Health Systems Strengthening is often described as improving the healthcare system of a country.
This invariably includes increasing funding of health infrastructure tied to budgetary allocation to health as a fraction of a country’s budget, in addition, improving health policy, working towards universal health coverage and all other health measures.
Nigeria’s progress towards universal health care (UHC) has been slow, with its citizens bearing high out-of-pocket health expenditures and inefficient government spending.
The journey of a thousand miles begins with a single step. Globally, many countries have taken several steps forward towards achieving the lofty goal of universal health coverage (UHC) by 2030. Those who have succeeded in progressing towards UHC have done so by investing a larger proportion of their public revenue in their health sector and increasing the efficiency of how these funds are used.
But Nigeria’s progress towards this goal has unfolded at a rather slow pace. The country’s health financing landscape is characterised by suboptimal and grossly inefficient public spending on health, and high out-of-pocket expenditure for citizens as households currently cover the cost of 77.5% of the country’s total healthcare spending. In addition, the country’s health system performance remains characteristically poor, and resources are further strained by the COVID-19 pandemic and a rapidly shrinking economy which all have negatively impacted access, availability, and the delivery of essential healthcare services.
Nigeria is placed at 142 out of 195 countries according to a Lancet report´s ranking of health systems performance using healthcare access and quality as its criteria. Nigeria also ranks poorly based on the World Bank’s Universal Health Coverage Service Coverage Index.
The problem of lack of access to quality health care is linked with wasteful use of resources. Furthermore, there is underutilization and bypassing of the primary health care facilities, as people prefer to use the hospitals. The gate keeping function of the PHC is made redundant mainly due to ineffective linkages between the different tiers of the health system.
In many cases, patients prefer to visit the secondary and the tertiary health centers, but they are more expensive and this worsens health care accessibility especially among the poor in the society.
Although access to healthcare for all Nigerians through the basic minimum package of health services is backed by the National Health Act, that package has faced huge challenges in dissemination and implementation as several State Governments are lagging in operationalizing it at ward levels.
Primary health care has been set-back due to weak governance and accountability systems, poorly remunerated health care workers, and weakly enforced transparency mechanisms and procurement laws. The suggestion that the Nigerian health sector is one of the worst sectors in terms of corrupt rating is plausible given the estimated 25% of the country´s current health expenditure of about 221 per capita in purchasing power lost due to corruption. This includes both private and public health expenditure.
Notably, where corruption exists, the implementation of actions to ensure effective delivery of health care often fails.
This is reflected in the increased cost of health services, stock-out of essential drugs and avoidable mortalities in health facilities, especially at the PHCs in the country. The Federal Ministry of Health’s ability to effectively superintend the health sector is weakened due to the lack of adequate information on health outcomes, health resources, costs and the utilization of services across the various tiers including the federal, state and local levels.
We stand with other Stakeholders such as Federal and State Ministries of Health, the Local Government Authorities, the health workers, the National Primary Health Care Development Agency, the State Primary Health Care Development Agency, the Economic and Financial Crimes Commission, and with all Nigerians in considerations on what is needed to position the country for the attainment of the Universal Health Coverage Targets; which include policy options such as revamping the PHCs and prioritizing the delivery of a basic minimum package of health care.
Furthermore, the implementation of strong actions to tackle corruption in the health sector will improve access to care and health outcomes and it does not incur extra financial investment.
This is achievable through improvement in public financial management and limiting corruption by making right choices in resource allocation towards pro-poor interventions. Similarly, well designed package of services and prioritization of primary care making best use of human resource will be beneficial. This is relevant to the Nigerian health system, leveraging the country’s decentralized administration and strengthening community health committees’ role in ensuring accountability and transparency at the PHCs.
Achieving sustained progress to UHC in Nigeria costs money and will require significant efforts at federal, state, and local government level to increase resources available and ensure that they are used as efficiently and equitably as possible. To build resilience in the wake of the pandemic, investments in health must increase while political commitments and mechanisms are institutionalised for efficiency and accountability of health spending. It is therefore imperative that the pandemic serves as a propeller of our progress towards UHC.
The relevance of accelerating progress to achieving universal health coverage in Nigeria cannot be overstated. UHC will strongly enhance access to essential health care for all population groups, especially the vulnerable and marginalised ones, strengthen Nigeria’s health security, and develop human capital leading to stronger economic growth.
NSSF is committed to building resilient health care systems through partnerships with governments, institutions, organizations, and individuals who share a common vision of a healthy, productive nation capable of preventing, responding, and recovering from health emergencies.
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