Stakeholders advocate alternate healthcare funding

By Moses Emorinken, Abuja

Nigeria needs to begin to seek out alternative sources of funding for the health sector, especially in the area primary health, care which is at the epicenter of achieving the Universal Health Coverage for all.

This was the focus of discussion for stakeholders in the health sector during a panel session by the development Research and Projects Centre (dRPC) in collaboration with the Partnership for Advocacy in Child and Family Health at Scale (PACFaH@scale) during a National Health dialogue by Premium Times in Abuja.

According to them, there was an urgent need for Nigeria to begin to capture everyone, especially those in the informal sector in its health insurance scheme. The informal sector comprises of about 70% of the working population and contributes overwhelmingly to the GDP of the country.

Explaining how Ghana leveraged domestic sources to fund universal health coverage through its health insurance scheme, the CEO of National Health Insurance Scheme of Ghana, Dr. Lydia Dsane-Selby, said that domestic funding through taxation played a pivotal role to the delivery health care to the majority of the population of the country.

According to her: “Ghanaians were so agitated to get health coverage that it was easy for the government to introduce a small levy to pay for it, which was statutory earmarked.

“The government put 2.5 per cent Value Added Tax (VAT) on all goods and services. Ghanaians were told that if they agreed to this, they will not have to pay in the hospitals, and the country agreed.
“The Health Insurance law was passed. That levy accounts for 70 to 75 per cent of the funding. The rest funding comes from 2.5 per cent on the pension contributions of formal sector workers, which accounts for 20 per cent of our funding.

“The rest comes from premiums from the informal sector. The premiums are not actually determined; it is a token just for people to have a sense of responsibility towards the scheme. The bulk of the funding for health is tax-based.”

She added: “Currently, we have changed the law. It isn’t even a levy on VAT but a straight tax which has increased the funding, and Ghanaians have accepted it because they know they don’t have to pay at the point of service.”

According to her, enforcement is usually a challenge to improve coverage, even in Ghana. To this extent, the Ghanaian government made it compulsory to have an active NHIS card before being admitted to school.

“We have also leveraged mobile technology to help people renew their health insurance cards and also help us capture the number of people in the scheme; this way, we also know their demographical characteristics.

“We need to find a way to make health a primary investment for our politicians and government. We must continue to demand this,” she said.

On the issue of additional funds from the government for health care like the consolidated fund of the Basic Healthcare Provision Fund (BHCPF), the Director, Department of Planning Research and Statistics Federal Ministry of Health, Dr. Emmanuel Meribole said, “The Universal Health Coverage (UHC) is a global agenda that can be achieved through resource mobilization.

“Apart from the 1% Consolidated funds of the Basic Health Care Provision Fund (BHCPF), we also have funding from international donors. The BHCPF is basically for the vulnerable in the society being children, women, and the poor. It will ensure that people do not pay at the point of service.

“The release of the consolidated funds started in 2018 and we are still pushing for a 100 per cent release of the funds because presently, we only have access to about 50% of it. We are also pushing for it to be made statutory as contained in the National Health Act (2014)”.

In order for this additional revenue to reach PHC services efficiently, it is necessary that strategies are in place to ensure accountability between the different stakeholders responsible for implementing the BHCPF at national, state, local and facility levels.

For the Director of the Department of Planning Research and Statistics of the National Primary Health Care Development Agency (NPHCDA), Dr. Garba Bulama, “The main issue for Primary Health Care (PHC) is governance. We need the PHCs to be under one roof (board); for this to happen good governance is all too important to make sure that every level of government agencies work in sync. Once governance is fixed, 80 per cent of the problems with PHC will be solved.

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“Bringing all PHC operations under one board is totally a function of good governance. If we don’t get this right, we will continue to have the same fragmentation, and our goal to achieve an effective PHC will not be achieved. This will also ensure discipline and management within the system.”

The lead of the Universal Health Coverage of the AMREF Kenya, Dr. Beatrice Gatumia, also added: “We need to use alternative ways to capture and enroll citizens to health insurance because proper population documentation is usually a challenge. We need to leverage technology and also incorporate the culture of quality healthcare delivery in our PHC centres.”

According to the Representative of the National Institute for Policy and Strategic Studies (Nipss), Rtd. Group Captain Mohammed Goni, “Funding for Universal Health Coverage involves not only the availability of more money for the health system, but also more health for the available money.

“We have the challenges of what population to cover, what services to cover, what percentage of cost for health should be covered.

“Our population statistics is a major challenge in determining funding for PHC; we don’t have adequate statistics for our demographic characteristics such as gender, age, number of pregnant women etc.

“We have the challenge of who is to be covered when we talk about financing PHC in Nigeria. There is also the challenge of how to finance UHC and how to implement it.

“We also have the challenge of raising funds for PHC in the presence of competing demands on national government; even developed countries cannot provide 100 per cent cover to 100 per cent of the population, for 100 per cent of the services, at 100 per cent of the cost. Therefore, raising revenues even for advanced economies is a challenge”.