Achieving Universal Health Coverage Through Health Financing in Southwest Nigeria

Damilola Araoye (UNICEF Roundtable)

In January 2019, the Development Agenda for Western Nigeria (DAWN) Commission in partnership with the United Nations International Children’s Emergency Fund (UNICEF) convened a two-day Roundtable on health insurance scheme in the Southwest Region of Nigeria with the theme ‘Achieving Universal Health Coverage in Southwest Nigeria’.

The Roundtable focused on improving health financial protection by strengthening the health insurance systems in Southwest Nigeria.

It is important to note that an effective healthcare system is key to the attainment of Goal 3 of the Sustainable Development Goals (SDGs) that was adopted by the United Nations in September 2015 which provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. It was subsequently signed and adopted by Nigeria.

Goal 3 of the SDGs – “Ensure healthy lives and promote wellbeing for all at all ages” – focuses on building a healthy global populace. The eighth target under this goal is achieving universal health coverage which includes financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. While some countries have improved significantly, some have been struggling to achieve the target. 

The World Health Report (2010) defines universal health coverage as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services do not expose users to financial hardship. 

The goal of financial protection in health is that payments made by people towards the cost of using health services should not severely impact on their living standards. Financial protection is mostly measured in terms of out of pocket payment categorized as catastrophic and impoverishing. 

It is catastrophic payments when a household’s out of pocket payment are higher than what they can afford while impoverishing payments are when a household is pushed below the poverty line because of what it costs to procure healthcare. 
However, in a bid to provide health coverage for all citizens, the National Health Insurance Scheme (NHIS) was established under Act 35 of 1999 Constitution by the Federal Government of Nigeria with the aim of providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems. 

However, after almost twenty years of operation, less than 10% of the country’s population are registered under this Scheme. The Federal Government has further decentralized the process by allowing States the autonomy to operate health insurance schemes. Though, all the thirty six States have passed the laws to establish health insurance schemes, few has however began full implementation. 
Thus, DAWN Commission/UNICEF Roundtable was essentially organised to assess existing health insurance systems in the States of Southwest Nigeria, identify issues limiting health financing and wider coverage of citizens on various health insurance schemes and to also jointly developed actionable solutions with stakeholders that will be monitored periodically. 

The event had in attendance senior government officials from the Ministries of Health, Health insurance management agencies across the six States, health sector-focused Civil Society Organisations (CSOs) and representatives of Health Management Organizations (HMOs). Also, in attendance to share their experiences with participants were representatives from Delta and Kano States Health management agencies because of the successes they have recorded in health insurance scheme.

The current status of health insurance scheme across the States were assessed at the event. Some of the progress highlighted by the States are; institutionalization of State Health Insurance through legislation; some level of funding for Health Insurance agencies; ICT framework and agency operational guidelines; amongst others. However, it was observed that the process is still very fraught with challenges despite the progress that have been recorded. Some of the problems highlighted are lack of regulatory and operational framework for health insurance; accessing health insurance benefits; poor PHC infrastructure; cultural beliefs and poverty; low technical capacity and inefficient processes. 

The roundtable rounded off with the following recommendations; 

• Launch of a national dialogue to push for implementation of salient policy issues which should be used for policy advocacy and promotion of collaborative actions towards achieving universal health coverage.
• Concerted effort towards developing ICT regulatory and operational framework for State Social Health Insurance.
• Develop a robust State social health insurance technical support group to assist States without technical partner support scale technical hurdles.
• Utilization of Basic Healthcare Provision Fund.
• Develop context-specific roadmaps for States journey towards achieving UHC.
• Adopt a functional approach to dealing with performance management systems, in-house capacity transfer mechanism, and inter-relationship with the national Health Insurance Scheme and Health Management Organizations (HMOs).
• Encourage a national consensus on Basic Health Care Provision Funds – State Health Insurance Scheme (BHCPF-SSHIS) alignment. 

Indeed, it is imperative the States give priority to the scheme so as to serve as a panacea to the high cost of accessing healthcare by the poor while it reduces the cost of out-of-pocket payment for a substantial number of citizens. More so, Nigeria should be seen as working towards attainment of Goal 3 of SDGs as a member of international community that signed and adopted the Goals.

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