by Oluwatobi Odetola
Every Nigerian, whether rich or poor, has had contact with the public health system. A common denominator in people’s narrative on their experience is poor (or no) service – everyone has a horror story to tell about that time when either they or their relatives needed medical attention.
The abject poverty of basic consumables in our hospitals is at the very least, life-threatening. To the conspiracy theorist, it would seem as if the government is on a covert mission to kill us all. A sort of silent genocide aimed at keeping our population growth rate from going through the roof.
The problems plaguing the public healthcare are legion and it would require another piece to describe them. However, the major ones crippling the sector are those revolving around funding and human resource management.
In recent time, we have seen citizen action save the lives of people in dire need of medical care. Social media platforms have become avenues to help fellow Nigerians overcome life-threatening ailments. As someone said, each successful effort at this is a shame to the government.
However, as good as these initiatives are, they represent a mere alleviation of the symptoms. An approach that can only provide temporary relief, rather than the much sought long-lasting solution. To realise that citizen action alone cannot breathe new life into a comatose primary healthcare system, cannot seal the transcontinental pipeline that ensures medical graduate ‘escape’ to better climes is not a Nobel Prize worthy thought. It would neither improve the diagnostic capabilities of doctors nor stop them from embarking on frequent strike actions.
As with most problems facing the country, there is no silver bullet that will reverse the downward march of public health care. However, a national health insurance service that works would go a long way. Nigeria has one of the highest out-of-pocket payments for health care service worldwide, with about 60 per cent of healthcare spending coming from households. In truth, those who are unable to pay can’t access medical care – which is commonplace these days. Imagine a situation in which the family of a Danfo driver who was involved in a ghastly crash is asked to pay an initial deposit N100, 000 before he is admitted into the intensive care unit. Did I hear you say Mission Impossible 4? This amount of money may not empty the pockets of an upwardly mobile man or woman.
However, imagine another situation in which same has a child who is suffering from a leukaemia and requires a drug which will be administered four times per day for one week with the cost of each dose being N110, 000.
It is obvious that most Nigerians regardless of financial standing – excluding those pilfering private or public coffers – would require a health insurance plan that works to enable them to access quality healthcare. Health care services are expensive and beyond the reach of the ordinary man.
Even the present American government recognised the pivotal role of medical insurance in the sustenance of the health system as evidenced by its tremendous efforts in getting the Medicare law passed.
It is not that past Nigerian governments have not tried to provide social health insurance. In fact, the idea for a National Health Insurance Scheme (NHIS) was first mooted in 1962. With the help of several committees, the NHIS in its present form was established by an act of parliament in 1999 but only became operational in 2005. Presently, there are just about four million Nigerians enrolled on the scheme, most being civil servants. The NHIS has been fraught with fraud, difficulty in accessing care at designated points, poor funding (isn’t a budget of N1.6 billion such a funny joke) and inevitably, the failure to fulfil obligations to the insured.
The scheme as it is presently structured lacks the required properties to make it functional. A health insurance programme must be built on pre-requisite conditions such as coverage, revenue generation, political and public acceptability, administrative capacity, information and a culture of risk sharing.
It is clear that the NHIS is supposed to bring much more than funding to the Nigerian health sector. One major dividend would be provision of improved managerial capacity which the sector is in dire need of. Another would be a revival of the primary health sector which is central to providing Nigerians with access to quality healthcare services.
Private forays into the insurance have brought some relief with the entry of Health Maintenance Organisations (HMOs). However, in a country where the majority are either self-employed or unemployed, this is like clearing 1 m2 in a hectare of land completely covered with grass. The time has come for us to take a long hard look at the NHIS, learn from its failures and begin work on a public insurance scheme that works. But not before we develop an identification programme that is close to as being accurate as possible.
This would definitely make the difficult task of the would-be planners of the project much easier by providing essential data on demographics.
However, one must realise that a big obstacle to achieving all of these is the humungous and inefficient central government. This project appears more suited to a state government. As with most projects, its success would ensure replication in other states.
Although, this is not as simple as it is written. It would to take a progressive and determined state government to produce a semblance of a proper public health insurance programme. Not one that sees inaugurating hospital buildings and sponsoring free medical missions as sure-fire ways of improving quality of health care.
We have done #SaveMeka, #SaveOke, #SaveFunmi and there are definitely several #SaveXYZ waiting to come to our attention. It’s time we told our politicians that the commencement of project #SaveTheHealthSector can no longer be delayed.