If there is one discuss currently dominating the global health space in the 21st century, it is Universal Health Coverage (UHC); an approach experts have said has the potential to address poor healthcare outcomes presently experienced by many countries of the world, including developing countries like Nigeria.
But as the approach continues to gain acceptance, the concern is shifting to how to finance it, and then sustain such financing, as healthcare anywhere in the world does not come cheap.
In Nigeria, for instance, the federal government and several states have keyed into the concept, which resulted in the birthing of the Basic Health Care Provisions Fund (BHCPF), states and national health insurance schemes, among other programmes, which are tools towards achieving UHC.
However, Nigeria’s push towards UHC is not coming on a platter. It is still a work in progress, with its heroes continually devising means towards expanding it across the country, especially to rural and hard to reach areas of the country.
Some of such heroes are the Federal Ministry of Health, led by Prof. Isaac Adewole, state ministries of health, development partners, including the World Bank Group, THISDAY Newspapers, the presidency, and a host of other stakeholders and bodies.
One other striking force behind all these is the Senate Committee on Health, led by its Chairman, Senator Lanre Tejuoso, who devoted more than half of his tenure as a senator to ensure Nigeria finally implements the National Health Act and set aside one per cent of the Consolidated Revenue Fund for the roll out of the BHCPF.
It was the setting aside of that one per cent CRF that led to the earmarking of N55.17 billion by the National Assembly, part of which the federal government has released for implementation. This is the first time since the passage of the National Health Act in 2014, that the federal government has earmarked such funds for BHCPF.
No wonder when the G20, in its last week summit in Tokyo, Japan needed one of the drivers of UHC in Nigeria to mount its global stage to share ideas on how to sustain financing of UHC, it was Tejuoso who was called upon.
Speaking at the summit, the man, now fondly called “Mr. One Percent” for the role he played in the earmarking of the one per cent of CRF to fund Nigeria’s BHCPF, said to achieve UHC, countries must provide quality health services and offer financial protection to enable people afford the services, adding that to do this; the system must minimise leakages and wastages and ensure a robust performance management system is in place.
Tejuoso said: “Using the BHCPF as an example, funds are pooled in a single account at the Central Bank of Nigeria and transferred electronically to the frontline service delivery centres based on services rendered. This guarantees that scarce resources can be maximise and those in need benefit. Equally important, is the comfort it gives to the Ministers of Finance, that scarce resources are being deployed to improve inputs of the production functions.”
“Also, we have built a robust performance management framework that evaluates program delivery before and after payment using independent verification agencies. This further strengthens the accountability mechanisms and improves transparency around the adequacy and flow of funds,” he added.
He said to sustain financing of UHC, the ministries of health and their finance counterpart must work together.
“For Nigeria, the two ministries can work together firstly by improving the budgeting process and aligning budget items to sector priorities. The Ministries of Health and Budget and National Planning have joint meeting sessions at the beginning of every budget calendar focusing on improving the quality of the budget making process and execution rates.
“Secondly, under the BHCPF, a national steering committee comprising permanent secretaries of the Ministries of Health, Finance, Budget and National Planning, will meet regularly to provide cross-functional leadership, strategic oversight, ensure programme visibility and serve as an advocacy group for increased resource mobilisation.”
Tejuoso, who spoke on ‘Universal Health Coverage: Ensuring Sustainable
Financing and Leveraging Innovation’ told the G20 audience that Nigeria’s health outcome has stagnated over the years with the coverage of basic health interventions low, adding that, “this low coverage rates suggest either of two things – limited availability of quality services or high cost of care for the average Nigerian. For us it is both”.
He mentioned that in Nigeria, 72 per cent of health care was funded out of pocket, pushing people into further poverty or making them forego healthcare services completely, adding that this was essentially because of the low levels of public financing for healthcare.
While noting that UHC was important to the Nigerian government’s Economic Recovery and Growth Plan (ERGP), he said: “We know that countries who invest in human capital are known to reap significant economic gains. Therefore, for Nigeria to compete in a global economy it must have citizens who are healthy and productive.
“This is the reason why Nigeria developed the ERGP, which has ‘investing in its people’ as one of its three pillars. The inclusion of human capital in the ERGP, specifically health, was in recognition of the linkage between good health, productivity and economic growth.
“Based on this, the Basic Health Care Provision Fund, (a funding vehicle to enable Nigeria achieve UHC, through the provision of an explicit but guaranteed set of services for all Nigerians) was developed. The National Assembly, of which I am the Chairman Senate Committee on health appropriated one per cent of the government’s CRF to fund the program in 2018.”
As the eight Senate winds down in few months time, the Ogun State born prince will be remembered for his role in saving Nigerian mothers, children the vulnerable and the poor from preventable deaths and illnesses.