Memo to President Jonathan on healthcare

The National Health Insurance Scheme (NHIS), which is a social health insurance programme established by Decree 35 of 1999 and was kick-started in September 2005 by former president Olusegun Obasanjo to provide health services to the formal sector as well as complement sources of financing health and improving access, has only provided coverage for less […]

The National Health Insurance Scheme (NHIS), which is a social health insurance programme established by Decree 35 of 1999 and was kick-started in September 2005 by former president Olusegun Obasanjo to provide health services to the formal sector as well as complement sources of financing health and improving access, has only provided coverage for less than 10 per cent of the Nigerian population. Achieving universal health coverage and maintaining it once it has been achieved is no doubt a daunting task but the following are steps President Jonathan can take to provide access to healthcare for the over 90 per cent of Nigerians who are either uninsured or underinsured.
Firstly, increase spending on disease prevention services and public health and ensure that curative services do not suffer as a result of this. The health of the Nigerian people must be a national priority. Though there are other issues that are begging for government’s attention, increasing budgetary allocation for the health sector to at least 12 per cent and at most 13 per cent of the GDP will go a long way in providing preventive services to the citizens. Research has shown that there is a strong correlation between the health of a nation’s citizens and its development and this is neither a myth nor fallacy. If we must experience economic growth, the Nigerian government must take the health of its citizens seriously. Government can give a directive that at least 50 per cent of health budget should be allocated to preventive services rather than be silent on the issue of resource allocation within health sector which clusters around curative services.
Secondly, scale-up community-based health insurance schemes across the federation. The National Health Insurance Scheme has so far only been able to provide coverage to about 10 per cent of Nigerians leaving majority of whom are in the informal sector to incur catastrophic expenses. The Federal Government needs to ensure that those in the informal sector are covered and provide safety nets for poor Nigerians who constitute about 65 per cent of our population in order to increase access to healthcare for the people. Most Nigerians are confronted with catastrophic expenses due to lack of social protection which makes them pay out-of-pocket. Besides, out-of-pocket payment for healthcare increases poverty. Thirdly, after several years of having the department of public health under the Federal Ministry of Health, there is a need to upgrade this department into an agency with or as part of the Federal Ministry of Health in order to focus on emergency planning and preparedness, disease prevention and control, and promotion of the health of Nigerian people. The public health agency should have its headquarters in Abuja with offices in the six geopolitical zones as well as locally throughout Nigeria. Its role will include giving advice to the public on how to stay healthy and avoid hazards; protecting the health of the public; providing emergency preparedness for new and emerging threats; providing data and information to government to help inform its decision-making etcetera. The establishment of a national public health agency will increase the capacity of Federal Ministry of Health to provide prompt and effective health interventions to Nigerians. This is necessary if government must reduce the incidence of diseases and disabilities.
Fourthly, there is an urgent need to create a public health agency in order to curtail outbreak of diseases. Fire brigade approach has led to the unnecessary deaths of Nigerians. There will always be heavy seasonal rains besides the scarcity of clean water and improper sanitation, which are public health problems that have been with us for many years; hence, the need for proper emergency planning, preparedness and response system to address public health emergencies. Fifthly, all Nigerian companies/employers should by law be mandated to pay for their employees’ healthcare insurance while the employees pay part of the cost of this insurance. Sick people who are not under insurance have to pay out of their pocket for medical care and those who cannot pay stay sick or die. There should also be a mandatory healthcare insurance for all Nigerian children. This will help reduce the rate of mortality among this vulnerable group in the society.
These suggestions, if carefully examined and carried out by Dr Jonathan, have a potential to help address the issue of inadequate access to healthcare services for most Nigerians. Taking no action at all or developing no legislation on healthcare in the executive arm of government shows that the president does not care about the health of the Nigerian people. The president’s steps towards developing legislation on healthcare and making it a law is instrumental to the achievement of the goals and objectives of the current minister of health as well as the Federal Ministry of Health.
Aregbeshola wrote from Lagos