Accelerating universal health coverage amidst COVID-19

Reports have shown that the Coronavirus (COVID-19) pandemic has further slowed the uptake of health insurance programmes, especially the National Health Insurance Scheme (NHIS) and consequently the quest for Universal Health Coverage (UHC).

Experts are concerned that 15 years after the establishment of the NHIS with the mandate to ensure UHC in Nigeria, fewer than 10 million Nigerians have any form of health insurance and more than 170 million others still pay out-of-pocket to access medical services.

To address the situation, a public health physician, health economist and Director General (DG)/ Chief Executive Officer (CEO) of Delta State Contributory Health Commission (DSCHC), Dr. Ben Nkechika, has unveiled a roadmap on how to accelerate universal health coverage in Nigeria.

The document is titled “Accelerating the Progress Towards Universal Health Coverage in Nigeria, leveraging the Opportunities and Challenges of the COVID-19 pandemic era and the journey so far from the Delta State Contributory Health Scheme.”

Nkechika, who was the guest speaker at the opening ceremony of the 40th Annual General Meeting of the Nigerian Association of Resident Doctors (NARDs), which took place for the first time in Delta State, said the COVID-19 pandemic had reawakened Nigerians consciousness of the need for a vibrant, viable, purposeful and resilient healthcare system designed to deliver quality healthcare services to all residents of the country at the best cost, all year round.

He said UHC had been identified globally as the mechanism to achieve quality “Health for All” in which no one is left behind and a well designed, structured and strategically implemented health insurance programme is the special purpose vehicle that will enable the country to achieve UHC,” he said.

Nkechika said the journey towards achieving UHC commenced with the establishment of the NHIS several years ago. “Over these several years, there has been a marginal success on the NHIS journey due to the challenges of policy inconsistencies which is now being redirected positively, a legal framework which has now been reformatted to current realities and a fragmented operating structure which is currently being redesigned to bring all health insurance activities under one roof where all entities operate within a framework that delivers a unified quality health insurance service to all Nigerians. With the current leadership of the NHIS, I believe the journey has recommenced in the right direction,” he said.

The public health physician added: “The Governor of Delta State, Dr. Ifeanyi Okowa, vigorously championed the establishment of the National Health Act (NHA) and the reinvigoration of the NHIS as Chairman Senate Committee on Health at the 7th Assembly. The ‘National Health Act’ has today become the fulcrum for an efficient and effective healthcare service system in Nigeria. The Basic Healthcare Provision Fund (BHCPF) a component of the NHA has also become a significant catalyst for achieving UHC in Nigeria especially in a post-pandemic era.

“The BHCPF is the healthcare financing programme under the NHA with a mandate to provide quality healthcare service to all Nigerians especially the poor and vulnerable in the society. Despite the several challenges in its start-up, it has remained resilient thanks to the purposeful work done and the output from the 7th Senate-Assembly Health Committee, which had his Excellency as the Chairman. With the new BHCPF guideline approved at the last National Council on Health meeting a few weeks ago for immediate implementation, I can safely say that the country is on the right path towards a vibrant, viable, purposeful and resilient healthcare system for all, irrespective of their social status in the society and their geographical location. No one should be left behind.”

Nkechika said all countries of the world have now experienced the consequences of neglecting or not giving appropriate attention to its healthcare system. “It ripples to every other sector of society. Thanks to the COVID-19 pandemic. The world economy nose-dived, social interactions became restricted, there were panic and confusion everywhere even amongst the most developed countries. No country was properly prepared for it,” he said.

The health economist said surprisingly most of the third world countries, despite their challenged healthcare system, survived the pandemic better, thanks to their local ingenuity. He hoped that Nigerians would develop the lessons learnt from this pandemic and use it to redesign the healthcare delivery processes leveraging local ingenuity.

Nkechika said Nigerians have the capacity and capability to enhance the healthcare service infrastructure, the country has the homegrown remedies that can be further refined to deliver solutions for healthcare service challenges and most important, Nigeria has vibrant human resources for health that when properly incentivised with adequate training, will deliver quality healthcare services all the time.

Nkechika said the country’s primary and secondary healthcare service delivery system must be made to function properly for quality healthcare service delivery at the tertiary level of healthcare service. He said a properly functional and quality primary and secondary healthcare service delivery system will definitely reduce service pressure and improve the efficiency of service at tertiary healthcare facilities, ensuring resource maximisation for their service requirement. “This should be our focus in the COVID-19 pandemic era,” he said.

The public health physician said the Infectious Disease Protection and Control measure consciousness of the pandemic era should continue to be a significant part of the healthcare service protocol to ensure that no doctor or health worker should die saving lives.

The DSCHC boss said Nigeria has one of the lowest public healthcare financings for health globally with 0.5 per cent of its Gross Domestic Product (GDP) as public health spending. He said the effect of COVID-19 on the economy has further adversely affected this public health spending situation but the poor public health financing situation is actually more of a non-prioritisation of spending than quantum of funds to spend.

Nkechika said the bulk of funds mobilised during the COVID-19 response should be resourced to healthcare need priority areas, to achieve a giant leap in positive health outcomes in Nigeria. For example, he said, funding to train and build capacity of doctors and other healthcare workers should be a top priority in Nigeria’s public health financing. Nkechika said a well-trained and remunerated doctor in a marginally equipped healthcare facility will achieve better outcomes with ingenuity than a poorly trained doctor in the most equipped healthcare facility.

He said the add on effect of increased unemployment and low economic activity in the country due to the COVID-19 pandemic, has further compromised the affordability by individuals towards their healthcare cost thus further compromising funds availability for healthcare services.

Nkechika said channelling the resources of the robust COVID-19 infrastructure response towards enhancement of the Primary Healthcare delivery system, will further enhance governments’ effort towards the improving the maternal and child morbidity and mortality situation in Nigeria.

He said Nigeria must develop a sustainable framework that addresses the countries healthcare service challenges most especially for maternal and child healthcare. Nkechika said the country must also start the measuring of health outcomes, as it is perhaps the single most powerful tool in revamping a healthcare system.

The DSCHC boss said the entire infrastructure that was mobilised towards the response to COVID-19 should be equitably redistributed to Health Care Facilities (HCFs) that lack and need them for better services. He said the several N95 facemasks, infra-red thermometers, ventilators, sanitary materials and laboratory equipment mobilised for COVID-19 response, should not remain locked up in stores.

The health economist said the continuous resource mobilisation from diversified platforms as was seen during the COVID-19 pandemic, prudent management of mobilised resources and fit for purpose distribution of these resources across all healthcare sectors, will go along way in acceleration the progress towards UHC in Nigeria.

Nkechika said a mandatory health insurance programme, is a known formidable system for healthcare resource mobilisation that ensures an equitable and efficient healthcare financial management. “In Delta State, under the dynamic leadership of Dr. Ifeanyi Okowa, a strong advocate for UHC coupled with a strong ‘Political Will’ for ‘Health for All’ where no one is left behind, a mandatory health insurance scheme was established as a first cardinal programme of his administration under the SMART Agenda.”

He said the Delta State Contributory Health Scheme has so far won several awards since the commencement of the Scheme in 2016. “Notable was in 2017 when the scheme won the Outstanding Healthcare Programme of the Year, presented at the Nigerian Healthcare Excellence Award ceremony in recognition of the States outstanding service delivery in the field of healthcare in Nigeria. In 2018, the Scheme won an award as the State with the most people covered under the State Social Health Insurance Scheme with focus on the Poor and Vulnerable population in Nigeria under the World Bank/FG – Save One Million Lives Program, presented by the Vice President of Nigeria, Prof. Yemi Osibanjo.”

Nkechika said the DSCHC is currently supporting other states in Nigeria through experience and best practice knowledge sharing and capacity enhancement. He said several states have so far been sponsored by United Nations Children Fund (UNICEF) and the World Health Organisation (WHO) for a study tour to Delta State to enhance the setting up and up-scaling of their health insurance programmes to ensure that Nigeria as a country is able to achieve the UHC mandate of ‘Health for All’ in the year 2030.

The DSCHC boss said the Commission would continue on its effort towards ensuring every resident of Delta State has access to quality healthcare service without a catastrophic cost consequence of receiving it.