Ladele: Nigeria Needs Political Will to Achieve Universal Health Coverage

Dr. Babatunde Ladele is the Chief Executive Officer, Clearline HMO and the Chairman, Health and Managed Care Association of Nigeria. In this interview with Martins Ifijeh, he said with political will, health insurance can be made mandatory, as this will ensure Nigeria achieves Universal Health Coverage. He also spoke on other sundry issues

What is your take on Universal Health Coverage being the biggest focus presently by Nigeria’s Ministry of Health?

Universal Health Coverage is not only the direction of Nigeria’s health sector, it is the direction of the world, and we have no choice than to key in because it is changing the globe. How do we achieve UHC as a nation other than through health insurance, healthcare financing, and access to affordable healthcare? These are what we have been advocating for in the last 20 years.

Over 70 per cent of Nigerians pay out of pocket for their healthcare. How do we change this narrative?

That has been a very big issue. Government is still paying lip service to healthcare because it has not really done its own part. Lagos for instance had a government that upgraded almost all health centres to general hospitals. It was termed health for all, such that private hospitals started complaining they were no longer getting patronage. But when you say you are going to give healthcare free for under five and above 65, yet people get to the hospital, and are asked to go buy cotton wool, and other consumables by themselves, so is that really free? The truth is everyone is aware of what needs to be done because having more than 70 per cent of Nigerians paying out of pocket for healthcare is unacceptable. For those in the middle class, can we really afford healthcare. If you are asked to provide N200,000 for health services, can you truly afford it?

To address this, there must be a political will. In countries like United States and Britain which we are trying to copy, they have health as a front burner. But here, we pay lip service. For those of us who have been talking about this since our 20s, and now we are in our 60s or 70s. hardly can we say anything more than what we have been saying.

Whose political will are you referring to; that of the minister of health, minister of finance or the president?

It is that of the president. If President Muhammadu Buhari says this is how he wants the health of his people to be, that is how it will be. This present Minister of Health, Dr. Osagie Ehanire is close to President Buhari, so it won’t be difficult reaching the president. That is why Ehanire is the right person to be there as minister. With his body language and the few things he has done, it appears we will be expecting some positive changes in the sector. So, for now, it is too early to judge them.

It’s been 14 years since we launched NHIS, and we are still on four per cent. Why is our scheme still stagnant?

I have mentioned political will which is the major push we need to change the situation. Another thing is that culturally, some people do not believe in insurance. They believe whatever happens to us is meant to happen. To such people, health insurance is a difficult buy. We are also very religious in this country to the point that some believe paying for healthcare in advance is wishing ill health upon themselves.

With political will, we can make health insurance compulsory in Nigeria. Let’s push a bill for this. We have been saying that for decades. When the bill is before the National Assembly, the set of lawmakers handling it will leave, and then a new set will restart the process. That is where we are again right now. Now the executive and legislator are from the same party, and are taking instructions from the same source, so why can’t they pass this bill seamlessly. Now we are talking of Hate Speech Bill, and before you know it, they will pass it, and people will be killed for voicing their opinions, but the Bill for Mandatory Health Insurance is still not in place.

Sometimes I wonder if it is in our DNA not to get things done. Some of us have stopped complaining. There are times I share lofty ideas with my friends, but when they get into government, they will no longer be reachable. You call them, and they drop the call promising to call you back which they never did. I am not only discouraged; I am utterly disappointed. Look how long it has got us to get health insurance working. Just when we were coming together to make NHIS work, someone was brought in who went berserk in the last three years. We know one of us was represented in the board in the last dispensation, but right now they working on a law that will ensure we and providers are no longer represented on the board.

The banking industry has had problems but you won’t see someone who hasn’t practiced from the sector as Central Bank of Nigeria Governor. In NHIS, the case is not the same, except for this last man now. He used to be in the sector before he went to read more books. If the Federal Ministry of Health and NHIS are in sync, the scheme will work.

What is the unique thing Clearline HMO is bringing into the health insurance space?

Clearline HMO is one of the pioneers of this industry. There are times we say we have gone through the learning curve. The Yorubas have an adage that when you cut a tree, you already know where it will fall to. So, we are presently in such a unique position to know what works. We are not analogue; we move with time. Clearline is presently trying to increase its investment base. We are disinvesting.

The technical aspect of this business is to focus on ensuring people do not suffer ill health because they have no money to pay for it. We don’t want anyone to suffer ill health because of lack of money. HMOs takes a token, insures you and then makes sure anytime you are sick, you get the needed healthcare services. Several people put money in the pool, and the few who get ill benefits from the pool.

If you were to advise the new NHIS Executive Secretary, what would it be?

He has been in the system, so he knows what to do. He is a professor of health financing; that is the kind of person I am ready to work with. There are people in the industry practicing health insurance the way it should be practiced and he will recognise those people. I just hope he has the political will to do the right thing. He is presently on a good ride right now, but how he will manage to write the wrongs the last Executive Secretary (ES) did is what I don’t know. There was so much mis-governance during the last ES’s tenure. I was one of those who kept him at a distance, and that has probably helped my sanity.

Unfortunately, we didn’t have the ears of those who put him there at the time. Even when we wanted to voice out for our experience and clout, we were not reckoned with. In the last two years we saw a lot. You wake up one morning to read screaming headlines and things done with impunity from the scheme.

Someone once asked me how much I think it would cost Nigeria to have UHC. I told him we will need at least N1.3 trillion a year. And this is possible. Some 15 or 18 years ago, we came up with a formula that for each minute call made on phone, one kobo be charged and then used to fund healthcare. When we multiplied it by the users and talk time, we found out it was more than five trillion naira, yet nothing happened in that regards. If the current political office holders slash their allowances by half and put it into health, it will be enough to fund healthcare.

There is no free healthcare anywhere; somebody pays. If an accident happens, hospitals wont reject patients knowing somebody or government somewhere is paying. Even in the bible, the good Samaritan helped someone to an inn (clinic) and deposited money and then told them when he comes back, he would pay the balance. So, healthcare is not free. It is the patient that suffers.