Nigeria’s half-hearted commitment to universal health coverage
It is a trite fact that consistency of good policies, plans and budgets in a continuum is at the heart of development and will be instrumental to the regeneration of the nation’s economy. Incidentally, the Federal Government and the states have always chorused the fact that growth needs to be restored, the economy needs to be competitive and investments have to be pro-people. The chorus goes on to eulogise the elevation of local content, building of new skills and competencies with education as the bedrock of social and economic progress. We also know as a fact that we need to be alive to enjoy the perquisites of development and progress thereby bringing to the fore the inextricable link between the rights to life and health.
However, a review of some health policies, plans, laws and their implementation in Nigeria within the context of the budget will demonstrate the fatality of stating one thing in law and policy and doing just the opposite. For the economy to grow and be competitive, the human beings who drive it need to be healthy. Now, the buzzword is about universal health coverage; various international human rights standards, the Sustainable Development Goals and the National Health Policy all eulogise how beautiful the day will be when health services will be available to all. Everyone from the President, to the Senate President, the Speaker of the House of Representatives, the Minister of Health and the civil society all affirm their dedication to seeing that day become a reality.
The National Health Act in moving the health for all mantra to the next level provided for the Basic Health Care Provision Fund which should be made up of not less than one per cent of the Consolidated Revenue Fund of the Federal Government. Contributions are also expected from donors and other sources. The Fund as provided by law would principally go into primary health care. The NHA became law in late 2014 but the excuse was that the estimates for 2015 had already been prepared by the executive; so, it would require extra work to accommodate the Fund in 2015. But this was just an unreasonable excuse considering that the National Assembly had yet to begin consideration of the executive proposals as of the time this bill got assent to become law. The Federal Government, in preparing the 2016 and 2017 federal budgets, simply refused to include the one per cent as a basis of attracting support from donors and other stakeholders. Yet, the same government through its principal officers continued swearing about their commitment to universal health coverage and health for all.
Enter the process of preparing the 2018 federal budget and the dance steps of senior government officials on the subject of the one per cent became very confusing. The 2018 federal budget call circular in Section 3.2 omitted the Fund as one of the statutory transfers. While discerning minds were considering the implication of the deliberate refusal to provide this Fund, the Medium Term Expenditure Framework 2018-2020 was sent to the National Assembly by the President. The MTEF at page 25 under the health theme states as follows: “The achievement of Universal Health Coverage is an important goal of government. It is expected that the funding provision for the Basic Healthcare Provision Fund of one per cent of the Consolidated Revenue Fund will be implemented over the medium term”. With this heartwarming statement, the financial projections of the MTEF still leave out the Fund! And information from very high and official quarters still indicates that the budget to be presented on Tuesday this week omitted the Fund.
As if the foregoing had not inflicted enough damage on the mantra of universal health coverage, the administration has nothing in terms of policy and legislative position to raise funds to pay for universal health care. It is a fundamental aphorism that universal health coverage needs to be funded for it to become a reality. Government is not pushing for compulsory health insurance nor is it thinking of any new revenue source to make health care available, accessible and affordable by all. Two years gone out of a mandate of four years, nothing new and no developments that encourage or push the envelope of hope that a new dawn is around the corner. Just a reminder; the mantra has not changed and the song of the year/decade is still about universal health coverage. In nearby Ghana, health insurance is compulsory and universal and government raises funding from other sources to ensure the improvement of health services. But this cannot happen in Nigeria. We are too big to use our faculties right.
The Federal Government keeps announcing its dedication and commitment to improving maternal and child health. One of the key parameters to measure this improvement is access to immunisation and immunisation coverage. The donors who are funding this are withdrawing and we are supposed to make alternative arrangements to do it ourselves through domestic resource mobilisation. What has the Federal Government done? What are the sustainability agenda and the domestic resources mobilisation framework? Maybe, borrow more from concessionary sources? Is the Federal Government even interested in the sustainability framework being devised by non-state actors?
Thus, how do we expect the health sector to grow and fulfil its mandate when all the provisions of laws, policies and plans have no relationship with actual governance activities where resources should be dedicated to their implementation? There is nothing esoteric about improving funding for health or access to health services and for which no literature exists or practices cannot be replicated and adapted from other countries. What is lacking is the political will to do what is right and practicable in the circumstances. As a young man growing up in the seventies and early eighties, I heard about Health for All by the year 2000 but when 2000 came, the goalpost was shifted to 2015. Then, when 2015 came, it was further shifted to 2030. So, for how long shall we continue to grope without direction?
The right to life and its concomitant right to health are the foundations and building blocks of economic regeneration and growth. The Federal Government should be seen to be implementing its plans, policies and laws through the revenue and expenditure framework and fiscal policies of the budget. Leadership is about practical ideas which drive resource mobilisation and when these resources are mobilised, they are channelled in an empirical and constructive manner for the greatest good of all.
Universal health coverage is possible; but where are the leaders? Where is the road map and who is in the driving seat? The ruling All Progressives Congress, the President and the Minister of Health should stand up and be counted and stop this half-hearted commitment towards universal health coverage.