Adopting Rwanda’s healthcare financing scheme to achieve UHC in Nigeria

With a population of about 197 million people in Nigeria, only less than five percent have access to comprehensive healthcare through pre-paid health insurance structure.

This, according to experts, is one of the ascribed reasons for the poor life expectancy experienced by Nigerians, hence, the need for harnessing community-based health insurance scheme cannot be underestimated in achieving the desired Universal Health Coverage (UHC), which they said is a veritable tool towards the attainment of the Sustainable Development Goal (SDG) in Nigeria.

This was the submission of local and foreign scientists/researchers at the Nigerian Institute of Medical Research’s (NIMR), fifth international scientific conference held in Lagos, with the theme: “Achieving Universal Health Coverage: The Role of Research.”Universal health coverage, which is based on the World Health Organisation’s (WHO) constitution of the 1948 declaration of health being a fundamental human right and on the Health for All agenda set by the Alma Ata declaration in 1978, provides that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

Furthermore, the UHC cuts across all of the health-related SDGs and brings hope of better health and protection for the world’s poorest. This means that there must be equity in access to health services – everyone in need of the services should get them with no restrictions to only those who can pay for the services; the quality of healthcare services should be good enough to improve the health of those receiving it; and people should be protected against financial risk, ensuring that the cost of using the services does not put people at risk of financial harm.

However, Nigeria’s goal of achieving the UHC has been in the front burner of the national health discuss and a priority area for the Federal Ministry of Health.The Director-General, Nigerian Institute of Medical Research (NIMR), Professor Babatunde Salako, in his address, argued that access to healthcare has been shown to be the primary factor that influences healthcare delivery in Nigeria, with less than five per cent of the citizens having comprehensive healthcare through prepaid health insurance scheme.

He said this has brought the country’s goal of the UHC under severe scrutiny, with the major challenge being health financing which appears to be the Achilles hill. Salako noted that, between the period of 2012 and 2018, government’s expenditure on health was estimated to be about 7.2 per cent, stressing that the figure is significantly below the WHO’s recommendation that 15 per cent of a nation’s expenditure should be on health.

He maintained that a direct relationship exists between Universal Health Coverage and healthcare financing, which he noted that efficient structures for the later leads to better health coverage for a nation.“The great pillar for healthcare financing is health insurance. This critical issue of UHC is considered a veritable tool towards the attainment of the SDGs in our country,” he stressed.

Also, the Chairman of the conference, who is the Vice Chancellor, University of Nigeria, Nsukka (UNN), Prof. Benjamin Chukwuma Ozuma stressed that, with the right policies put in place, Nigeria could achieve the UHC within a decade.He made reference to Rwanda and its ability to attain the required UHC by the WHO, using the community-based health insurance scheme, which covered no fewer than 80 per cent of its population within a decade.

The professor of Obstetrics and Gynecology said technology, especially the mobile phones, have been a vital tool towards the attainment of the UHC in Rwanda and other countries who have made progress, stressing that Nigeria is still lagging behind despite being the largest market in mobile technology.

“Nigerians are not covered by health insurance, all we need is first of all, we can at the state and local government, operate and have community-based health insurance and then nationally, it is never easy trying to do things from the top, we must introduce community based health insurance scheme.“In Rwanda, they did community-based health insurance service. It must be initiated by the end-users, local and state government, whereas the federal government can take care of the national.

“America does not operate only one health insurance, Nigeria is a very big and diversified country. So far, the National Health Insurance Scheme (NHIS) has failed us. Within a decade we have been using that figure – five per cent coverage,” he moaned.Rwanda runs a universal health care model, which provides health insurance through a system called Mutuelles de Santé, meaning, community-based health insurance scheme, where residents of a particular area pay premiums into a local health fund, and can draw from it when in need of medical care.

With this premium paid per year, the Rwandan health insurance scheme provides basic health services such as maternity care, treatment for the most common causes of death, such as diarrhea, malnutrition, malaria, infections, and pneumonia.Also, most of the health centers have medicines that are on the World Health Organization’s list of essential medicines, while some even have diagnostic laboratories for blood and urine analysis.

With these, about 92 percent of Rwanda’s population are now covered by the nation’s health insurance scheme, which is celebrated as one of the most successful in the world.

Meanwhile, the keynote address, which was delivered by the Vice President, South Africa Medical Research Council (SAMRC), Prof. Jeffrey Mphahlele, titled: “The Role of SAMRC in Building Health Research Capacity for Sustainable Development,” highlighted some of the major breakthrough measures put in place by the country towards achieving the UHC. Mphahlele said South Africa has identified certain areas which are health priorities in the country, noting that the SAMRC as a science council, funds health research to ensure it supports the national department of health in their health priorities, which includes, addressing the burden of diseases, with the top 10 killer diseases range from infectious diseases, like Human Immunodeficiency Virus (HIV) and Tuberculosis to violence and injuries.

He said some of the other areas funded in research include, the non-communicable diseases, which range from hypertension to diabetes and many others, adding that the NCDs are the second most important cause of mortality and morbidity globally.“This is not just an African health challenge, it is a global health challenge and so we are funding research in that space as well,” he said.

The Vice President, SAMRC maintained that the role of research in UHC is very crucial and important “because part of the research should be able to come up with solutions, in terms of how we can deliver healthcare services as efficient as possible and how we can identify the gaps that are there in healthcare service, and being able to fill these gaps and also how we can deliver quality healthcare services to the people.”

He said part of the steps taken is in vaccine production, which is a big area in addressing epidemic and emergency in disease outbreak.
“Vaccine production is an exciting area, so what we are doing in South Africa is that we are working with international partners to develop HIV vaccine, and also we are working in the space of TB vaccine, because this two combined, are actually important cause of infectious related morbidity in South Africa, so we are at a stage where we are participating in a clinical trial, which is called HVTN 702, it is an HIV vaccine trial network.

“It is a consortium that is been doing a number of clinical trials in the field of HIV, so specially on HVTN 702, they are testing the vaccine candidate, which if it works is most probably going to be licensed because the vaccine can show reasonable efficacy against HIV. I think the results will be available sometime in 2019 and so we are waiting for 2019 to see how this clinical trial has performed,” he noted.

Meanwhile, Ozuma stressed that NIMR was set up to address issues of disease outbreaks in terms of vaccine production, adding that due to poor government funding the country has not been able to boost vaccines produced locally.He noted that the vaccines developed locally in the country’s research institutes do not receive boost and support by the government.

“We have to produce our vaccines locally and it is possible. We must do research and produce vaccines, look at what has been done by Redeemers University during the Ebola outbreak, they went ahead and made breakthroughs, they were of national importance with their vaccines. It can be replicated all over Nigeria,” he stressed.

Also, the DG, NIMR stressed that developing vaccine against diseases is not an easy job, as it takes years of consistent research in laboratories.He said that many of the diseases do appear to be wiser, “so when you are trying to use a particular target on them, developing vaccines – the diseases are changing that target to something else and you eventually see that the vaccines you are using are not effective. And that process has to continue until you are able to get the ones that will be effective.

“Talking about vaccines that have been produced already like the meningitis vaccine, the measles, cholera, yellow fever and others, scientists have continued to work and they are still working on vaccine development on all these diseases and for the developed vaccines, government should provide funding, significant enough to buy the number of vaccines that will provide close to 100 per cent coverage in Nigeria.

Salako, however, noted that the research institute has taken the bull by the horn by constituting a research team that has already commenced research into some aspect of Lassa fever and has also developed an Arbovirus laboratory to assist in surveillance and disease detection, as the management eagerly await their report soon.