Achieving UHC through Nigeria National Health Policy 2016

Achieving UHC through Nigeria National Health Policy 2016

Temitope Musowo, Lagos

The current population of Nigeria based on the latest United Nations estimate is 199,783,091. While many people may be seeing this from a negative perspective when placed side by side with other indices, however, an increasing population could be an advantage only to the extent that it is healthy and productive. 

Good health is essential to sustained economic and social development, as well as poverty reduction. Access to needed health services is crucial for maintaining and improving health. 

Therefore, achieving Universal Health Coverage (UHC) is an important objective for all countries to attain equitable and sustainable health outcomes and improve the well-being of individuals and communities.

Universal Health Coverage is defined as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose their user to financial hardship.

Consequently, UHC has become a major goal for health reform in many countries and a priority objective of World Health Organisation (WHO). This necessitated the review of the Nigeria National Health Policy 2014 (NNHP 2014) in the year 2016 to embrace the UHC.

The National Health Policy 2016 is a comprehensive health document that spells out the functions and responsibilities of all levels of government.  The overall goal of the policy was to strengthen Nigeria’s health system particularly the primary healthcare sub-system to deliver qualitative, efficient and comprehensive healthcare services to all Nigerians.

Government’s effort and the National Health Act 2014

The National Health Act 2014 took a long period from 2004 to 2014 before coming to existence. This is a document that set out a legal framework for the provision of health services, a strong potential to transforming health care provision in Nigeria. 

On 22 of June 2016, there was a meeting on the National Health Policy in Abuja where the finalization of the National Health Policy was revised for the attainment of Universal Health Coverage (UHC).

During the Abuja stakeholders’ meeting that was chaired by the Minister of Health who was represented by the Permanent Secretary in the Federal Ministry of Health (FMOH), Dr. Amina Shamaki, who stated that prior to the current National Health Policy document, Nigeria had developed and implemented two others in 1988 and 2004. Both were said to be developed at a critical stages in the evolution of Nigeria health system and had far reaching impact on the system over the course of their lifetime.

The Minister noted that over the last two decades and half, Nigeria has recorded some progress in the performance of the health system, while he assured of a good foundation and that Nigeria is in the right direction as the country earnestly seeks to achieve the visionary goal of UHC.    

With a recurrent expenditure of N315.62 billion for the ministry of health in the 2019 appropriation bill, about 46.3 billion increase from the last year’s recurrent expenditure, which was N269.3 billion. Can we then say the government is committed to the attainment of the UHC?

Achieving UHC in Nigeria still a challenge

Despite government’s efforts at attaining the UHC, Nigeria still face challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One of such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians.

Only a small proportion of Nigerians have prepaid health care. Quality health care of course answers to adequate funding, sufficient manpower, effective monitoring and proper regulation, all these seems to be a challenge in the Nigeria health system giving the fact that Nigeria health sector is largely public sector driven. 

According to a Public Health Physician & Senior Lecturer Dept. of Health Policy and Management, College of Medicine, University of Ibadan, Dr Oluwaseun Akinyemi, who was speaking on the challenges of attaining the UHC in Nigeria.

He said apart from poor funding, one of the major challenges is health care resource allocation in Nigeria which he said is skewed in favour of secondary and tertiary care as against primary care and Primary Health Centres (PHC).  A direct consequence of this according Dr Akinyemi is that most people bypass PHC facilities to seek primary care at secondary and tertiary facilities, a situation he said promotes inefficiency and inequities

Dr Akinyemi talking about health inequality in Nigeria also mentioned the distribution of health workforce in Nigeria which he said is also skewed in favour of secondary and tertiary facilities located in urban areas as incentives for health workers to accept rural postings are often nonexistent or poorly applied.

‘’The government does very little to control the geographic location of health facilities by both private and public sector owners leading to allocation inefficiency: Overprovision in some areas while other areas are not covered’’.

The absence of social security for vulnerable groups, regressive taxation, poor planning and targeting of public funding for health, corruption, and lack of coordination across the three tiers of government, he said all contributing to health inequality slowing Nigeria down in the journey to attaining Universal Health Coverage.

Meanwhile, during the Abuja meeting of 22^nd June, 2016 that witnessed the National Health Policy revised for the attainment of Universal Health Coverage (UCH) and other health-related Sustainable Development Goals (SDGs). The minister of health, Prof. Isaac Adewole urged state governors to allocate at least 15 per cent of their annual budget to the health sector in line with Abuja declaration, for the implementation of National Health Policy.

He said the Federal Government is going to allocate at least one per cent of the Consolidated Revenue Fund for the establishment of the Basic Healthcare Provision Fund as provided by National Health Act 2014. He called on state governors to ensure timely release and disbursement of allocated funds for health to achieve the objective of the National Health Policy.

It remained to be seen whether the three tiers of government are committed to the terms of the Abuja declaration and the National Health Act 2014.