SIR: Nigeria stands at a critical juncture, where the administration of President Bola Tinubu has an opportunity to prioritize and accelerate efforts to ensure affordable and quality healthcare for all Nigerians. With pressing challenges in the Nigerian health system, such as high out-of-pocket (OOP) expenditure, limited health insurance coverage, and a burden of disease that encompasses both infectious and non-communicable ailments, the need for transformative action is more urgent than ever.
Nigeria faces a significant hurdle as approximately 75% of total health spending in the country comes directly from the pockets of individuals and families. This places an immense financial strain on households and creates a high risk of impoverishment due to medical expenses. Shockingly, less than 5% of the population currently has any form of health insurance coverage, leaving millions vulnerable to the devastating consequences of inadequate healthcare access. In light of these statistics, the imperative to reduce OOP expenditure and increase the population covered, services covered, and the proportion of costs covered cannot be overstated.
The country carries a heavy burden of reproductive, maternal, neonatal, and child health conditions, ranking among the highest in the world. Additionally, malaria and tuberculosis (TB) continue to pose significant challenges to the country’s healthcare system. Equally concerning is the growing incidence of non-communicable diseases (NCDs), which accounted for 29% of deaths in Nigeria in 2016. This convergence of health issues demands immediate attention and a comprehensive approach to healthcare provision.
Despite commendable efforts in the past, progress towards UHC targets in Nigeria has been slow. Insufficient public health financing and an overreliance on external support are worrisome, particularly in light of impending donor transitions and reductions in concessional external financing for health. This delayed progress towards UHC is further compounded by the “4Ds” of transition: shifts in demography, disease burden, development assistance for health, and domestic health finance. The changing disease burden, including the rise of NCDs and injuries, coupled with existing challenges in maternal, new-born, and child health, presents a formidable task for the healthcare system. Additionally, the shifting demographic profile of Nigeria’s population, with a significant bulge in the adolescent band, adds complexity to the pursuit of UHC.
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Addressing these challenges and achieving UHC necessitates intentional efforts and collaboration between multiple stakeholders within the health ecosystem. It requires the unwavering commitment of the new administration, supported by a robust policy framework that acknowledges and addresses these transitions. The success of UHC will depend on the knowledge and capacity of all stakeholders involved, as well as the implementation of relevant policies that take into account the evolving health landscape.
President Bola Tinubu has an opportunity to set the agenda and place universal health coverage at the forefront of his administration’s priorities. This calls for bold and decisive action, including increased public health financing, the expansion of health insurance coverage, and the strengthening of primary healthcare systems. To achieve these goals, partnerships with international organizations, civil society, and the private sector will be crucial in mobilizing resources, expertise, and innovation.
One crucial tool that can be leveraged to achieve UHC is the expansion and strengthening of health insurance coverage. By prioritizing health insurance as a key component of the UHC agenda, Nigeria can make significant strides in reducing out-of-pocket expenditure, improving access to essential services, and safeguarding its population from financial hardships due to healthcare costs.
By expanding the population covered under health insurance schemes, Nigeria can ensure that more individuals and families have access to essential healthcare services without incurring catastrophic costs. This expansion should aim to encompass the most vulnerable segments of society, such as low-income households, informal sector workers, and rural communities. Special attention should also be given to women, children, and individuals with chronic illnesses, as they often bear a disproportionate burden of healthcare expenses.
To achieve these goals, Nigeria must prioritize key actions. First, there is a need to strengthen the regulatory framework for health insurance, ensuring that it is robust, inclusive, and aligned with the principles of UHC. This includes developing clear guidelines for the establishment and operation of insurance schemes, promoting transparency, and safeguarding against fraud and abuse.
Second, efforts should be made to promote public awareness and education on the importance and benefits of health insurance. Many Nigerians remain unaware of the options available to them or the rights and entitlements that come with health insurance coverage. Effective communication campaigns, community outreach programs, and partnerships with civil society organizations can help bridge this knowledge gap and encourage enrolment in health insurance schemes.
Nigeria’s journey towards UHC will not be without its challenges, but with strong leadership and a shared commitment, the nation can overcome these obstacles and ensure that no Nigerian is left behind in accessing quality healthcare. President Tinubu has the opportunity to leave a lasting legacy by prioritizing universal health coverage, ensuring a healthier and more prosperous future for all Nigerians.
•Victor Okeke,
Centre for Social Justice, Abuja.