By Victor Adeoti
Achieving universal health coverage (UCH) is one of the targets that nations set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015.
At the UN General Assembly High Level Meeting on UHC in 2019 countries reaffirmed that health is a precondition for and an outcome and indicator of the social, economic and environmental dimensions of sustainable development.
The World Health Organisation (WHO) says UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.
The UN agency said protecting people from the financial consequences of paying for health services from their pockets reduces the risk of poverty.
It said such expenditure eats deep into life savings, leads to selling of assets, or borrow, thereby capable of destroying their future and in some instances, that of their children.
As a way of meeting the 2030 target Nigeria inaugurated the National Health Insurance Scheme (NHIS) in 2005, but only passed a law establishing mandatory health insurance in May 2022.
According to the 2018 National Demographic and Health Survey, the country has only achieved coverage for 3 per cent of the Nigerian population.
Medical experts say in spite of making health insurance mandatory, enrollment remains alarmingly low with only 5 per cent coverage at the national level.
They say this has created a significant financial barrier, forcing many Nigerians to pay out-of-pocket for essential healthcare services.
This financial burden disproportionately impacts low-income Nigerians leading to preventable deaths for those who could be saved with timely medical care.
Experts also say that most people with health insurance coverage are in the formal sector citing poor policy implementation due to a lack of policy awareness and low government spending on health as reasons for this.
Other factors, they say, are poor evidence-informed decision-making, in keeping with global challenges.
Therefore, the question posed by medical experts is Can Nigeria achieve UN’s Sustainable Development Goal of Universal health Coverage by 2030?
The federal government assures that the country is on track to make it a reality.
Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, said recently that health of Nigerians is not just a matter of well-being, but also a fundamental human right.
He spoke at the 64th session of the National Council on Health in Ado-Ekiti.
Pate said that universal health coverage is the embodiment of the vision for a healthier and more prosperous nation.
He, however, acknowledged that the pace of progress has not been commensurate with the investments and the complexities of the country’s health system, adding that the effort would be escalated.
“It is a measure of our commitment to equity, justice and dignity of every individual.
“Achieving UHC is not a choice; it is an obligation, a promise to provide quality healthcare to all regardless of their socio-economic status.
“Achieving UHC requires us to ensure that our healthcare resources are allocated effectively. We need to invest in preventative care, primary healthcare and essential services that reach the most vulnerable among us”, he said.
Pate said President Bola Tinubu wanted the ministry to establish structures and frameworks to effectively and efficiently coordinate efforts aimed at addressing the wider determinants of health.
As part of efforts to achieve the 2030 target UNICEF says it will continue to advocates for more concerted efforts by relevant stakeholders in addressing systemic challenges in attaining universal health coverage.
Dr Ijeoma Agbo, UNICEF Health Specialists, said health insurance is a gateway to achieving universal health coverage.
She said this at a two-day dialogue workshop entitled “Changing the narrative on Child Mortality Through Health Insurance” recently held in Ibadan,
Agbo, who spoke on the topic “Access to Health Insurance as a way to Achieve Universal Health Coverage for all in Nigeria”, said health insurance brings financial protection by reducing the burden of out-of-pocket expenses.
She said for Nigeria to achieve its target of universal health coverage, governments must commit to dedicate a percentage of the consolidated revenue to health insurance scheme to fund premiums for the poor and vulnerable.
The UNICEF Health Specialist said that government should invest more in the primary healthcare to make it affordable to all and benefit packages that includes the minimum basic essential health services.
Agbo said that in 2021, almost one billion people spent more than 10 per cent of their household budget on out-of-pocket health expenses and more than half a billion people were pushed into extreme poverty due to out-of-pockets payment.
“Health insurance enhances access to a wider range of healthcare services, including promotive, preventive, curative, and rehabilitative services.
“Individuals with health insurance are more likely to seek timely medical care, leading to early detection and treatment of illnesses.
“Achieving universal healthcare requires a multi-sector and collaborative approach, involving government agencies, healthcare providers, civil society organisations, the private sector, communities and the media,” she said.
Also, UNICEF Communication Officer, Blessing Ejiofor, said that access to health insurance plays an important role in ensuring that children receive timely healthcare they need to survive and thrive.
Ejiofor enjoined journalists to become active advocates of health insurance by using their various channels to draw attention to the issue that could help in bridging the gaps in health insurance coverage for vulnerable populations.
Meeting the health insurance target not only requires the efforts of the federal government but also that of other stakeholders, including state governments.
Dr Olusola Akande, the Executive Secretary of Oyo State Health Insurance Agency (OYSHIA) said the government was already intentional about scaling up the scheme.
Akande said the initiative was to ensure that ensure that all categories of people in the state had access to health insurance.
“What we are pursuing is to get as many people as possible on the health insurance and leaving no one behind, including the poor, the rich, the rural and urban dwellers”, he said.
Akande said the state is changing the narrative of maternal, and child health and the general health of citizens as well as driving universal health coverage.
Akande, who noted that the agency was established in 2016 while the enrolment began in 2017, said it had enrolled 190,968 people till date.
He said while the formal sector has enrolled 104,533, the informal sector has 86,435 subscribers, adding that the agency is targeting 500, 000 vulnerable enrolees in the year.
“I won’t say that it has succeeded, but we are succeeding. We have about 3 to 4 per cent of the population enrolled.
“And when you consider the beliefs and attitudes of people on insurance, that’s a great gain”, he said.
Medical experts say for Nigeria to meet the UHC target by 2030, it must improve on its health sector financing and community system.
They say six years before the target date Nigeria is at a critical stage in delivering on the goal and therefore urge government to strengthen existing health infrastructure, including primary health care system and scale up health sector investments. (NANFeatures)
