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Universal Health Coverage – Nigeria Intensifying Her Strategic Plans


The National Health Insurance Scheme was set up to ensure that every Nigerian has access to good health care services without let or hindrance, and to protect families from the financial hardship of huge medical bills. Recently, the second National Strategic Health Development Plan (NSHDP) and the Basic Healthcare Provisions Fund (BHCPF) was launched by the Federal Government in Abuja. According to the Minister of Budget and National Planning, Sen. Udoma Udo Udoma who represented President Muhammadu Buhari on the occasion, said the second National Strategic Health Development Plan as approved by the Federal Executive Council on Sept. 5, 2018, is the health sector’s plan leading to attaining universal health coverage for all Nigerians. But how equipped are the strategic plans on ground to be able to achieve the desired results in no distant time? PharmaTimes Editor, MORGAN NWANGUMA writes.

Nigeria’s healthcare services have not been in the best of forms for a long while. Going by the recent health development indicators available, there is no gain saying that achieving the much desired Universal Health Coverage for the country is still some good distance away.

The recent WHO report on the country’s healthcare situation means that a lot still needs to be done. With Nigeria recording some of the worst indices on maternal, newborn and child health, nutrition status, human capital development and disease prevention, there seems to be an uphill task for the federal government in trying to achieve full coverage.

According to WHO life expectancy at birth m/f as at 2016 stood at 55/56, while the nation’s medical doctors-patient ratio in 2018 stood at one doctor to 6,000 patients compared to India’s 1:2,083 and the US, 1:500. But with the launch of the second National Strategic Health Development Plan (NSHDP) and the Basic Healthcare Provisions Fund (BHCPF), the Federal Government may just be beaming a ray of hope in the direction of healthcare services, leading to a better implementation of the National Health Insurance Scheme (NHIS) in the nation. In the light of the Fund which was launched recently by President Muhammadu Buhari, there is now a greater need for the country to advance rapidly in the direction of attaining Universal Health Coverage (UHC). Nigeria majorly lags behind in giving her citizens the required health care coverage due to the lack of political will to do what is right for the greater majority of the population.

ISSUES MILITATING AGAINST FULL COVERAGE Poor funding The African Heads of State meeting in Abuja 2001 declared that a minimum of 15 per cent of the total budget of each country be devoted to healthcare. But so far the reality on ground has been a far cry from this prescription. Experts and observers alike have over the years identified poor funding of the health sector as a major factor working against the success of the project. Coupled with this is the fact that the greater majority of the people are impoverished; human capacity building in order to buoy up the income per capita will go a long way.

Emigration of experts, poor remuneration Another obstacle experts have identified is that of mass emigration of healthcare experts to Europe and America. On the average, more than fifty per cent of graduates from the medical schools in the land want to go abroad in search of greener pastures. Thus poor remuneration in the health care services as in most sectors, is leading to brain drain and thereby hampering the system. Also, an important issue to note is the long standing unhealthy rivalry among the different professional bodies that work in the health sector, aside the recurrent industrial actions. The recent JOHESU strike vis-a-vis the imbroglio with the Nigerian Medical Association is still fresh in our memories. Other obstacles confronting the full implementation of the National Health Insurance Scheme (NHIS) as well as militating against the actualisation of a Universal Health Coverage for the nation according to experts include: drug insecurity, abuse and misuse; as well as the issue of quacks engaging in the various professions along the value chain.

FUNDING THE DEVELOPMENT PLAN The development plan that is right now in place is expected to cover the five year planning period (2018 – 2022), and guarantee that the health sector nay health standards of every Nigerian is appreciably enhanced by applying the 5 strategic pillars, and in the given 15 priority areas. The planned pillars for the road map will – ensure a healthy atmosphere so that the targeted objectives in the health sector generally can be achieved; Improvement in the way and manner vital health services are deployed; fortifying the health systems as well as securing them in times of crises and urgent situations, and funding health services in general. And conversely, the BHCPF is a fund set aside to furnish the citizenry with the essential healthcare needs. Last year (2018) the federal government budget made provisions for it using one per cent of the Consolidated Revenue Fund in the tune of N55.7 billion.

This of course, has been complemented by funding from development partners such as – the World Bank’s Global Financing Facility, and the Bill and Melinda Gates Foundation. The Minister of Health, Prof. Isaac Adewole speaking, stated that the programme is already on, adding that the Buhari administration has already commenced the release of N57.15 billion made for the fund among others.

“This fund means Nigerians will be entitled to free antenatal care, free delivery, and free caesarian sessions. It also covers for diabetes and hypertension screening, as well as free treatment for malaria and tuberculosis tests,” he stated. “We are particularly happy for this launch because this will benefit poor Nigerians who are quite disadvantaged. The health indicator for the rich in Nigeria is not different from what is seen in developed countries. So this will go a long way in improving the healthcare of poor Nigerians, and by extension improve human capital development. “We have worked on the national health policy, developed the national health strategic plan and the BHCPF.

We are now starting a brand new journey to ensure we expand access to every nook and cranny of the country.” The Minister is optimistic and promised that the funds will be well managed, adding that it will be kept safe in the Central Bank of Nigeria (CBN) from where disbursements will be made to states according to their needs. Adewole said to this effect, accountability is guaranteed; it includes the fact that government has reached an agreement with the contributors to come audit the account “anytime they want.”

SETTING AGENDA FOR THE FUTURE In 2016 Nigeria narrowly missed being completely free of any form of polio infections safe for the insecurity in the North-East of the country, and so immunisation has as well been terribly hampered by insurgency. The gap left led to the re-emergence of the virus after a period of elimination. But for most partners, especially the Bill & Melinda Gates Foundation, this remains a top priority for 2019. Moving forward, experts see the need to raise the level of private sector involvement in health funding. Time has come also to intensify the role even as we seek to intensify Primary Health Care in the country – also through increased funding. Nigeria’s maternal and child health indicators are not on the favourable side given that the country still rates as the fourth highest in maternal mortality globally. In addition, raising a sustainable family size with access to basic quality health needs will automatically translate to a healthy and wealthy nation. Thus family planning issues must be given adequate attention hence the need to support the National Family Planning Blueprint through a well laid out and committed domestic funding programme for family planning. And lastly, government is gearing up to surpass its marginal gains in the year 2018 especially with the signing into law the bill or act establishing the National Centre for Disease Control (NCDC) on the 13th November of that year – by President Buhari.

To further boost its activities, the federal agency is looking to strengthening the nation’s readiness in times of epidemic outbreaks or emergencies, by setting up a number of reference laboratories at different locations. With the efforts so far made, hopes are rather high that the government is poised to drive its policies far enough to meet the Universal Health Coverage for Nigerians.

As the poor health indicators are corrected, human capital is bound to be enhanced as the partners are in a united front to make this happen. The World Bank Group and the Bill and Melinda Gates Foundation cooperating to devote as much as US $180 million towards the implementation via BHCPF, is by no means going to fast track our hitting the target. As President Muhammadu Buhari assumes a second tenure in May, health watchers and stakeholders alike are hopeful that with continuity and further implementation of these policies, the road map will even be navigated more seamlessly, leading to easy access to improved quality of health care for the generality of the masses.

By  Morgan Nwanguma

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