UNIVERSAL HEALTH COVERAGE AND THE 2030 AGENDA

PAUL A. OBI argues that meeting the 2030 agenda will strengthen the nation’s health ecosystem

“Universal health coverage is one of the most powerful social equalisers among all policy options.”

– Dr Margaret Chan, Former Director General, World Health Organisation (WHO)

When health economists and other social scientists debate agents of social change, even equalizers and levelers, they often point to access to affordable and universal healthcare coverage as a benchmark to attain such a target. The primacy of such social intervention by the state in a way, particularly, within healthcare service delivery denotes the number of citizens able to access free healthcare services at most tiers of health institutions. This contribution of universal health coverage to global well being informed the critical role of the Sustainable Development Goal (SDG) goal three – good health and well-being to global health in general. The goal remains a touchstone for evaluating how countries progress or regress into oblivion and economic woes in the business of healthcare service delivery and socio-economic well-being.

In Nigeria, and in line with the SDGs, the policy framework of the federal government is significantly tied to universal health coverage in view of the 2030 agenda. But despite the government’s efforts in that direction, Nigeria’s performance, according to the National Bureau of Statistics (NBS), the country has just about a single percent of the population under health insurance coverage. Going by this percentage, and relying on SDGs Indicators 3.8.1 (coverage of critical and essential health services), Nigeria still has a long way to go on universal health coverage. And when we consider SDG Indicator 3.8.2 (expansive health funding/spending), the signpost for attaining the 2030 agenda remains almost wishy-washy. Combined with the United Nations SDGs Report in which approximately 382 million people globally were railroaded to the poverty bracket as a consequence of out-of-pocket spending for healthcare, the challenge is quadrupled. The overall calculus of out-of-pocket spending for health services by socio-economically disadvantaged citizens tends to condition countries and their citizens to further poor economic performance. This situation for countries of the Global South like Nigeria far becomes more precarious.  

But the history of universal health coverage at the return of democracy in 1999 was first set out in 2005 with the establishment of the National Health Insurance Authority (NHIA). But the legislation and enactment of an act for mandatory health coverage only became feasible in 2022. This gap between the political will to institutionalize health coverage with the launch of an agency and grounding its policy implementation through an act of parliament legislation poses an obstacle to meeting the 2030 agenda to cover all Nigerians. However, the Coordinating Minister of Health and Social Welfare, Prof Muhammad Ali Pate thinks the federal government, other federating regions and development partners are capable of meeting the 2030 agenda.

Speaking during the International Universal Health Coverage Day last year which is held every 12^th of December, Pate explained that universal health coverage “takes into consideration the needs of all people regardless of their income, where they live, gender and other differences.” According to the minister, the catalyst to implementing UHC and attaining the goal by 2030 lies in creating a synergy between the government and development partners in ensuring that a larger percentage of Nigerians are captured within NHIA and the burden of out-of-pocket is exponentially reduced. In Pate’s view, harnessing the diversity of the Nigerian federal state, where each tier of government addresses the existential gaps in universal coverage remains the most tenable pathway towards attaining UHC and the 2030 agenda.

At another forum earlier this year, Pate talked about “recognizing the need for a more robust governance structure and clearer guidelines, the ministry and its development partners are committed to making health services accessible to Nigeria women, children and for all citizens, especially those in the vulnerable groups”.  The minister further observed that “the goal is to reduce the necessity for patients to travel long distances for care thereby qualitatively and equitably improving the overall health and well being of Nigeria.”

Similarly, Minister of State for Health, Dr Tunji Alausa stressed that the designation and segmentation of coverage will define how Nigeria addresses the challenges. “We’ve designed different levels of coverage. One important level of coverage is that people will get a caesarean section if they need it. And as we escalate, different plans have been put in place even by the National Health Insurance Authority and the state insurance agencies whereby all diseases will be covered depending on the plan you’ve chosen,” Alausa further reiterated. As the minister of state observed, the key to achieving SDG three and expanding the reach of UHC across Nigeria lies on how the three tiers of governments: federal, state and local government work hard to reduce out-of-pocket spending for health services.

Still, the implication and consequences of this lack of synergy among the three tie

rs of government remains the bane of the UHC and the 2030 agenda. Such that, policies initiated at the federal level in Abuja are often not tailored down to local communities. Besides few states who have established state health insurance agencies, much of the 36 states across the country are still far from the national coverage net expected to tilt coverage widely. Much also depends squarely with what happens and goes on at the National Health Insurance Authority. The NHIA Director General, Dr Kelechi Ohiri appears to be defiant in seeing that Nigeria pushes ahead with UHC and 2030 agenda. According to Ohiri, health insurance scheme coverage for both the federal and state governments stood at 18.7 million in 2024, far higher than the 16 million recorded in the Q4 2023.

Some 18.7 million figures compared with a national population of 220 million people remain a drop in the ocean, and may also not win much applause. The dynamics of universal health coverage in an administration that is in dire need of economic revival is huge, considering the ripple and multiplier effect in the long run. A well-tailored UHC and meeting the 2030 agenda has the capacity to put more money in the pockets of citizens, improve healthcare and strengthen the nation’s health ecosystem. With the trio of Pate, Alausa and Ohiri on the saddle at different strata of healthcare leadership, universal health coverage should now be Nigeria’s definitive piece of policy and plan to provide healthcare for all. As the International Universal Health Coverage draws near ahead of the 12^th December day, the 2030 agenda may seem far off, but only actionable plans can keep hope for better healthcare alive.

Obi is a lecturer, journalist and researcher based in Abuja