Inadequate funding threaten Nigeria’s UHC 2030 target

Common Well being Protection (UHC) is a world mandate geared toward making certain that everybody, all over the place can entry high quality well being providers with out struggling monetary hardship.

It’s a cornerstone of the Sustainable Improvement Targets (SDG) 3.8, which reads, “Obtain UHC, together with monetary danger safety, entry to high quality important health-care providers and entry to secure, efficient, high quality and inexpensive important medicines and vaccines for all.”

In keeping with the World Well being Organisation (WHO), UHC covers the total continuum of important well being providers, from well being promotion to prevention, therapy, rehabilitation and palliative care.

Nonetheless, with solely six years left till the 2030 goal, Nigeria, Africa’s most populous nation, faces mounting strain to fulfil its UHC dedication.

Whereas vital strides have been made by coverage reforms just like the Nationwide Well being Insurance coverage Authority Act (NHIA 2022) and the Primary Well being Care Provision Fund (BHCPF), thousands and thousands of Nigerians nonetheless grapple with inequitable entry to healthcare.

Because the world marked UHC Day on 12 December with the theme “Well being: It’s on the Authorities,” PREMIUM TIMES examines Nigeria’s journey to this point, challenges, and prospects for attaining UHC by 2030.

NHIA, a serious step

As a part of efforts to make sure well being protection for all, former President Muhammadu Buhari signed into regulation the Nationwide Well being Insurance coverage Authority Invoice 2022 on 19 Could 2022. The brand new regulation replaces the Nationwide Well being Insurance coverage Scheme (NHIS) Act, which existed for about 18 years with no vital impression.

The NHIA makes medical insurance obligatory for all residents and authorized residents and creates a mechanism to finance well being service supply for the poor and weak.

It’s one mechanism for offering monetary safety from the prices of healthcare providers, a key pillar of attaining UHC. That is particularly essential as analysis from the World Financial institution and the WHO signifies that greater than half a billion persons are pushed into excessive poverty yearly resulting from healthcare bills.

Regardless of this, in response to a 2024 survey by NOI Polls, solely about 19 in 100 Nigerians have medical insurance protection in Africa’s most populous nation.

Additionally, in response to the World Financial institution, Nigeria’s out-of-pocket healthcare expenditure stood at over 76 per cent in 2021.

Though most Nigerians are but to be coated by medical insurance, the Director-Normal of NHIA, Kelechi Ohiri, mentioned the nation has recorded vital progress in recent times.

Mr Ohiri, at a press briefing to commemorate the 2024 UHC Day, mentioned earlier than the enactment of the NHIA in 2022, Nigeria’s medical insurance protection stagnated at roughly seven per cent for almost 20 years.

He mentioned this was largely because of the restricted scope of medical insurance, which predominantly served the formal sector, leaving the poor and weak underserved.

Nonetheless, he mentioned medical insurance protection has elevated from 16.7 million to 19.2 million Nigerians – a 14 per cent progress in a few yr.

“The NHIA now goals to deal with current gaps by implementing obligatory medical insurance, growing public consciousness, and restoring belief within the system,” he mentioned.

Bolanle Faleye, chief of celebration for the USAID Native Well being System Sustainability (LHSS) mission, acknowledged the progress made by UHC initiatives however emphasised persistent gaps in monetary danger safety, equitable healthcare supply, and entry to important providers.

Mrs Falaye highlighted the burden of out-of-pocket funds, which she mentioned ought to ideally be lowered to not more than 30 per cent of complete healthcare spending.

“Out-of-pocket bills, a key barrier to UHC, stay as excessive as 76 per cent. This locations a big monetary burden on people throughout weak moments,” she mentioned.

She harassed the necessity to considerably enhance medical insurance enrolment to satisfy the 2030 UHC goal, emphasising that solely about 19 million persons are coated beneath medical insurance nationwide – a far cry from the goal.

Primary Well being Care Provision Fund (BHCPF)

Established in 2014 beneath Part 11 of the Nationwide Well being Act, the BHCPF gives funding to reinforce entry to major well being care, a important step in the direction of advancing the nation’s progress in the direction of UHC.

It was designed to be financed from at the least one per cent of the federal authorities’s Consolidated Income Fund (CRF) and different sources, together with donors’ contributions.

The Fund gives a Primary Minimal Bundle of Well being Providers (BMPHS) geared toward growing the fiscal area for well being, strengthening the nationwide well being system, significantly on the PHC degree, and making certain entry to healthcare for all.

Though the BHCPF was established in 2014, funding was not allotted for its implementation till 2018. Since then, over 8,000 major healthcare centres (PHCs) throughout the nation have benefited from the fund, in response to the Coordinating Minister of Well being and Social Welfare, Muhammad Pate.

In December final yr, Mr Pate mentioned the BHCPF would obtain at the least $2.5 billion in pooled and non-pooled financing from 2024 to 2026 to enhance the first well being system nationwide.

Through the ministerial sectoral briefing in Could, Mr Pate mentioned N260 billion has been put aside to revitalise PHCs nationwide.

Additionally, in November, he mentioned N45 billion had already been disbursed by direct amenities to the state and to serve the nation’s inhabitants.

“Beneath the PHC 2.0 reform, we’ve emphasised fairness by allocating monetary and human assets throughout over 8,000 major healthcare centres. Direct facility disbursements totalling N45 billion have been despatched to states, reaching our folks instantly,” he mentioned.

Regardless of these efforts, challenges persist in implementing and managing the BHCPF. Delayed disbursements, weak accountability mechanisms, and disparities in fund utilisation have restricted its effectiveness.

Many PHCs nationwide nonetheless lack important gear, medicines, and skilled personnel, making it troublesome for them to satisfy their communities’ calls for.

Nigeria Well being Sector Renewal Funding Initiative (NHSRII)

One yr in the past, President Bola Tinubu unveiled the Nigeria Well being Sector Renewal Funding Initiative (NHSRII) to drive Nigeria in the direction of attaining UHC by 2030.

The initiative goals to enhance inhabitants well being outcomes by the first healthcare system and improve the nation’s reproductive, maternal, and baby well being providers.

On the unveiling, Mr Pate mentioned the hunt to realize UHC and higher well being for Nigerians requires a multi-sectoral and whole-of-government method.

He mentioned the initiative will leverage the BHCPF, in partnership with state governments and improvement companions, in a transformational Sector-Extensive Method (SWAp) to enhance well being outcomes. The thought is to align assets with nationwide well being priorities, cut back duplication of efforts, and foster accountability.

Well being consultants are optimistic that the method, specializing in collaboration and coordination, will considerably impression the nation’s well being outcomes.

The Government Director of the Vaccine Community for Illness Management (VNDC), Chika Offor, mentioned the sector-wide method is commendable as a result of the federal government can’t obtain these well being aims alone.

Ms Offor mentioned all sectors, together with the personal sector, should absolutely interact within the course of.

Well being sector funding

Nigeria’s well being sector has lengthy struggled with underfunding, which stays a important barrier to attaining UHC and enhancing general well being outcomes.

In 2001, African Union (AU) member nations, together with Nigeria, dedicated to allocating at the least 15 per cent of their nationwide budgets to healthcare beneath the Abuja Declaration. Nonetheless, Nigeria has persistently fallen wanting this goal over the previous 20 years.

A assessment of the budgetary allocation to the well being sector within the final 22 years revealed that Nigeria has persistently fallen beneath the 15 per cent benchmark. In 2024, regardless of expectations for a shift in funding priorities beneath President Tinubu’s administration, the well being sector acquired simply over 5 per cent of the nationwide finances.

The low allocation to the sector has led to insufficient healthcare amenities, delays in implementing well being programmes, and chronic gaps in important providers, significantly in rural areas.

Ms Offor mentioned the well being sector is underfunded, which is why it’s underperforming. She famous that almost all of youngsters are nonetheless unimmunised due to an absence of ample funding within the well being system.

“As Nigeria approaches the 2030 UHC goal, this shortfall in funding continues to undermine efforts to enhance life expectancy, cut back maternal and toddler mortality charges, and strengthen the nation’s general well being infrastructure,” she mentioned.

Workforce disaster, mind drain

One of the vital urgent challenges dealing with Nigeria’s well being sector is the continued workforce disaster. A important scarcity of expert healthcare professionals, significantly medical doctors and nurses, has undermined efforts to realize UHC and ship high quality care nationwide.

The disaster is especially extreme in rural and distant areas, the place healthcare professionals are unwilling or unable to work resulting from poor infrastructure, insufficient compensation, and restricted skilled improvement alternatives.

In consequence, many rural communities stay underserved, with little or no entry to important well being providers equivalent to maternal and baby care, therapy for infectious ailments, and power illness administration.

Along with these geographical disparities, Nigeria has been grappling with an growing exodus of healthcare professionals, particularly medical doctors, pharmacists, and nurses, to developed nations. In keeping with current stories, hundreds of healthcare professionals depart Nigeria yearly to hunt higher alternatives overseas.

In March, Mr Pate disclosed that about 16,000 medical doctors had left the nation within the final 5 years, noting that Nigeria now has solely 55,000 licensed medical doctors to serve its rising inhabitants of over 200 million.

The mass exodus of expert healthcare professionals, which has additional strained the nation’s healthcare system, is pushed by poor working circumstances, low salaries, restricted profession development, and insecurity.

In keeping with Mohammad Mohammad, president of the Medical and Dental Consultants Affiliation of Nigeria (MDCAN), fewer than 10 per cent of PHCs have medical doctors, and specialist shortages at major and secondary healthcare ranges intensify the disaster.

Mr Mohammad, a surgeon, harassed the necessity for deliberate methods to retain healthcare staff and incentivise rural postings.

“Out of the 110,000 registered medical doctors inducted by MDCN, solely about 40,000 stay in Nigeria. This uneven distribution will increase workloads, resulting in burnout and compromising the standard of care.”

Dependence on donor funding

Nigeria’s well being sector has traditionally relied closely on donor funding to maintain many programmes. Contributions from worldwide organisations just like the World Fund, Gavi, and USAID have performed a significant function in addressing the nation’s urgent well being wants.

These funds help a good portion of immunisation initiatives, making certain thousands and thousands of youngsters obtain life-saving vaccines, and contribute extensively to HIV/AIDS programmes, amongst different well being interventions.

Whereas donor contributions have been instrumental, this heavy reliance poses vital dangers to the sustainability of Nigeria’s well being system. Unpredictable funding flows – usually influenced by world financial challenges and shifting well being priorities in donor nations – may end up in abrupt programme disruptions.

As an illustration, in 2021, the UK introduced it could withdraw its annual £3 million from the basket fund for Household Planning (FP) commodities in Nigeria. This choice left the Nigerian authorities scrambling to bridge the funding hole, which jeopardised girls’s entry to important contraceptives.

Such reliance additionally limits home possession, making it difficult for Nigeria to determine and maintain domestically pushed well being initiatives.

Well being consultants imagine that attaining UHC by 2030 requires Nigeria to take the lead in financing its well being system.

The Government Director of VNDC, Ms Offor, harassed the significance of transitioning from donor-dependent programmes to sustainable, domestically financed initiatives.

“By taking the lead in financing its well being system, Nigeria would have larger management over its well being priorities and useful resource allocation,” she mentioned.

She mentioned overcoming this dependency will necessitate elevated funding within the well being sector, strategic partnerships with the personal sector, and sustainable funding mechanisms to make sure continuity and resilience in healthcare supply.

She added that this shift is important for attaining UHC, strengthening Nigeria’s well being sovereignty and making certain long-term well being outcomes will not be on the mercy of exterior selections.