‘Nigerians should enforce their right to health care’

Serah Makka-Ugbabe is the country director of ONE, an international advocacy and campaigning organization focused on ending poverty and preventable diseases, especially in Africa. As Nigeria joins the rest of the world to mark this year’s World Health Day today, she speaks on how Nigeria can achieve Universal Health Coverage (UHC), why healthcare response should […]

Serah Makka-Ugbabe is the country director of ONE, an international advocacy and campaigning organization focused on ending poverty and preventable diseases, especially in Africa. As Nigeria joins the rest of the world to mark this year’s World Health Day today, she speaks on how Nigeria can achieve Universal Health Coverage (UHC), why healthcare response should not be left to government alone and the activities of ONE in Nigeria, among others.

Daily Trust: What is your take on universal health coverage?

Serah Makka-Ugbabe: Right now, Nigerians pay 70 percent of their healthcare bills out of their pockets. The cost of taking care of our health is too high. It is higher than other countries of the world. In fact, Nigeria contributes less to our health per person than South Sudan. 

Universal Health Coverage (UHC) means that I and you can walk into a health care centre, and the bill for our health care is affordable. 

That means we don’t have to choose between getting treatment for malaria and eating, it should be affordable and accessible. Universal Health Coverage means there is functional primary health care centres with doctors, nurses and commodities, and that we can get care. 

Universal health coverage should actually cover everybody. So how do we reduce the cost of care and increase the access to care, so that you don’t have to travel far to get good quality care and you don’t have to spend too much money to treat your children, women and others?

We need to work on our health insurance. The National Health Insurance Scheme (NHIS) is still covering single digit Nigerians. There are only five percent of Nigerians accessing health insurance, which means 95 percent of us are paying out of pocket. 

There is also the issue of doctors leaving Nigeria to go elsewhere because the environment is not conducive enough for them to operate as they should.

All these are elements that the National Health Act (NHA) seeks to address.

We are not asking for new polices, we are asking for implementation of our existing policies. 

DT: The theme of this year’s World Health Day is Universal Health Coverage. In what ways can Nigeria achieve it?

Makka-Ugbabe: Firstly, we need to improve funding for the health sector.  The National Health Act (NHA) established an organizational and management structure for the health system in Nigeria, including funding provisions. 

Specifically, the act created the Basic Health Care Provision Fund (BHCPF) and stipulated that funding of the Basic Health Care Provision Fund is to be derived from contributions that include an annual statutory transfer from the Federal Government of Nigeria of not less than one per cent (1%) of its Consolidated Revenue Fund (CRF). 

Full funding of the Basic Health Care Provision Fund would provide a Basic Minimum Package of Health Services (BMPHS) to citizens, in eligible primary or secondary health care facilities through the National Health Insurance Scheme (NHIS). The Basic Minimum Package of Health Services is a set of preventive, protective, curative and rehabilitative health services or interventions published from time to time by the Minister of Health, after consultation with the National Council on Health (NCH).

Unfortunately, the National Health Act has never been fully implemented since its passage (from the 2015 Budget to date) especially the budgetary provision of the Federal Government’s 1% of its revenue, resulting in the denial of these services to millions of Nigerians and the perpetuation of the country’s poor health outcomes, including millions of preventable deaths annually.

We also need to strengthen our primary health care system; it is the first place that determines the strength of our nation’s hospitals and clinics. 

The third thing is commodities, we can’t have a strong health care system without the availability of drugs, vaccines, and at the end it all boils down to funding.

With this in place, there are some basic levels of health care you should have; ante-natal care to certain extent should be free, when you are involved in an accident, no one should be asking you questions,  you are supposed to go to the hospital and get treatment, then they ask you for payment later. 

Vaccination for children under five should be at a very reasonable  price, caesarian operation, and delivery for pregnant woman should be reasonably priced and you know Nigeria is one of the places where mothers die giving birth, we are second only to India.

We have to make sure that basic health care is affordable to Nigerians, especially for those in rural areas. This is given through the primary health centers. 

Unfortunately, we focus on tertiary health care a lot in Nigeria. By that we are limiting access to good quality care. There should be primary health care centres close to where people live so that any Nigeria walking on the street can go there to access treatment. 

We are piloting the Basic Health care provision fund right now in Nigeria. 

We are starting it in three states – Abia, Niger and Osun. The pilot is important because one of the arguments of the federal government is that ‘we have never piloted this thing before, we don’t know how it is going to work, and how do we get money to cover this?’ 

However, few people said we would pilot it. The Global Financing Facility (GFF) gave us $20 million dollars to pilot it in the states. Department for International Development (DFID), Bill and Gates Foundation has added money and each of the states also added theirs.

So it is one billion naira from the donor funds and N100 million from state contributions. Each of the three states are set to pilot and test Universal Health Coverage in their respective state.

DT: In what other ways can Nigeria strengthen her health system?

Makka-Ugbabe: Health care affects all of us. It is not something that any of us can run away from. More so, we can’t leave it to just the federal government or the National Assembly.

Nigerians have to know their right to health care. They must be able to mount pressure on the National Assembly, the federal government and governors to make sure they deliver quality health care services.

Health is the business of all of us. It is not just the business of doctors or government. And if the government does not fulfill its end of the bargain, we have to use our voice.

Education and health are really tied together. ONE is working on girl child education in the northern states. I think it is also worth noting that the greater education a girl has, the less she dies giving birth. 

If you educate a girl child for additional four years, you can enable her have fewer pregnancies, and fewer children. Also the stronger we educate, the more the investment we give to them and the healthier our kids will be. 

DT: How is ONE helping to make healthcare affordable for Nigerians?

Makka-Ugbabe: We are working in four areas in Nigeria – agriculture, health care, education, and transparency and accountability. 

In the area of health care, we have been doing a campaign called #MakeNaijaStronger (MNS). It was launched in 2016 to address health funding and contracting practices and procedures in Nigeria’s health sector. 

The campaign focuses on two policy and advocacy objectives:  pressuring the executive and legislature to include a statutory transfer of at least 1% of the Consolidated Revenue Fund (CRF) of the Federal Government to the Basic Healthcare Provision Fund (BHCPF) in its budget, as provided for by the 2014 National Health Act (NHA), and secondly to pressure the executive to publicly ensure that open contracting is implemented in the health sector.

The campaign has been conducted in close collaboration with the Health Sector Reform Coalition (HSRC) and several civil societies organization. 

 We want to make sure that there is transparency in health care. And an open contract is a good way to start. 

DT: In what ways have you achieved the set target?

Makka-Ugbabe: The federal government has not been forthcoming with making sure that the one percent is in the budget, which is why we keep applying pressure, and stressing how important it is. 

However, the National Assembly has been very supportive. The Senate President, Saraki;  the chairman Senate committee on health, Senator Tejusosho and  House chair health services, Hon. Chike Okafor, have all assured us they will put the 1% in the 2018 budget but you know how our budget works,  it will still have to go to the executive for assent.

For many years now, other countries have been putting money into Nigeria’s health care system. Nigerians need to tell government that other people cannot care about us more than we care about ourselves.