THE CHALLENGE OF UNIVERSAL HEALTH COVERAGE 

The states, local governments, as well as private sector organisations should be enlisted in the scheme

During the Universal Health Coverage (UHC) Day Walk last December, the Coordinating Minister of Health and Social Welfare, Mohammed Pate promised to expand the quality of healthcare services that Nigerians access through the primary healthcare systems and hospitals. “We expect that states will complement with the participation of every stakeholder, to ensure that the society is healthier,” Pate said at the occasion. “This action requires that everyone has access to quality healthcare services that are affordable.” But the minister must move from rhetoric to action on this issue if he is to make any meaningful impact.  

Like Nigeria, most of the countries that have made appreciable progress in achieving UHC have also implemented some form of comprehensive government-led health financing reforms. Unfortunately, despite a reform of the sector in our country and the law already put in place, majority of the population are not covered by any health insurance schemes. That is perhaps because the scheme is driven by the executive at the federal level rather than by the three tiers of government and the private sector. Many of the states and local governments are yet to come on board. For the health of our people, it is important that critical stakeholders begin to address this challenge.  

In Nigeria today, hundreds of thousands of citizens die on account of lack of access to quality healthcare which a functional health insurance scheme could have guaranteed at all levels. Admitted that there can never be a one-size-fits-all model for guaranteeing health insurance for the society, we however believe that the defining trouble with the National Health Insurance Scheme (NHIS) is the system-wide inequalities in its implementation which has resulted in the lack of financial protection for the healthcare needs of most Nigerians.   

Ordinarily, the main goal of the NHIS is “to facilitate fair-financing of healthcare costs through pooling and judicious utilisation of financial resources to provide financial risk protection and cost-burden sharing for people, against high cost of healthcare, through various pre-payment programmes prior to their falling ill.” But a scheme that is voluntary in practice cannot guarantee proactive protection for the country’s sick population. The fact that other federating units outside the federal government do not participate in the NHIS makes it somewhat ineffectual. How to get the states and local governments, as well as private sector organisations enlisted in the scheme should therefore be a priority.  

Indeed, as it stands with the NHIS, only a small proportion of Nigerians have prepaid healthcare, and this is not right if we must lead or keep a healthy population. To therefore achieve the UHC which the country has signed on to, we are of the strong view that strengthening and adopting a comprehensive social health insurance scheme would have to happen and quickly too. We also believe that reforming the country’s healthcare financing through a review of the NHIS Act is critical to achieving the objective. The effectiveness of a social health insurance in Nigeria would also be strengthened with the inclusion of 36 states into the scheme and getting them to set up and manage their own insurance schemes in line with the provisions of a reviewed NHIS.  

The benefits of a health insurance scheme that works in a country like ours are many. One, the idea of cashless treatment for those insured makes it imperative for them to get immediate treatment during sudden ill-health while the premium paid on health insurance is usually tax deductible. It is therefore important for Pate to work with all the stakeholders in the health sectors and authorities in the states on this issue. Until we can extend health insurance to all citizens, the country’s push for UHC will be a mirage.