Nigeria is on its way to critical elections in February 2019. Now therefore is the time for aspirants, candidates and political parties to ask for votes and support. It is also an opportunity for the citizens, being the electorate, to ask critical questions and bring up core issues of interest to the front burner. One of such critical issues is the state of health services, which from all available indicators produced by national and international organisations, places Nigeria at the bottom rung of civilised societies. Our indicators are only comparable with those of nations coming out of many years of war and conflict.
From low life expectancy, poor maternal, new born and child health indicators, prevalence of communicable and non-communicable diseases; doctor-patient ratio and the ratio of other medical personnel to the population, available hospital beds, health goods, services and facilities, Nigeria is portrayed as a nation that does not prioritise good health care. The implication is that we do not take our lives seriously because the right to health is a component of the right to life. The easiest way to deprive a man, woman, boy or girl of their life is to deny them of health-supporting conditions and facilities to the point of abrogation.
Yes, politicians will come and promise free, quality and acceptable health services, but the central question we need to ask is; how will the services be funded and where will the human, material and financial resources be generated from to achieve this? In terms of economic accessibility (affordability): How will the party increase affordability of health care? Considering that budgetary resources for health may never be enough to adequately fund health care services, how else will the party improve financing for health? Nigeria’s out-of-pocket health expenditure is about 72 per cent of total health expenditure, which is one of the highest in the world, at a time the country has acquired the notoriety of having the largest population of the poor in the world.
The Committee on Economic, Social and Cultural Rights states that “Health facilities, goods and services must be affordable for all. Payment for health care services, as well as services related to the underlying determinants of health has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups. Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households”. Also, “The committee … states that even in times of severe resource constraints, the vulnerable members of society must be protected by the adoption of relatively low cost targeted programmes.”
Political parties and candidates need to disclose to Nigerians their plans for improving health insurance as the current coverage of both public and private health insurance is less than five per cent of the population. Health insurance and prepaid health care pool resources from a large number of insured for the treatment of persons who need the services; facilitate access to health care and reduces the burden of out-of pocket-expenditure. For health insurance to be effective, it has to be universal and compulsory while the state intervenes to provide resources for the poorest of the poor who cannot afford to pay the premiums.
Nigeria is heavily indebted and its debt to revenue ratio is more than 40 per cent. The Federal Government has been borrowing money from the World Bank and other sources to finance health sector activities. Examples include the borrowing of $200m to fund vaccines procurement in 2015 and the $500m loan being used for the Saving One Million Lives Programme-for-Results (SOMLPforR). How would the political parties and candidates respond to this development? Would the parties continue to borrow for health care? Although the health programmes are laudable, borrowing for health care financing is not sustainable.The candidates should think through innovative local resource mobilisation mechanisms to fund the health sector sustainably. This will include expansion of non-oil revenue. Creation of the enabling environment for the organised private sector and small businesses to thrive may help to improve the revenue profile of the country and improve quality of life.
Nigerians need to find out the position of the parties and candidates on the Basic Health Care Provision Fund (BHCPF). Section 11 of the National Health Act provides for a BHCPF as follows: (1) There is hereby established a Basic Health Care Provision Fund (in this Act referred to as “the Fund). (2) The Basic Health Care Provision Fund shall be financed from – (a) Federal Government annual grant of not less than one per cent of its Consolidated Revenue Fund; (b) grants by international development partners; and (c) funds from any other source. The stated percentage of the Federal Government grant is the minimum and not the maximum, meaning that it can be increased. What other sources as stated in subsection (d) can the party exploit in increasing funding for the BHCPF? What percentage of the Consolidated Revenue Fund will the party commit to the BHCPF? If there are plans for the expansion of funds available under the BHCPF, what strategies would the party use in the expansion?
Considering the experiences of states in accessing the Universal Basic Education Fund, parties need to be interrogated on how they intend to operationalise and improve access to the BHCPF? The UBEC fund is available but states, due to a number of reasons, are not accessing the idle funds.The National Health Act in Section 11 states: “(5) For any State or Local Government to qualify for a block grant pursuant to subsection pursuant to subsection (1) of this section, such State or Local Government shall contribute (a) in the case of a State, not less than 25 per cent of the total cost of the project; (b) in the case of a Local Government, not less than 25 per cent of the total cost of the project as their commitment in the execution of such project. (6) The National Primary Health Care Development Agency shall not disburse money to any (a) Local Government Health Authority if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of this Act; (b) State or Local Government that fails to contribute its counterpart funding; and (c) States and Local Governments that fail to implement the National Health Policy, norms, standards and guidelines prescribed by the National Council on Health”.
In conclusion, political parties and candidates need to develop a governance and political agenda for health. We cannot afford to continue on a muddle through approach which simply seeks to get power and later think of how to solve health challenges. Let the agenda be unveiled and let the health funding debate begin.