The Guardian (Nigeria)
Nigeria’s healthcare in danger
WE preach it as private doctors and it is indeed true that the greatest wealth of a nation is the health of the people. This is the slogan of the Association of Nigerian Private Medical Practitioners ( ANPMP). Of all possessions of man, what can be more valuable to him than a healthy mind and body? Nothing.
The only person that is likely to hold a different opinion is the man who has never been very sick, especially that man who has not been so ill that shadows of doubt are cast over his recovery. A time always comes in the course of a severe illness that the possibility of death begins to cross the minds of the patient and his relations alike, even the doctors. At such a time, nothing else will matter to the apparently dying: Neither his millions and billions in the bank nor his choice cars, nor his position in the office or political party or government, nor his mansions nor the business connections will matter at this point. Not even food, drink or personal appearance. Such is the emptiness of life without health. Only the healthy can feel good and think and work and only the healthy can be productive and only a healthy people make a wealthy nation.
In the light of the above, the singular most strategic welfare programme a people can have is a healthcare scheme that addresses the health and wellness of the people without exception; a health programme that provides for the haves and the haves- not alike. The solution is in universal health coverage. This is a health insurance scheme that has become so successful as to cover everybody or nearly everybody in the country. Since health insurance enables individuals and families, personnel of corporate organizations and communities to make little, more readily affordable advance contributions towards their future healthcare, sickness when it strikes, is no longer a financial emergency as the affected covered person will not be required to pay out of his pocket after he has been treated in the hospital. This is because he had paid in advance for his treatment by the regular contributions he made when he was not sick. Such contributions cover him and his family the way contributions by Ministries, Departments and Agencies cover their workers and the contributions of corporate organizations cover their personnel. All that the sick person does after receiving his treatment is to sign his bill. At the end of the month, the hospital or other providers affected will send the bill to the health insurance manager, the HMO and in a system where things work well, the provider will be paid for its services within the agreed time, usually, 30 to 45 days of receiving the bill.
This is the paradigm shift from waiting to be sick to pay medical bills to planning for and paying medical bills in advance knowing that sickness is part of life, is inevitable and does not ring a bell. No one knows when and how it will come. Nobody prays for it or desires it but it comes.
Health insurance makes it possible for the rich and the poor, the young and the old, the employed and the unemployed to be covered and for all to be treated when they are ill without recourse to money. It is a non- discriminative, all inclusive concept that cares for everybody. It provides for the employed and for the unemployed, the young and the old, the able and the disabled, the very rich and the very poor.
Because of the peace of mind, the convenience and the financial security that comes with health insurance model of payment for medical expenses, the worst thing that can happen to a people is to leave them at that stage of development where they have to pay for their medical treatment out of their pocket, making access to healthcare available only to those who can afford it. This is a selective and discriminatory alternative that exposes the wider majority of the population who cannot afford their medical bills to the risk of avoidable death when sick.
Because the actualization of Universal Health Coverage in Health Insurance is true and possible and doable and has been done by the advanced world as well as by the committed developing nations of the world, the ANPMP is tacitly committed to the advocacy for Universal Health Coverage for our country.
For health insurance to succeed and for Universal Health Coverage to be actualized in any country, the scheme must be operated under the universally acceptable set conditions of health insurance, rule of law, transparency, accountability and good conscience. As a country, we are far from meeting these conditions. As an association, we are the largest medical association in Nigeria after the Nigerian Medical Association ( NMA), the largest providers of healthcare in Nigeria and the oldest medical association in the country. We are also the most available and accessible doctors in the land, the doctors that provide over 70% of the healthcare needs of the Nigerian population.
Our standpoint is advocacy with the people and with government that we channel greater energy into such good governance as will get Nigerians out of their present predicaments of a weak and poor healthcare delivery system and protect Nigerians from out of pocket payment for medical treatment.
Healthcare is in danger in Nigeria for so many reasons. They include poor funding through the consistently low budgetary allocation of less than 6% of the annual national budget rather than the prescribed minimum of 15%.
Our healthcare system administration is on the concurrent legislative list which allows the federal, state and local governments make laws on health independently. This has created a lot of conflicts in their operations. In the midst of the conflicts, progress has been slow and minimal.
Again, the law setting up the NHIS made health insurance optional and this remains one of the greatest impediments to the actualization of Universal Health Coverage. Since the inception of the NHIS as a federal government agency and the introduction of health insurance into Nigeria in 2005, no state in the country set up its own health insurance scheme to help build the critical numbers to help attain the much desired UHC until recently when the federal government enticed the states with financial compensation.
With the lure of money, many states have hurriedly put together makeshift and make- belief agencies that remain a caricature of health insurance programme. They lack ideology, sustainability index in structure and funding including population mobilization strategy. The states showed up on the health insurance scene pursuing the federal government money rather than demonstrate a clear ideology. They showed up worse than their predecessor the NHIS that they ought to be eager to learn from its mistakes and improve on its records. The atmosphere is in such disarray.
Our health insurance scheme which ought to be the answer to the numerous questions on healthcare is in jeopardy; it is defective; it is not driven on the wheels of set global standards and it is not yet meeting expected outcomes. The following are a worth considering:
Health insurance thrives by the principle of pooling of resources and sharing of risks. It takes huge numbers or populations to achieve this. The more the number of people registered for and contributing into the scheme, the more the pool of funds and the more the resources and the greater the capacity to successfully administer the program.
It is predicated on the concept that at any one time, everybody who contributed will not be sick. Indeed, in a decent society, where there is good quality of life and affordable cost of living including environmental hygiene, good food, security, a functional system, it is expected that a very small percentage of the population, not more than 5 to 10% will be sick and in need of medical care at any point in time except when there is an epidemic.
To be continued tomorrow