On December 12, the world celebrates Universal Health Coverage Day to commemorate the 5th anniversary of the unanimous United Nations resolution calling for countries to provide affordable, quality healthcare to every person, everywhere.
In Nigeria, the celebration of UHC day is somewhat overcast by the grim fact that only an estimated 1% of Nigerians have been covered by the National Health Insurance Scheme (NHIS) in the 12 years of its existence.
Despite this, there are things still worth celebrating in Nigeria when it comes to Universal Health Coverage. Recent steps signal an upward momentum in the advocacy to take Nigeria even closer to achieving UHC in Nigeria.
First of these bold acts is the memorandum approved by the National Council on Health empowering states to sign their own health insurance bills. This move was made to address the gaps in UHC caused by inadequate leadership and buy in from the state governors and the states’ lack of control over the state schemes.
In just over two years since that memorandum was signed, Lagos, Oyo, Ekiti, Delta, Bayelsa, Cross River, Akwa Ibom, Kwara, Abia, Adamawa, Kano, Anambra, Sokoto, and Enugu have passed health insurance bills tailored to meet the needs of their communities.
This unprecedented progress can largely be attributed to the tireless work of advocates and health activists who are helping spread the message to all Nigerians that health and UHC is a right, not a privilege, and a right they must demand.
Sa’Adatu Hashim is the Amira, Federation of Muslim Women Association of Nigeria (FOMWAN). During her talk at the Health Watch Forum 2018 themed The Elephant in The Room: Men as Change Agents in the Family Planning Discourse, she said that ‘’we have been targeting women who are not the decision makers, so we should really target the men because the men are our problem.’’ Listen to the rest of her talk.
The path to Universal Health Coverage is not easy, but it is worth the struggle. Today, we at Nigeria Health Watch celebrate all organizations and individuals in Nigeria that are making a difference by tirelessly working to ensure that as citizens, we realise that health is our right, that we demand it and ask to receive the healthcare we all deserve.
Of particular note is the #Health4AllNaija project on UHC, fully funded by Christian Aid UK Nigeria. The project has helped bring to the fore issues around access and costs of healthcare. According to Christian Aid, the overarching reason for its increased focus on this area is its strongly held belief that poverty eradication as well as any form of national development is dependent on the ability to achieve access to quality health care without suffering financial harm, a reality we call universal health coverage. Other efforts towards achieving Universal Health Coverage in Nigeria include the Legislative Network for Universal Health Coverage which seeks to bring together legislators from the thirty-six states of the Federation for learning, knowledge and experience sharing on a wide variety of health issues as they relate to the legislature.
Universal Health Coverage exists when all people receive the quality health services they need without suffering financial hardship. UHC combines two key elements, the first relates to people’s use of the health services they need and the second to the economic consequences of accessing that care. The need to pay for care at the point of use, whether through explicit policies on user fees or informal payments, discourages people from using services, and causes financial hardship for those that do seek care. According to health finance experts, the best way around this is to expand coverage through health insurance mechanisms where compulsory prepayments are made and subsequently pooled to spread risks. Contributions should reflect people’s ability to pay which means that there will always need to be subsidies for the poor as well as vulnerable populations.
Moving toward UHC is a political and social process. This means that advocates, who we could call ‘marketers for health’ must help people understand why UHC is in everyone’s best interest and create opportunities for marginalized groups, patients, health workers and citizens to raise their voices together. On the other hand, it is also our duty to make a strong case for UHC and the benefits it confers to all political office holders and the nation.
The awareness of and demand for UHC is clearly increasing but some political office holders may still have questions as to why they should join the bandwagon and work towards achieving UHC in Nigeria. There are several important reasons why.
For a significant proportion of the Nigerian population, access to Universal Health Coverage is literally a life or death issue. Globally, increased coverage of health services within a country has been shown to improve its health indicators and contribute to stronger economic development, including the reduction of poverty levels. For political leaders, supporting a UHC agenda can deliver considerable political benefits because the majority of the electorate, want access to affordable, good quality health services.
History has shown that courageous political leaders support UHC so that their citizens do not have to choose between staying healthy and staying out of poverty. However, it is also important to establish that smart political office holders push for UHC because ultimately, that is what the people want. Giving the people what they want earns you political mileage.
Universal Health Coverage is ultimately, a political goal rooted in the human right to health. But no right has ever been guaranteed politically until people decide to demand for it.
The need for continued improved advocacy to get Nigerians to demand for UHC can be aptly expressed in this quote from a talk by Melinda Gates; “The fact that people need something does not mean that we don’t have to make them want it.”
We at Nigeria Health Watch join our voice alongside other “marketers” for health in the continued demand for universal health coverage, until we live in a Nigeria where UHC is recognised as a fundamental right of every citizen in every state, and implemented accordingly.