Since its launch in 2005, Nigeria’s former National Health Insurance Scheme (NHIS) and now the National Health Insurance Authority aimed to provide accessible and affordable healthcare for its citizens. However, despite these efforts, many Nigerians continue to pay out of pocket for medical expenses, leading to catastrophic health expenditures.
The country’s health care system heavily relies on out-of-pocket payments, which means that individuals and households are responsible for financing their own medical expenses. As a result, the ability to access and afford health care services is closely linked to income levels.
Low-income individuals and households often struggle to meet their health care needs due to financial constraints. They may be forced to forgo necessary medical treatments or delay seeking care, which can have detrimental effects on their health outcomes. In contrast, individuals with higher incomes generally have better access to quality health care services and are more likely to afford the associated costs.
Catastrophic health expenditure defined as healthcare costs exceeding a certain percentage of household income, has severe economic consequences. It forces individuals and families to sacrifice basic necessities, deplete savings, and suffer a loss of income and productivity. Nigeria’s health financing system relies heavily on out-of-pocket payments, with inadequate government funding and low health insurance coverage. The government’s budgetary allocation to the health sector remains well below the international benchmark of 15%, at an average of only 5%.
As a result, Nigeria faces significant challenges in achieving Universal Health Coverage (UHC). The country’s health insurance contribution to total health expenditure is a mere 2%, far below the target of 90% set for UHC. Despite the passage of the National Health Bill in 2014, which aimed to increase access to basic healthcare for vulnerable populations, many Nigerians still bear the burden of high medical expenses. Approximately 97% of the population lacks financial protection from large medical bills, particularly the less privileged and vulnerable groups.
Out-of-pocket payments for healthcare in Nigeria remain alarmingly high, accounting for over 70% of total health expenditure and more than 90% of gross private health expenditure. This heavy reliance on out-of-pocket payments restricts healthcare access, exacerbates inequality in accessing quality care, and exposes households to catastrophic health expenditures. The government’s insufficient investment in health infrastructure further compounds the problem, leading to poor access to quality healthcare services.
To address these issues, comprehensive and up-to-date studies are needed to understand the factors contributing to catastrophic health expenditures, the extent of inequality in healthcare financing, and its socio-economic determinants. Recent studies have shown that unemployed household heads, lack of health insurance, and the presence of elderly members in households increase the risk of incurring catastrophic health expenditures. Furthermore, findings indicate that inequality in healthcare financing disproportionately affects the poor, particularly in rural areas.
Health expenditure, especially the cost of malaria treatment, poses a significant burden on the Nigerian population. As malaria remains a major public health concern in the country, it is crucial to explore effective strategies that can alleviate this burden and improve the overall well-being of Nigerians.
First, expanding health insurance coverage, particularly for vulnerable populations, can greatly reduce out-of-pocket payments for malaria treatment. By enhancing the scope and reach of such the NHIA and various state health insurance initiatives, more Nigerians can access malaria treatment without facing financial hardships.
Again, implementing subsidies or waivers for malaria treatment, especially for low-income individuals and households, can significantly alleviate the financial burden. This can be achieved through partnerships with pharmaceutical companies, international organizations, and government-funded programmes. Ensuring affordable access to antimalarial medications is essential in reducing the economic strain of treatment.
Also, fostering collaborations between the public and private sectors is vital to increase the availability of affordable and quality malaria treatment. Negotiated pricing agreements with private healthcare providers can ensure access to affordable antimalarial drugs and diagnostic tests, making them more accessible to a wider population. In this regard, putting a strong focus on malaria prevention strategies can help reduce the incidence of the disease, thus decreasing the need for costly treatment. Promoting the use of insecticide-treated bed nets, indoor residual spraying, and environmental management techniques to control mosquito breeding sites is crucial. Prevention efforts can be more cost-effective in the long run and can significantly reduce the burden on healthcare resources.
Investing in research and development of new antimalarial drugs, vaccines, and diagnostic tools is essential. Encouraging local innovation and collaboration can lead to more affordable and effective solutions for malaria prevention and treatment in Nigeria. Research should also focus on identifying cost-effective interventions that can guide policymakers in allocating resources efficiently.
There is also need to activate strong political commitment to malaria control and treatment because adequate funding, policy implementation, and robust monitoring and evaluation mechanisms are necessary to address the burden of health expenditure effectively. The government should prioritize health and actively work towards reducing the economic burden on Nigerians.
Nigeria faces significant challenges in achieving universal health coverage due to high healthcare costs and limited financial protection. The reliance on out-of-pocket payments and inadequate government funding contribute to the prevalence of catastrophic health expenditures. Urgent policy measures are required to improve health insurance coverage, reduce inequality in healthcare financing, and provide financial relief for vulnerable populations. By addressing these issues, Nigeria can take significant strides towards realizing universal health coverage and ensuring affordable and accessible healthcare for all its citizens.
Okeke writes from the Centre for Social Justice (CSJ) Nigeria
