‘Addressing care challenges requires multi-sectoral approach’
*Over 7.6m Nigerians enrolled in one form of health insurance scheme
Nigeria on Sunday April 7 joined the rest of the globe to mark the World Health Day (WHD). The theme was “Universal Health Coverage (UHC): everyone, everywhere.” Minister of Health, Prof. Isaac Adewole, in this interview, said the federal government has been putting in place structures to achieve UHC and can meet the United Nations (UN) Sustainable Development Goals (SDGs) target of 2030 with multi-sectoral approach. CHUKWUMA MUANYA with excerpts:
Is UHC possible in Nigeria?
UHC is a goal that all countries strive to achieve. Some countries such as the United Kingdom (UK) and Canada have gone far ahead of others. In Nigeria, over the last five years, the federal government has been putting in place the structures to achieve UHC.In 2014, we approved the National Health Act, which provides a legal framework for achieving UHC. This was followed by a Presidential summit on UHC. In 2016, we developed the National Health Policy and also developed the National Strategic Health Development Plan II in 2017.
In 2018, the Government of President Muhammadu Buhari approved the release of N55.1bn for the provision of an explicit but guaranteed set of services for all Nigerians under the Basic Health Care Provision Fund (BHCPF). These legal, policy and implementation measures are geared towards achieving UHC.
Can the country meet the UN target of UHC by 2030?
The UN has set the year 2030 as the target year for achieving UHC. Nigeria has keyed into this and we are working hard to meet the target. We have now defined our performance indicators to include coverage of high impact services such as skilled birth attendance and routine immunization as well as mortality indicators.We are aggressively tracking our performance using surveys and routine data.
In addition, Mr. President has demonstrated great political will and we are cautiously optimistic that we can meet the UN target. We would however need the all stakeholders (Federal and State Governments, development partners, and other sectors that address the socio-determinants of health) to come together, buy into this vision and take action.Addressing health care challenges requires a multi-sectoral approach, with active collaboration with the Ministries of, Education, Water resources, Environment, among others.With the right political will and the collaboration of all these sectors, we shall meet the UN target.
How can Nigeria achieve UHC?
By defining an explicit and guaranteed set of services, funding this services and instituting a mechanism to control for the quality of services delivered.
Stakeholders are concerned that less than four per cent Nigerians are on any form of health insurance, which is one of the major ways of achieving UHC? Are you concerned? What are you doing to address this?
A lot is being done at the moment.Health is not only the responsibility of the Federal Government but also for the states and local government. With the current support being extended to the States and LGAs the number is expected to grow exponentially in a couple of years.
As you are aware the Basic Health Care Provision Fund is currently targeted at the poor, rural and vulnerable for provision of high impact primary health care services. We envision that more than 40 per cent of the population will receive access to the basic minimum package of health services under the BHCPF.Relatedly, we are strengthening our tertiary health facilities and public health institutions, improving Intersectoral collaboration as well as private sector engagement
Most State governments are embarking on having a functional health insurance system and most of them will soon take off. Community health insurance scheme is also taking off in many areas to widen the net of health coverage.The law establishing NHIS will soon be amended to make it mandatory. We hope this will also improve coverage.Our investigation revealed that the NHIS is stalled without leadership. In fact nothing is happening because the Acting
Executive Secretary (ES) cannot take major decisions. Why is that and what are you doing about it?
The issue of NHIS leadership will soon be resolved. The Presidency is looking into it and all we need to do is to be patient. I can assure you that the acting ES is doing his best in running the scheme, A lot is happening in keeping the NHIS mandate especially as it relates to improving our UHC drive in the country
When is the NHIS going to get a substantive Executive Secretary?
It would not be long before the presidency takes necessary action on this. Let us remain patient.
How many Nigerians are enlisted with the NHIS?
All federal civil servants and their families are enrolled under the NHIS by law. A recent FEC approval given has also included the enrolment of all Nigerians undergoing National Youth Service Corps (NYSC). Similarly, there are a number of schemes under the NHIS such as the Tertiary Social Health Insurance Programme (TSHIP), which focuses on providing services to university students; (ii) Vital Contributor Social Health Insurance Programme (VCSHIP), which is a voluntary contribution scheme for any Nigerian willing to partake.
Beyond this however, there are numerous private sector companies who have their staff covered using schemes provided by the Health Maintenance Organisations (HMOs).
In sum, there are over 7.6 million Nigerians enrolled in one form of scheme. We recognize this is grossly inadequate and will continue to push for increased coverage. With the implementation of State Insurance Agencies, we are going to see a quantum leap in the number of Nigerians covered under a scheme in the next couple of months.
Does Nigeria have anything to celebrate as the world marks World Health Day?
Of course! That we are alive is a cause for celebration. Health is universal and you are asking these questions because you are healthy. With all the epidemic outbreaks in the country, we have come out of them stronger, as a health system. We should celebrate because we are on the right track with strong political will to do all that is necessary for our people; we should celebrate because we have hope; we should celebrate as a way of galvanizing all stakeholders to action.In addition, we now have the policies and strategies in place, to provide direction for program implementation. We have also released funding for BHCPF, which should help us achieve UHC.
From a results perspective, we have witnessed a reduction in Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) prevalence from 3.0 per cent in 2015 to 1.4 per cent in 2018, there’s a decrease in prevalence of malaria from 42 per cent to 27 per cent, and we have increased number of children immunized for Penta 3 vaccine from 48 per cent to 57 per cent.
A pentavalent vaccine, or five-in-one vaccine, is a combination vaccine with five individual vaccines conjugated into one, intended to actively protect people from multiple diseases.The most widely used example is a vaccine that protects against Haemophilus influenzae type B (a bacterium that causes meningitis, pneumonia and otitis), whooping cough, tetanus, hepatitis B and diphtheria. The generic name for this vaccine is diphtheria, tetanus, pertussis (whole cell), hepatitis B (rDNA) and Haemophilus influenzae type B conjugate vaccine (absorbed) or DTP-HepB-Hib. We have screened over two million people for tuberculosis (TB), with 204,000 treated in 2017 and 2018. We have expanded HIV/AIDS treatment to additional 78,000 Nigerians since 2017. We are intensifying the war against malaria with the distribution of 33.1m nets between 2017 and 2018. We will distribute an additional 12.3 million nets this year. This has led to a modest reduction of the burden from 42 per cent to 27 per cent in the last two years.
In line with our commitment to the health of our people particularly children under five, we engaged the Global Alliance for Vaccines Initiatives (GAVI) to continue their support for Nigeria. GAVI’s approval of our request means, Nigeria has enabled us unlock additional resources to the tune of $1.03bn for vaccines procurement and Health System Strengthening over the next decade. We are gradually rebuilding the Nigerian Health System to handle cancer and other major cases in Nigeria. We have upgraded tertiary health institutions to enable them treat cancer cases. The National Hospital in Abuja now has two high-end Linear Accelerators (LINAC) with capacity to treat up to 200 patients daily. The official commissioning of the LUTH-NSIA Cancer Centre is a major achievement of this administration.
Bunkers for radiotherapy machines, brachytherapy machines and other relevant equipment have been procured for the following teaching hospitals: University College Hospital (UCH), Ibadan; University of Benin Teaching Hospital (UBTH); Usman Danfodio University Teaching Hospital (UDTH) Sokoto; Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Kaduna state; and University of Nigeria Teaching Hospital (UNTH) Enugu. All these give us reasons for celebration, but we are not resting on our oars.
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