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Renewed call for universal health coverage to be implemented worldwide



NIGERIA had in 2009 set 2015 target to achieve Universal health Coverage (UHC) by getting all her citizens enlisted into the National Health Insurance Scheme (NHIS). 

    However, 10 months to the deadline, less than 30 per cent of Nigerians have any form of health insurance meaning that most Nigerians still pay out of pocket for health services.

    The Executive Secretary of the NHIS, Dr. Olufemi Thomas, was last year given a marching order by President Goodluck Jonathan to get at least 30 per cent of Nigerians on the scheme by December this year. 

    Nigeria’s renewed vigour to achieve UHC is supported by a new report calling for the concept to be implemented worldwide.

     Health professionals and policymakers came together on Tuesday February 17, 2015 to debate the human right to UHC. 

      Delegates at the World Innovation Summit for Health (WISH), a global initiative of Qatar Foundation for Education, Science and Community Development (QF), heard from the report’s lead author, Sir David Nicholson, who is also the former chief executive of the National Health Service in England, as he launched The Next Billion: How to Deliver Universal Health Coverage.

     The roadmap to a healthier world was unveiled as more than 1000 world leaders, policy makers and healthcare experts gathered in Doha on Tuesday to discuss new and ground-breaking solutions to the most urgent global health challenges at the second WISH.

    Indeed, with the spread of Ebola, the continuing rise in heart disease, the advancing wave of diabetes, the growing cost of cancer care, the mental illness; there has never been a more pressing time to address these issues and identify solutions for generations to come. 

     The WISH policy report on UHC, which is based on a review of all available evidence, highlights the substantial benefits UHC can deliver – for individuals, for countries and for politicians – and provides a solid framework to support policymakers in transitioning their nations’ health services to UHC.

      The report recognises that designing and implementing a UHC strategy cannot be seen as a one-size-fits-all process. But a consensus is emerging on effective approaches to UHC that can be applied universally and it’s these evidence-based recommendations that will see the global movement towards UHC continue to gather momentum.

      UHC is the basic concept that every person, everywhere, should have access to healthcare without suffering financial hardship. This essential human right is a cornerstone of sustainable development and global security. But today, a billion people worldwide live without access to basic healthcare services and every year millions are forced into poverty after having to pay for healthcare out of their own pocket.

      On the benefits of implementing UHC, a WHO fact sheet reads: “UHC maintains and improves health. Good health allows children to learn and adults to earn. This helps people escape from poverty and provides the basis for long-term economic development.

    “At the same time, financial risk protection in health prevents people from being pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.”

        Launching the report at WISH, lead author and Forum Chair Sir David Nicholson said: “Evidence shows that in any country it’s important that the whole population is covered with a priority health package providing good quality primary, community and some general hospital services. When it comes to financing, our research suggests that the most effective mechanism is a publicly governed compulsory financing system. Above all, strong political leadership, careful monitoring and strong institutions are needed to see successful implementation of health reforms.

      “No one is pretending that improving health systems is easy – but case studies from around the world show it is possible. Complex issues need to be discussed and difficult decisions made at the highest level. My message to policymakers is to be brave and bold.”

     Professor The Lord Darzi of Denham, Executive Chair of WISH and Director of the Institute of Global Health Innovation at Imperial College of London, said: “The report we have published today provides clear recommendations for policymakers to help them implement much needed change in how healthcare is financed and delivered. The discussion was lively and positive and we now look forward to working with health leaders as they take crucial steps in their home countries towards ensuring that every citizen – regardless of income – has equal access to high quality healthcare.”

     The report’s recommendations have been endorsed by a wide range of organisations – including the World Bank and the Lancet Commission. This WISH report aims to keep UHC at the top of the global health agenda and stimulate further informed debate and action across the globe.

      In December 2012 the United Nations passed a resolution calling on all countries to plan or pursue the transition of their health services towards universal coverage. According to the World Health Organization (WHO), UHC is the single most powerful concept that public health can offer.

      Recent research looking into the health of 2035 showed that for every $1 invested in health today, the world could reap $20 increase in income over the next 20 years. Recognised as a subject of such importance, the World Bank Group has identified UHC as a top priority for sustainable development. 

      To date more than 80 countries have asked the WHO for help in moving toward UHC, including the emerging economies of Nigeria, Brazil, Russia, India, China and South Africa.

     UHC is one of eight reports being presented at the 2015 WISH Summit, which took place in Qatar, where leading international health experts are joining an influential community of heads of state, government ministers, academics, clinicians, policy makers and business leaders to discuss innovative solutions to some of the most pressing global health challenges.

Addressing rising cost of cancer treatment

     Another major issue militating against the achievement of UHC is the rising cost of cancer treatment. However, the new report launched at WISH presents roadmap for delivering affordable cancer care.

     Leading cancer specialists from around the globe gathered on at the WISH to debate the increasing burden of worldwide spending on cancer treatment and care.

       At the Summit, a new report was launched ‘Delivering affordable cancer care: a value change to health systems’, which presented a compelling body of evidence to illustrate the true scale of the disease and the rising cost to the global economy.

     Delegates heard how the burden of cancer is only set to intensify with new cancer diagnoses expected to increase by around 16 to 32 per cent over the next 10 years. The report also gave startling predictions on the rise in incidence of cancer from 2008 to 2030; by 65 per cent in high-income countries, 80 per cent in middle-income countries, and 100 per cent in the world’s poorest countries.

     Policy makers were informed of the three root causes of excess spending, overtreatment and unnecessary interventions, technology without value and inefficient service delivery. To counter this, four clear policies were put forward. Informed patient engagement, better decision making, reduced costs with maintenance of standards of care and rewarding of outcomes. A roadmap to implement change was put to the Forum.

     The report drew on a number of innovative projects from around the world to demonstrate how efficiencies could be driven and treatments improved for patients.

    Professor Robert J S Thomas, ‘Delivering Affordable Cancer Care’ WISH Forum Chair said: “Through our work we want to encourage governments, policy makers and healthcare organisations to address the problem of affordability in cancer care and treatment. This is a key and real issue for patients across the world. The status quo cannot be maintained when individual and total costs for cancer care are rising dramatically, and where we know we could deliver and drive better value. Today’s forum will provide practical solutions that can be put in place. These include optimal clinical pathways for patients, which can be costed and evaluated for wasteful interventions and provide benchmarks that can be used in a wide variety of settings to improve value for patients and providers”.

       Darzi said: “Cancer has a huge impact on millions of lives globally and with populations ageing the disease’s prominence is only going to intensify. The only way to help patients get the treatment they need is to ensure that money across the world is spent effectively. This report offers a sensible and clear roadmap to help policymakers and healthcare professionals address the challenges we face today in trying to deliver affordable cancer care for future generations.”

     Participating in the WISH Delivering Affordable Cancer Care panel discussion, Her Royal Highness Princess Ghida Talal, Chairperson of the Board of Trustees of the King Hussein Cancer Foundation (KHCF), said: “Affordability and accessibility have long been the core focus of our cancer care model at the King Hussein Cancer Foundation and Center and I look forward to sharing our experience in developing the model and discussing suggestions for further development as discussed in the report.”

How to ensure universal health coverage 

    According to the WHO fact sheet on UHC, moving towards UHC requires strengthening health systems in many countries. An important component of UHC is health financing where attention needs to be paid to raising sufficient funds, minimizing out of pocket payments through prepayment and pooling, and using available funds including donor funding where relevant efficiently and equitably.

      The WHO fact sheet reads: “Countries must also have a health workforce that can support an affordable, efficient, well-run health system that meets priority health needs through quality people-centred integrated care. Good governance, sound systems of procurement and supply of medicines and health technologies and well-functioning health information systems are other critical elements.

       “UHC emphasizes not only what services are covered, but also how they are covered through focusing on people-centred health care and integration of care. A shift in health service delivery is necessary to better tailor services to the individuals of the population they serve. Health systems should be organized around the needs and expectations of people in terms of holistic long-term health to help them better understand their own health-care needs.

    “Integrated health services mean a delivery that enables people to receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services, through the different levels and sites of care within the health system over the course of a lifetime. Members of a community are then better equipped to take preventative measures on their own creating cost-saving efficiency in the long term.”

      A paper on “Achieving Universal Health Coverage in Nigeria One State at a Time: A Public-Private Partnership Community-Based Health Insurance Model” published in 2013 by Emily Gustafsson-Wright and Onno Schellekens noted: “The inability to pay for health care expenses, which forces people to reduce spending on food or other basic needs, and the lack of access to quality care are unfortunately common realities seen by many poor and underprivileged. Falling ill can have devastating and long-lasting consequences especially for poor households, both through income loss and high medical expenditures. Data suggest that more than 150 million people globally suffer financial catastrophe every year due to out-of-pocket health expenditures. Nigeria has among the highest out-of-pocket health spending and poorest health indicators in the world. 

    “Most people would agree with the idea that all individuals should have access to health services and should not face financial hardship as a result of health care costs. UHC, the concept that encompasses these goals, has gained wide attention and support in recent years. 

    “How to achieve UHC however, is a more complex question with a variety of disparate viewpoints. In this paper, we discuss UHC in the context of Nigeria, a middle-income country that nevertheless is facing enormous health challenges. We discuss the constraints that have prevented Nigeria from attaining UHC to date. We then present promising evidence from large and small-scale insurance interventions in other parts of the developing world. Next, we describe a public- private partnership model of community-based health insurance currently operating in Nigeria and other parts of Africa and show evidence of the program’s ability to increase health care utilization, provide financial protection and improve health status in target communities. 

    “We contend that UHC in Nigeria can only be achieved by addressing both supply and demand-side constraints simultaneously. The solution must also include building on existing public and private institutions and informal networks, leveraging existing capital, and empowering clients and local communities. An innovative model such as the one presented here that has been implemented successfully in one Nigerian state, could be replicated in others; tackling this challenge one state at a time, to eventually achieve the goal of access to health care and financial protection for all.”

      President Goodluck Ebele Jonathan, on March 10, 2014, at the opening of the Presidential Summit on UHC in Abuja declared that for the concept to be a reality in Nigeria, health Insurance must be a compulsory policy.

     The President, who was represented at the historic event by the Vice President, Mohammed Namadi Sambo, tasked Nigerians to elevate the UHC into a National movement stating “Nigeria is not where it ought to be in terms of UHC with other Nations in the same development bracket”.

     He reaffirmed the Federal Government’s political commitment towards providing equitable, qualitative and universally acceptable healthcare for all Nigerians without suffering financial hardship but acknowledged that numerous challenges are limiting the full potential of the UHC.

    The Nigeria’s Presidential Summit Declaration affirmed that health is a fundamental human right and the responsibility of government in assuring the health of all Nigerians. It acknowledged the progress made despite the existing challenges towards attaining UHC in Nigeria through initiatives at all levels of government.

       The Declaration recommended that the Government of Nigeria should work towards instituting mandatory health insurance in Nigeria, with contributions from all income earners-formal and informal- and make available special funds to cover the poor (UHC Fund).

     It was further recommended that a standard benefit package of essential health services that address priority health care needs of all Nigerians should be defined. In addition, it was said that UHC cannot happen unless there is a functional health system, where there is adequate human resource for health, life saving commodities and supplies, sustainable financing and a mechanism to maintain quality services.

      It was also proposed that there should be a committee or taskforce to ensure that UHC is initiated, implemented and sustained in Nigeria for all Nigerians.

     The NHIS boss, however, has assured that the Scheme is presently going through a major transformational phase, in its bid to achieve its statutory mandate of ensuring that Nigerians enjoy easy access to effective healthcare. 

     According to him, the transformation includes the on-going   restructuring and creation of more Departments in the scheme, to strengthen it for more efficient discharge of its duties.

   Thomas said his administration has developed strategies for the accomplishment of UHC in the country.

    “Some of these strategies’’ according to him, “include the complete digitalization of the various operations and processes within the Scheme, which will include the use of biometric registration of enrollees in all our operations to guarantee the accuracy and integrity of our database”. 

     He said the recent passage of the National Health Bill by the Senate, and the processes of amending the Act establishing the NHIS currently going on in the House of Representatives, will increase the capacity of the organization to be more effective and responsive to the yearnings of Nigerians.

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