Nigeria is on its way to critical elections in February 2023. Now is the time for aspirants, candidates and political parties to ask for votes and support. It is also an opportunity for the citizens, being the electorate, to ask critical questions and bring up core issues of interest to the front burner. One of such critical issues is the state of health services.
Politicians will come and promise free, quality and acceptable health services, but the central question we need to ask is; how will the services be funded and where will the human, material and financial resources be generated to achieve this? How will the party increase the affordability of health care?
Considering that budgetary resources for health may never be enough to adequately fund health care services, how else will the party improve financing for health? Nigeria’s out-of-pocket health expenditure is about 72 per cent of total health expenditure, which is one of the highest in the world. Therefore, political parties and candidates need to disclose to Nigerians their plans for improving health insurance as the current coverage of both public and private health insurance is less than five per cent of the population.
Health insurance and prepaid health care pool resources from a large number of insured for the treatment of persons who need the services; facilitate access to health care and reduce the burden of out-of pocket-expenditure. For health insurance to be effective, it has to be universal and compulsory while the state intervenes to provide resources for the poorest of the poor who cannot afford to pay the premiums.
Nigeria is heavily indebted both at home and abroad. How will the political parties and candidates respond to this development? Would they continue to borrow for health care? Nigerians need to find out the position of the parties and candidates on the Basic Health Care Provision Fund (BHCPF).
Section 11 of the National Health Act provides for a Basic Health Care Provision Fund (BHCPF) to be financed by (a) Federal Government annual grant of not less than one per cent of its Consolidated Revenue Fund; (b) grants by international development partners; and (c) funds from any other source. The stated percentage of the Federal Government grant is the minimum and not the maximum, meaning that it can be increased. What other sources as stated in subsection (d) can the party exploit in increasing funding for the BHCPF? What percentage of the Consolidated Revenue Fund will the party commit to the BHCPF? If there are plans for the expansion of funds available under the BHCPF, what strategies would the party use in the expansion?
The political parties and candidates need to develop a governance and political agenda for health. We cannot afford to continue on a muddle through approach which simply seeks to get power and later think of how to solve health challenges.
In May this year, the President signed into law the new National Health Insurance Authority Act of 2022. Section 3 (b) of the NHIA Act, under the functions of the Authority, provides for the NHIA to ensure mandatory health insurance for every Nigerian and the country’s legal residents.
It means that every Nigerian is now mandated by law to get health insurance! Specifically, the Act requires all employers and employees in the public and private sectors with five staff and above, informal sector employees and all other residents in Nigeria to get health insurance.
The major difference between health insurance and out-of-pocket health expenditure is that out-of-pocket health expenditure insists that patients pay upfront to access health care services whilst health insurance provides the insured access to health care services which payments would be settled from the pool of contributions paid by all the insured in the health plan.
One advantage of compulsory health insurance is that it is a gateway to universal health coverage. The World Health Organisation defines universal health coverage as a situation where everyone has access to the health care services they require; at the time and place they require them without financial hardship.
UHC safeguards all people from public health risks and protects all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick.
Improved health outcomes hinge on the possibility of attaining UHC in that as more persons are covered, their basic health needs are met. Protecting people from the financial hardship of having to make out-of-pocket expenditures for health services reduces the risk of their sliding into poverty when unexpected ill-health necessitates using up life savings, selling assets, or even borrowing.
However, despite the mandatory nature of the scheme, there will still be citizens who due to their special financial and physical circumstances, may not be able to afford the premium to make them eligible to be covered by a health insurance scheme.
This is where the core obligation of the state on the right to the highest attainable state of physical and mental health kicks in to ensure that special equity funds established under the law will fill the gap. This ensures that such persons access at the very minimum, the minimum package of care provided in the National Health Act. Section 25 of the National Health Insurance Authority Act provides for the vulnerable group fund.
At the signing of the Act in May, President Buhari promised to set up the Vulnerable Group Fund “to ensure coverage of 83 million poor Nigerians who cannot afford to pay premiums.”
Funding from the VGF will come from a component of the Basic Health Care Provision Fund due to the Authority, Health Insurance Levy, Special Intervention Fund, and any investment proceeds, donations and gifts to the Authority.” This means that The Federal, States, Local Governments, Development Partners and private organisations will pay contributions in advance into the Vulnerable Group Fund.
Vulnerable Group Social Health Insurance Programme is designed to provide health care services to persons who due to their physical status (including age) cannot engage in any meaningful economic activity.
They include the following: 1. Physically/Mentally Challenged Persons who due to their physical status cannot engage in any meaningful economic activity. 2. Prison Inmates Social Health Insurance Programme (PISHIP. 3. Children Under Five (5) Social Health Insurance Programme (CUFSHIP). 4. Pregnant Women 5. The aged.
Surprisingly, the take-off grant in the Special Intervention Fund for the Vulnerable Group Fund provided in section 25 of the National Health Insurance Authority Act was missing from the health budget proposals. It is also not provided in the Service Wide Votes.
The implication is that the Federal Government is not ready to kick-start the fund considering that the BHCPF, which is one the sources of its funding, is merely recycling existing resources already created by the National Health Act. It is not new, or more money for health. The imperative of this special intervention fund is the leveraging power it can bring to bear on the VGF. The activation of the Fund and indeed the compulsory health insurance regime of the National Health Insurance Authority are expected to pool trillions of naira every year in new funds to the health sector. The minimum the government can do at this time of lean resources is to activate this new source of funding, which can reduce the pressure on unavailable public finances.
Okeke writes from the Centre for Social Justice (CSJ) Nigeria.