Will the Nigerian Senate Get it Right on Health Care?

The timeless aphorism says that health is wealth, yet one of the biggest challenges facing Nigeria since independence has been the country’s inability to guarantee affordable and universal health care to its citizens. Little wonder that we are consistently ranked in the comity of poor nations? Access to health care is not only important, it is also fundamental to all areas of social development, from combating poverty to achieving a high standard of living.

In May 2017, the Nigeria Academy of Pharmacy in partnership with the Pharmaceutical Society of Nigeria organised a symposium in Lagos, tagged, “Health of the Nation – the imperative of Inter-professional collaboration.” The keynote address delivered by Prof. Eyitayo Lambo, a former Minister of Health and foremost health economist, was revealing and damning. Nigeria, said Lambo, was ranked 187 among 191 countries by the World Health Organisation in 2000. X-raying the sundry challenges which the nation’s health system has had to face over the years, Lambo noted that the constitution makes very scant provision for health while there is hardly any legislation that defines the roles and responsibilities of the three tiers of government, while adding that the National Health Act 2014 has not resolved the problem.

In Nigeria today, demands on the health care systems have increased alarmingly and health care organisations are feeling overwhelmed and pressured to provide more timely services while at the same time working with limited human and financial resources. There is an urgent need to strengthen national health systems and improve health outcomes for the citizenry.

According to data from the National Demographic Health Surveys, in a research conducted by the National Bureau of Statistics, about 900,000 children and mothers die each year in Nigeria from health reasons that could often have been successfully resolved with an effective health care system. Nigeria contributes just under 15 per cent of all maternal deaths globally and about 13 per cent of all under-five deaths worldwide. If we are to challenge these grim statistics, then we must get good health care into every home.

Along these lines, the weakness and gaping holes in our health system especially from an insurance point of view are evidently manifest in the rise of crowd-funded medical cases. Remember Mayowa of the blessed memory, Baby Ade and most recently, Sadiq Daba as well as the many other Nigerians who have resorted to platforms like Gofundme to raise funds for medical reasons. While Nigeria has several private health care providers, their service, expensive and limited, are largely exclusive to the well-to-do citizens residing in the cities and urban areas. The National Health Insurance Scheme, which largely caters to public service employees, is also, as currently constituted, very limited in scope.

Neither existing solutions can cater to the health care needs of the majority of Nigerians, who are either rural dwellers, unemployed or involved in the informal sector. In view of the aforementioned, the importance of reforming our health care system cannot be overemphasised.

Fortunately, it would seem that the need to get our health care system right is fast rising on our list of national priorities and gaining attention in the right quarters. With our population growing astronomically, urbanisation more rapid than ever, there is now a greater call for social development to catch up with societal expansion. It therefore gladdens the heart to see some level of advocacy in the National Assembly where senators are tabling bills and debating ideas on how to get an efficient and effective health care system for every Nigerian.

Recently, Senate President Bukola Saraki stated that one of the best ways to achieve Universal Health Coverage was to provide health insurance scheme to the informal sector. Perhaps, he is drawing from his experience as the Governor of Kwara State, when he introduced the Informal Health Insurance Scheme to cater to people in the rural areas. To see Saraki leading the charge and leading his colleagues in the Upper Chamber with the same drive and determination to see health care extended to every man, woman and child who is Nigerian is a clean break from the selfish toga with which the Red Chamber had been adorned.

The ongoing amendment of the National Health Insurance Scheme is evidence of moving from passion to action. Central to this bill, which seeks to repeal the National Health Insurance Scheme Act and enact the National Health Insurance Commission Bill 2017, is the need to ensure a more effective implementation of a health insurance policy that enhances greater access to health care services for all Nigerians. This means that the bill would lay down the framework for a universal health care system where everyone pays into the insurance scheme and everyone gets quality health care delivery, regardless of their employment status or personal wealth. The bill is also geared towards effectively regulating private health insurance providers in Nigeria to ensure that they deliver, not just for the well-to-do, but also the poor and people in rural areas.

In December, the Senate Committee on Health held a public hearing on the amendment, which was well-attended by the representatives of public and private health institutions, regulatory and professional bodies as well as labour and trade unions. At the public hearing, the Senate Committee Chairman on Health, Senator Olanrewaju Tejuoso, disclosed that in order to ensure that Nigeria attains the Universal Health Coverage, the Senate had passed a resolution mandating the Appropriation Committee of the Senate to make provision for the Basic Health Care Provision Fund in the 2018 budget. This is a crucial step towards achieving the objective of the National Health Act, signed into law in 2014, which stipulates that one per cent consolidated fund for the improvement of Primary Health Care services through the Basic Health Care Provision Fund. This consolidated fund means that in addition to what it gets from the annual budget, health care would also gain more financing going forward.

Going forward to achieve universal health care will never be an easy road, but staying on our current path is much worse. This is why we all, as Nigerians, must follow and actively support the Senate’s resolution, passed last year, to implement the Basic Health Care Provision Fund. At the heart of this resolution is the fundamental principle that to achieve a healthy, and thereby prosperous, society, we need cross-subsidisation and solidarity in health care, whereby the rich support the poor, the well support the sick and the haves support the haves not. Senate bills, Acts and resolutions cannot on their own bring these principles to life, they need the active support and buy-in of the general public.