Nigeria at 58: Universal Health Coverage still a mirage

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Nigeria at 58: Universal Health Coverage still a mirage

Four days after the 58th independence anniversary of Nigeria, concerned stakeholders have expressed concern over continuous slide in the health indices of the country. Among those who appraised performance of the health sector and returned damning verdicts include the President of the Nigerian Medical Association (NMA), Dr. Francis Faduyile, Vice-President of the Joint Health Sector Unions (JOHESU), Dr. Obinna Ogbonna, President of the Pharmaceutical Society of Nigeria (PSN), Dr. Ahmed Yakasai, Dr. Bassey Enya Bassey, president of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), among others. All were unanimous in attributing the poor performance being recorded in the sector to inadequate budgetary allocation.

Similarly, they bemoaned endemic corruption in the country as part of the factors hindering progress. While blaming previous successive governments for lacking the political will to drive programmes that could turn the table in the past decades, they also blamed the current administration of President Muhammadu Buhari for failing to fully implement the 2014 National Health Act (NHA), a scheme that could guarantee Nigerians Universal Health Coverage (UHC).


UHC is a healthcare system that provides healthcare and financial protection to all citizens of a particular country. Its goal is to ensure that all people obtain health services while ensuring that the use of these services does not expose the user to financial hardship. For over 13 years that the National Health Insurance Scheme (NHIS) has been instituted, less than five per cent of Nigerians are covered, leaving over 95 per cent of the populace in the cold as most are unable to access healthcare due to out-of-pocket payment for services. The negative impact of this includes the inability to expand the number of persons covered under the NHIS, thereby hindering UHC for majority of Nigerians. Other outcomes include the record number of preventable deaths and morbidity.

Part of the programmesto ensre the UHC was promise by the administration of Buhari to construct 10,000 primary health centres (PHCs) for care delivery at all levels, the revitalisation of seven cancer treatment centres, among others. Nigerians have continued to await the actualisation of these promises while the time slips by; yet, there is nothing tangible to show that the promises would be fulfilled.

Other factors that are contributing to increase the disease burden of Nigeria include the non-certification for polio-free status. The country is still classified among the three countries that constantly transmit the child-killing paralytic disease.

Similarly, Nigeria has the second highest burden of tuberculosis (TB) in Africa and ranked 7th on the list of 30 high-burden TB countries globally.

Also, the country is considered by the WHO as habouring high burden of not only TB, but TB/HIV and multi-drug resistant (MDR-TB).

Furthermore, Nigeria is ranked as the second largest HIV epidemic nation and has the highest paediatric HIV globally.

While the chaotic drug distribution system driving drug abuse and misuse especially among youths was still on the target date of dismantling open drug markets in the country – December 2018 may not be feasible, according to the President of the Pharmaceutical Society of Nigeria (PSN), Dr. Ahmed Yakasai. “There is nothing on ground to show the readiness of the Federal Government to actualise that plan,” he added.

While other countries including the United States (US), India and China are reaping billions from natural medicine industry, traditional and herbal medicine practice in Nigeria is still wobbling, seeking recognition and integration into the healthcare system. The global herbal medicine market size was valued at USD 71.19 billion in 2016 and is expected to exhibit profitable growth over the following years.

The highlighted are just a few of the poor indices of the nation’s performance in the health sector as captured in this report.

Nigeria Medical Association (NMA)

Giving an assessment of the health sector at 58 years after the country’s independence anniversary, President of the NMA, Dr. Francis Faduyile said generally, performance in the health sector had improved: “We have more facilities in place; we have increased the number of medical personnel and various professionals are doing well in their areas.”

Besides, he praised the present governments for improving on the number of people that were getting immunisation for vaccine preventable diseases. However, Faduyile lamented that Nigeria was still very far away from where it was expected to be with regard

to chronic poor funding for health which was militating against the optimal performance of specialist facilities and medical personnel.

Again, he lamented that Nigeria has not been able to touch the grassroots people because largely, the primary health centres (PHCs) have not been very effective and “we expect the governments, especially the states to improve funding for health so that they could employ more personnel at that level for the teeming population of this country.

The president of the NMA urged the Federal Government to ensure the stability of the NHIS, saying it could pave the way for Nigerians to access healthcare anywhere without restrictions.

He said, “It is only the NHIS that can assure UHC. “This has to do with the federal and state governments as well as the communities.”

Faduyile blamed successive governments in the past five decades for their failure to actualise UHC, saying the premium they placed on health was low. “Out of the little money that the country has, governments are not interested in health particularly.

“The budget for health this year is 3.8 per cent, which is a far cry from the agreement reached by African heads of state to earmark 15 per cent of the total budget to health.”

He similarly, lamented that money budgeted for health was not being judiciously released and used.

Joint Health Sector Unions


In his view, the Vice President of the Joint Health Sector Unions (JOHESU), Dr. Obinna observed that the health indices of the country’s pre independence era were better. “We were ranked among the best in Africa and then, even nationals of some foreign countries used to come for medical tourism in Nigeria.

“But now, the reverse is the case. We are the ones going for medical tourism. Out of 190 nations in the world, Nigeria is ranked 183; it is nothing to write home about at all. As it is affecting the health sector, it is affecting our economy.”

According to him, the main factor responsible for not getting things right in the health sector was the issue of corruption. The pre-independence leaders, were having Nigeria as a project, but after independence from Britain, we are now having individuals that are having themselves as the project of Nigeria, not Nigeria as their project.

Still Speaking on the issue of corruption, Obinna said, “If we do not fund health very well, we will not be able to thrive; we will not be able to replace obsolete medical equipment that are supposed to be replaced.”

While blaming brain drain for the shortage of doctors in the country, Obinna said although, the nation was blessed with resources, but the working environment was not conducive to help bring out the best in care professionals. He consequently urged the current leaders to allocate adequate funding for health.

Based on the need to have enough manpower, Obinna lamented that many workers were overworked now because there was restriction on employment. “So, as the older ones were getting retired, we were not employing new hands. It’s really telling on our healthcare services.”

Laboratory scientists

On his part, the President of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), Dr. Bassey said based on ranking, Nigeria was the 189th country in the world. Which means smaller countries with lower GDP than Nigeria were even ahead of the country.

Looking at it from that perspective, he reasoned that Nigeria was not doing better because the country has lost all the achievements recorded in the 1960s and 70s in the health sector due to bad leadership in the health sector.

He added, “There has been continuous decline in health indices as far as Nigeria is concerned.”

Bassey asserted, “It is the leadership that will determine the budget in the health sector. It is the leadership that will determine if what is budgeted is being released. It is the leadership that will determine if what is released is properly utilised or is prioritised to fit into the major challenges we have in the health sector,” adding, “So, the leadership is a key component.”

According to him, other factors were built based on the capacity of the leadership to deliver service to the people.


The President of the Pharmaceutical Society of Nigeria (PSN), Dr. Ahmed Yakasai described the current state of the health sector as terrible.

Similarly, Yakasai reminded the Federal Government of the delayed release of the one per cent consolidated revenue that was supposed to accrue to the health sector and the implementation of the NHA. “If the government can implement these, we will be able to run the sector averagely, but the way it is, the health sector was in a very bad shape.”


While urging the federal and state governments to make effective healthcare delivery their priority, Obinna said they should follow the minimum recommendation of the African Union to earmark at least 15 per cent of the total budget to fund health. He also called for staff and equipment auditing in public health facilities from time to time, adding, “There are so many obsolete equipment that need to be replaced.” Similarly, Bassey called for the appointment of right and competent leadership, saying how the minister of health drives the policies of governance matters.

With specific focus on the activities of the chief medical directors (CMDs) and medical directors (MDs) of various tertiary health facilities, Bassey lamented that the various chief executives have commercialised care services in those hospitals. “Nigerians can no more afford care services.

He noted that if those services were no more affordable, they are no more accessible. Then, there will be nothing we can provide as far as the health care needs of the Nigerian people were concerned because these care service points have been commercialised by the CMDs and the MDs in those institutions. “

Consequently, he reasoned: “So, why can’t we be 198 out of the 194 countries in the world? That is where the issue lies.”