Report by the Global Health Expenditure Database 2018 published by the World Health Organisation has shown that Nigeria may not achieve universal health coverage as out-of- pocket payment for healthcare peaks at 76.6 percent.
The report shows that Nigeria’s expenditure on healthcare has not significantly improved over the years despite the Federal Government’s pledge to achieve universal health coverage by 2030.
Experts say meeting the goals of universal health coverage can only be achieved when access to health services and financial risk protection are equitably addressed.
Equitable financial protection, they say, means that everyone, irrespective of their level of income, is free from financial hardship caused by accessing needed health services.
But the WHO report shows that out-of-pocket spending continues to be a major component of health spending in low- and middle-income countries like Nigeria.
The WHO defines out-of-pocket payments as direct payments made by individuals to health care providers at the time of service use.
It warned that unregulated direct charges often constitute a major access barrier to needed health care and contribute to high out-of-pocket payments, generating problems of financial protection.
According to peer-reviewed online journal The Lancet, about 70 percent of Nigerians are living in poverty, and out-of-pocket payments can make households and individuals incur catastrophic health expenditure and this can exacerbate the level of poverty.
The Minister of Health, Dr. Osagie Ehanire had, last year, reiterated Federal Government’s commitment to scaling up UHC in the country through the National Health Insurance Scheme.
“This is to ensure the attainment of UHC and to address human resources gap in the facilities we have,” Ehanire had said.
The WHO report notes that health spending (percentage Gross Domestic Product) for 2017 in Nigeria was 3.76 per cent, while that of 2018 was 3.89 per cent.
Out-of- pocket payment for healthcare in 2017, according to the report, was 77.22 per cent, while that of 2018 stood at 76.6 per cent.
For health spending per capita, the report put that of 2017 at $81.41, while that of 2018 was $83.75.
Findings by PUNCH HealthWise showed that Nigeria has not been able to meet the 2001 Abuja Declaration by African leaders and the World Health Organisation’s stipulation to allocate at least 15 per cent of yearly national budgets to health.
Nigeria hosted the Heads of State of member countries of the African Union in 2001 who made the “Abuja Declaration” under which the leaders pledged to commit at least 15 percent of their annual budgets to improving their individual nation’s health sector.
Since the declaration, Nigeria has not attained the pledged funding benchmark, not even in the N512. 21bn the Federal Government allocated to health in the 2021 budget, which experts say was inadequate and below the 15 per cent benchmark.
Reacting, the Association of General and Private Medical Practitioners of Nigeria said the Federal Government’s N512. 21bn allocations to health in the 2021 budget estimate would not galvanise desired development in the sector.
President Muhammadu Buhari had, on October 8, presented N13.8trn as 2021 budget estimate to a joint session of the National Assembly.
The proposed allocation to the health sector in the budget was N512. 21bn for both current and capital expenditure, and N35bn for the Basic Health Care Provision Fund.
Speaking in an interview with PUNCH Healthwise, National President, Healthcare Providers Association of Nigeria, Dr. Jimmy Arigbabuwo, said in order to have improved health budget that will reduce out-of-pocket payment for healthcare in Nigeria, the government must have the political will and make health insurance work.
Increase in health budget, Arigbabuwo noted, is critical to the country’s attainment of universal health care.
He said, “Out-of-pocket payment for healthcare in Nigeria’s health system is not new, but it has gotten to a skyrocketing level. It is a reflection that the government has a role to play in improving social services.
“Access to good health is a basic fundamental human right. We have been dancing around three to six percent in our health budget, which is against the 2001 Abuja Declaration. We need health insurance to achieve universal health care.”
Arigbabuwo maintained that to improve the health of citizens and reduce out-of pocket payments for health, there must be more focus on funding, health insurance, manpower, adequate equipment and infrastructure.
Another medical practitioner, Dr. Tunji Akintade, gave reasons for the high out-of-pocket payment for healthcare in Nigeria.
“First, it is not our culture to save for health. We also have the culture of ‘it is not my portion;’ so, health insurance is alien to us.
“Therefore, we need more enlightenment. People do not believe in insurance generally,” Akintade said.
He called on the government to invest more in health and make health insurance compulsory.
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