Low public funding in health exacerbates poverty, says Nigerian health minister

Nigeria's Minister of Health Isaac Adewole talks to Bennett Oghifo about the country's commitment to provide universal health coverage by 2030

By Bennett Oghifo
Published: Wednesday 28 November 2018

Basic Health Care Provision Fund guarantees that Nigerians will receive a set of high-impact services for free at the point of use. Credit: Getty Images

Why is out-of-pocket expenditure high in Nigeria? 

Nigeria's out-of-pocket expenditure is high primarily because public funding in health is low. In a large informal economy, traditional methods of revenue generation through contributions are inapplicable. At 70 per cent of total health expenditure, out-of-pocket expense in Nigeria thus exacerbates poverty. A number of other factors further contribute to this, like the way health systems are financed. There are three methods for financing healthcare-taxation, contributions through insurance and user fees (out -of-pocket expense).
In the past, Nigeria provided free healthcare to its citizens and funded this through taxation. To deal with the impact of the fiscal crunch experienced in the mid-eighties, the then government introduced the user-fee policy. User fees are not bad, as these can help reduce unnecessary usage of services just because they are free. Unfortunately, the policy faltered in its implementation, as basic services were no longer adequately financed and patients then had to pay for everything on their own.

Will Nigeria be able to fulfil Universal Health Coverage?
We are positive that the country will meet the SDG goal of Universal Health Coverage (UHC) based on the foundation we are putting in place. Enabling policies have been developed and relevant programmes are being rolled out to ensure a reduction in out-of-pocket payments for basic services. We developed the National Health Policy in 2016. The main thrust of the policy is achieving UHC. This sets the stage for strategic approaches and programme development. I must say that President Muhammadu Buhari is recognising the impact of human capital development as a driver of economic growth. In September, our National Strategic Health Development Plan committed to improve the health and overall well-being of all Nigerians was passed at the Federal Executive Council meeting.
Our health plans are supported by the Basic Health Care Provision Fund (BHCPF), which guarantees that Nigerians will receive a set of high-impact services for free at the point of use. These services, which address 70 per cent of the disease burden in the country, include ante-natal care, delivery, treatment of childhood illnesses, treatment of malaria and screening and referral for certain non-communicable diseases. In addition, BHCPF supports improvement in the quality of services at primary healthcare facilities by providing monthly operational budgets.

Where would you get funds for all these initiatives?
In 2018, four years after the National Health Act was passed and three years after it was gazetted, we managed to get 1 per cent of the Consolidated Revenue Fund (a total of US $180 million) set aside in the Appropriation Act for financing the delivery of high impact primary healthcare interventions in the country.

Investment in the health sector is also being improved through Gavi. After months of negotiations, we have received a commitment from Gavi to extend its support to Nigeria. This commitment unlocks $1.03 billion from Gavi to support Nigeria's financing of vaccine procurement and strengthening of health systems over a 10-year period. With this, I am proud to say we have secured long-term grant for procuring life-saving vaccines for our children.

This is a huge and unprecedented step in the history of Gavi, as no other country has received such a support before. I consider it a due recognition and approval of the reforms we are undertaking.

(This article was first published in the 1-15th December issue of Down To Earth under the headline 'Health for all by 2030'. It is part of a series on healthcare in Africa. See previous articles in related stories).

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