An insight into the healthcare funding gap in Nigeria
by Damimola Olawuyi
In 1946, the 61 nations of the world signed the constitution of the World Health Organization. This document defines the right to health as the enjoyment of the highest attainable standard of health. This concept of health as a fundamental human right was further enshrined in Article 25 of the United Nations’ Universal Declaration of Human Rights of 1948. This idea has been validated by various international conventions and agreements over the years.
In various countries around the world, healthcare and the means by which it is provided is a hot-button political issue that can bring about the downfall of entire governments. In the United Kingdom, the funding and management of the National Health Service is a problem that has bedevilled both Conservative and Labour governments in recent years.
The idea that leaving the EU would free up funds that could be used to support social services, including the NHS, was a significant argument advanced by campaigners for Brexit. The fate of the Patient Protection and Affordable Care Act (PPACA) or Obamacare is the one constant factor of American politics since its passing in 2010.
In the recent midterm elections, the Democratic Party’s focused campaign of healthcare and the attempts by Republicans to repeal Obamacare with its protections of people with preexisting conditions as well as the expansion of Medicaid was instrumental (40% of voters said it was their most important issue) in their sweeping victories.
In Nigeria, since the first healthcare facility, a dispensary was established in 1880 by the Church Missionary Society, provision of health care and its funding has been a mixture of government, private and missionary enterprises. The activities of Christian missionaries in Nigeria have centred across the provision of educational and healthcare services as a means of outreach to their host communities.
The colonial administration provided policy direction through the administration of public health, training of medical personnel and the operation of General Hospitals. The availability of private health facilities was limited and available for only the wealthiest of individuals. This health architecture remained more or less unchanged even after self-rule was granted in 1960 and into the 1980s.
The failure of public healthcare which started in the 1980s resulted from the general downward spiral of the economy which led to reduced funding for the sector as well as the brain drain of health professionals searching for greener pastures outside the country.
With government hospitals unable to meet the demands of the public and with their infrastructure decaying, those who had the means were forced to resort to private health providers springing up across the country. Those without the means of accessing privatized healthcare were paying increasingly for even the most essential items such as drips, medicine and syringes.
Those with even fewer means resorted to dispensaries, patent medicine stores and in extreme cases, traditional practitioners. The implication of this is that the government has been increasingly less involved in the funding and provision of healthcare to the citizens.
To address this funding gap, the administration of President Olusegun Obasanjo in 2004 passed the National Health Insurance Scheme Act, with the NHIS itself established in June 2005. The purpose is to manage the provision of healthcare by bringing together Health Maintenance Organizations, Healthcare Providers and government support under one roof.
However, 13 years after its founding, the success of the scheme has been limited at best. The 2018 HMO industry report by Agusto & Co. revealed that only 5% of Nigerians have health insurance and 83% of Nigerians still pay for their health expenses out of pocket. A majority of these members enjoy the coverage through their employers, leaving the informal economy mostly without coverage.
The outcome is that the majority of Nigerians are one major healthcare challenge away from poverty. On a regular basis, the media is inundated with appeals for assistance with people with serious health challenges. The decaying health structure that has boosted medical tourism among the wealthy and well-connected forces the poor to scramble both for funds to cover healthcare as well as their travel expenses.
This is a significant part of the 11% of the world’s population spending more than 10% of its annual income on healthcare in 2017. In the same year, over 100 million people across the world were pushed into poverty from incurring substantial medical expenses.
Recently, the Lagos State Government has launched the biggest mandatory health insurance scheme in Nigeria with a target of 2.5 million residents in 2019 and a minimum of 1% of the state’s consolidated revenue fund as the equity fund targeted at the poor, civil servants and members of the informal sector. How successful the scheme will be, only time will tell.
Ultimately, there are different models for the provision and funding of healthcare available all over the world. However, regardless of whatever scheme is adopted, the government cannot shy away from its responsibility to provide affordable healthcare at all levels for all its citizens.
The obligation to provide policy direction, quality management and regulatory supervision cannot be handed off to the private sector. Until governments at all levels live up to their responsibilities as enshrined in Sections 17(3c) (d), Nigerians will continue to live at the mercy of unexpected health challenges and the potential impoverishment of entire families.
Editor’s Note: This article was originally published in The Spark Magazine. Find the magazine here to read other articles.