 13, if indices from the World Health Organisation (WHO) are referenced.
Contrary to this reality on ground, Nigeria joined the rest of the world last Sunday, April 7, to commemorate World Health Day bringing to mind the state of the country’s healthcare.

Premium to Universal Health Coverage
Experts however believe Nigeria has all it takes to change the sorry narrative if it gives premium to universal health coverage (UHC), where Nigerians, especially the poor and vulnerable would no longer have to be further impoverished by paying out of their pocket whenever they need to access health services.

A public health expert, Dr. Rufus Momoh said if the Nigerian government, including the 36 states of the federation and the Federal Capital Territory give priority to primary healthcare services, it will go a mile closer to achieving universal health coverage for Nigerians, as this represents the closest connection between the citizens and healthcare services.

“Governments should give primary healthcare facilities some level of financial autonomy because thousands of PHCs in Nigeria gets zero budgets for drugs, equipments or even fixing a bad bed in their clinics. So what happens is that such centres die natural deaths since citizens cannot go there to access healthcare. This is what happens in many of the PHCs in the country – lack of funding.

“Because of this, many Nigerians have lost confidence in the primary healthcare system of the country. I believe this is the circle; when PHCs function properly, the citizens will have confidence in them and access healthcare there, and in turn the health of the people will increase,” he said.

WHO’s Message
The World Health Organisation (WHO) in its message to mark the day, said although countries have made enormous progress against some of the world’s leading cause of deaths and diseases, there is still a lot more to be done, especially in middle and low income countries where mostly the poor still lack access to quality and affordable healthcare.

WHO said: “Today, half the world’s population cannot access essential health services. Millions of women give birth without help from skilled attendants; millions of children miss out on vaccinations against killer diseases, and millions suffer and die because they can’t get treatment for Human Immuno Virus (HIV), Tuberculosis, and malaria.

This is unacceptable in 2019. But the good news is that there is a growing movement to address these inequalities.
“In the Sustainable Development Goals, all countries have committed to achieving universal health coverage by 2030. To meet that target, we need to see one billion people benefitting from UHC in the next five years. This is not an unattainable dream, nor will it require billions of dollars to implement. UHC is achievable, right here, right now, for all of us,” the global health body said in a statement.

Disconnect Despite BHCPF
While the Nigerian government said it is making effort to address issues around out of pocket payment for its citizens through the implementation of the Basic Healthcare Provisions Fund (BHCPF) and the operationalisation of the 2014 National Health Act, there still remain a disconnect between this effort and the country’s national healthcare budget, which by the way is one of the lowest globally.

In 2016, total government health expenditure was 0.6 per cent of Gross Domestic Product (GDP). And as a share of total government expenditure, government health spending was also low at 6.1 per cent, amounting to just $11 per capital.

This level of spending is grossly below regional and lower middle income averages and the recommended US$86 per capita for low and middle income country benchmark needed to deliver a limited set of key health services.

Nigeria’s present national health budget is less than five per cent as against recommendation from the Abuja Declaration where all African Heads of governments agreed to increase health allocation in their national budgets to at least 15 per cent.

While it is Nigeria’s right as a world health member state to commemorate World Health Day, it is still far from celebrating the day just as is seen in many countries that have improved their health indices through expanding access to healthcare, reducing out o pocket payment for healthcare, and increasing their health budgetary allocations to significant figures. Will Nigeria in 2020 celebrate better healthcare on World Health Day? Time will tell.