Towards achieving universal health coverage

The health sector roadmap unveiled recently by the Federal Ministry of Health, which admitted that huge gaps exist in the all-important sector, is a call for concerted efforts to achieve universal health coverage, reports Associate Editor ADEKUNLE YUSUF

Improve the health sector and provide better healthcare services to all Nigerians. This was the vow President Muhammadu Buhari made to the nation when he unveiled his nine-point agenda last year. With the nine-point agenda, which is meant to run for three years, President Buhari aspires to propel the country towards the attainment of universal health coverage when “all individuals and communities receive the health services they need without suffering financial hardship”.

The presidential charge was promptly followed up by the Minister of Health, Dr. Osagie Ehanire, who listed the agenda to include implementation of mandatory universal health insurance for all Nigerians in collaboration with the state governments and the Federal Capital Territory (FCT) administration. As he christened, “Next Level Agenda in the Journey towards Universal Health Coverage: Health for All Nigerians.” This included operationalisation of the basic health care provision fund in collaboration with partners and agencies; recruitment and deployment of 50,000 community health extension workers; revamping federal teaching hospitals across the country and collaboration with private sector investors to establish high-quality hospitals in the country.

The rest are reduction of gaps in all health-related SDGs by at least 60 per cent; reduction in the current imbalance between primary, secondary, and tertiary health care; active collaboration with the private sector to create a large number of well-paying jobs for Nigerian youths; and contributing to the realization of taking 100 million Nigerians out of poverty in the next ten years. Dr Ehanire reiterated that the mission of the federal government is “to build a health system that guarantees availability of universal access to appropriate, equitable, comprehensive, affordable, efficient and quality healthcare for Nigerians.”

According to him, the most troubled part of the health sector is the primary health care system, which ordinarily should provide treatment for common diseases and injuries, provide essential drugs, render basic and essential services for women, especially maternal and child care and complications arising during birth. Findings show that the reverse is currently the case nationwide – a negative trend the Buhari administration is determined to reverse.

Among other things, present realities indicate the absence of a fully developed and functional primary health care system, which constitutes a development challenge in Nigeria with a large population living in rural areas where access to basic health care system is crucial.  Poverty, long distance, bad road networks and high cost of travel are obvious hindrances to seeking medical services in urban or more developed areas by people in remote settlements. Experts have said repeatedly that reaching people in hard-to-reach areas requires a health care system that caters to the needs of a relatively small population and which delivers essential preventive and curative medical services to the communities at affordable cost. To this end, primary health care is widely recognised as the most cost-effective way to reach the goal of universal health coverage and address comprehensive health needs close to people’s homes and communities.

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According to the ministry of health, there are over 33, 000 primary health care centers across the country. Of the figure, fewer than 20 per cent are functional. Escalating poverty coupled with a high level of illiteracy in Nigeria makes the case for an efficient and sustainable primary health care system even more urgent.

Statutorily, the National Primary Healthcare Development Agency (NPHCDA), is saddled with the task of ensuring that primary health care services are available and accessible to all citizens. However, the current primary healthcare system is under-utilised with a significant burden transferred to the secondary and tertiary health systems.  The system, which is expected to provide quality healthcare services for about 70 per cent of Nigerians, currently carters for about 20 per cent, leaving the secondary and tertiary facilities overwhelmed.

Owing to inadequate funding, inadequate staffing and a myriad of logistical problems, primary health care facilities are operating at different levels of functionality with shortages of critical human resources, health experts said. Despite these challenges, many are of the view that the NPHCDA has made significant progress in the last few years. Many health professionals believe the country has recorded some progress, no matter how modest it seems. In August 2020, Nigeria was certified free from the wild polio virus, even as   immunisation coverage jumped from 33 per cent in 2016 to 71 per cent in 2019, the cited as part milestones recorded in recent years.

Others laud the agency for supporting initiatives to reduce the impact of COVID-19 in Nigeria, training over 220,000 health workers and community volunteers at the national and state levels, working in collaboration with the Nigeria Centre for Disease Control (NCDC) and other stakeholders at all levels of government, and supporting the provision of personal protective equipment to health care workers.

But NPHCDA  said it is poised to more so that the agenda of President Buhari on universal health coverage can be realised. Projecting ahead, the NPHCDA said it has plans to work with states, local governments and other critical stakeholders to deploy a four-point agenda to fast track progress towards achieving UHC. These are revitalisation of all PHCs with optimal human resources to improve services; improved technology for PHC data, services and vaccine distribution; up-scaling social and behavioural change communication and strengthening Post-Polio PHC System.

Fortunately, the strategic plan at the NPHCDA has received the support of President Buhari and his consent to host an international summit on Primary Health Care. It was learnt that health managers are fine-tuning details of the global summit, which is expected to leverage on efforts in kicking the wild polio virus out of the country and the deft management of COVID-19. Barring last minute changes, the summit will hold in Abuja before the end of October or early November in actualisation of the promise made earlier by the Executive Director of the NPHCDA, Dr. Faisal Shuaib, to prioritise strengthening the PHC system through a robust revitalisation agenda.

As part of its efforts to achieve the mission, the agency had engaged with the heads of community medicine departments of universities to discuss and receive critical feedback on prevailing issues of interest to primary health care development in Nigeria. That was last year. It also met other critical stakeholders in the bid to strengthen the PHC system and deliver affordable, accessible and equitable services.

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“My vision is to strengthen PHC systems to deliver affordable, accessible and equitable services to all Nigerians. It is in this light that we will be convening a global PHC Summit in 2021 with the theme: Strengthening PHC towards achieving universal health coverage in post-Polio, Peri -COVID era.

“The overall goal of the summit is to galvanize stakeholders and present a compelling investment case for PHC financing, leveraging on the gains made during the polio eradication to strengthen PHC systems from 2021 to 2030. I am optimistic that this event will be a success and a global agenda to be reckoned with,” Dr. Shuaib said.

The summit aligns with the vision of Dr.  Ehanire on addressing the inadequacy of primary health care services across the country and the need to revitalise one PHC in each ward in demonstration of prioritizing community based health care and scaling up the Community Health Influencers, Promoters and Services (CHIPS) programme launched by President Buhari in 2018 at Lafia, Nasarawa State. CHIPS is designed to improve access and equitable coverage to essential health services, especially those relating to maternal, new born and child survival.

The President added that it will also remove barriers to PHC services; ensure supply of integrated PHC interventions by linking the health workforce at health centres in rural and underserved communities to the households; tackling delays in decision to seek care, reaching care and receiving adequate healthcare. Many therefore believe that the forthcoming summit is coming at a time when government resources have become inadequate to fund the health sector, especially with the global COVID-19 pandemic and the resurgence of cholera in many states across the country.

At a recent meeting with federal lawmakers, the Secretary to the Government of the Federation, Mr Boss Mustapha, had said that COVID-19 provided a unique opportunity to x-ray the state of Nigeria’s health care sector which is in dire need of reforms and funding. “The weaknesses in our health system became more glaring as we see how more established health systems in Europe and America buckled under pressure. There’s no doubt that a strengthened and well-resourced health system will not only place the country in a better position to deal with future emerging infections but will also provide a solid foundation for medical research and development,” said Mustapha.

Stakeholders are thus optimistic that the summit will rally the support of the Coalition Against COVID-19 (CACOVID), the private sector-led organisation assembled by the Central Bank of Nigeria (CBN) to assist the federal government in combating COVID-19. The coalition of industry giants, banks and several private organisations and individuals raised huge funds to procure essential supplies, equipment while also accelerating tests and treatment for COVID-19.