On The Cover  

Towards Inclusive And Sustainable Healthcare Industry

By Itunu Azeez Kareem

02 April 2023   |   6:00 am

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All days are important, but some are more. One of such important days in the world is World Health Day (WHD), which is celebrated every April 7. Since its inception in 1984, the world has often come together, every year, to address health issues confronting humanity. When the Day was first observed in 1984, the…

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All days are important, but some are more. One of such important days in the world is World Health Day (WHD), which is celebrated every April 7.
Since its inception in 1984, the world has often come together, every year, to address health issues confronting humanity.

When the Day was first observed in 1984, the HIV (Human Immunodeficiency Virus), a virus that attacks the body’s immune system, was prevalent. If HIV is not treated, it can lead to AIDS (Acquired Immunodeficiency Syndrome). There is currently no effective cure. Once people contact HIV, they have it for life.
However, with proper medical care, HIV can be controlled.

The theme for WHD 2023 is ‘Health for All’, which is aimed to achieve universal health coverage and ensure that everyone, everywhere, has access to the health services they need without facing financial hardship.
No doubt, since the celebration of WHD, the concept of health for all has evolved and expanded, encompassing not just access to health services, but also the social, economic and environmental factors that affect health.
The World Health Organisation’s (WHO) vision for health for all is a world where every person, regardless of his or her age, gender, ethnicity or socio-economic status has opportunity to attain their full health potential and live a healthy and productive life.

For this year, it’s about health for all
Considering the various health challenges facing the world, how do you create a healthy environment for all. On WHD and beyond, it is important to remember that health is a fundamental human right, and everybody must work together to ensure that everyone has opportunity to live a healthy and fulfilling life.

Achieving health for all requires collaboration and action from governments, healthcare providers, communities and individuals. This includes, investing in healthcare infrastructure, strengthening health systems, promoting healthy lifestyles, and addressing the underlying social determinants of health such as poverty, inequality and discrimination.

World Health Day In Nigeria
While Nigeria remains true giant of Africa, not just in population nor popularity, but also Africa’s giant on other vital aspects. But how has the world’s most populous black nation fared in terms of health?

Since independence in 1960, Nigeria has had a very limited scope of legal coverage for social protection besides over 90 per cent of the Nigerian population being without health insurance coverage.
One of the major challenges in the healthcare industry in Nigeria is inadequate allocation of financial resources to improve and maintain general public health. Currently, the existing healthcare resource allocation is skewed, with a high proportion going towards secondary and tertiary care facilities.

Though the Nigerian health system has been evolving over the years through healthcare reforms aiming to address the public health challenges confronting it, the system, however, is faced with several obstacles, such as inadequate funding, poor infrastructure, scarcity of medical personnel, limited access to basic healthcare services, and deficient management of health resources.

The inability to effectively address the country’s numerous public health challenges has contributed to a persistent and high level of poverty and weakness in the system. Consequently, there is a high incidence of preventable and treatable ailments, as well as low life expectancy rates.

According to health experts, political instability, corruption, limited institutional capacity and an unstable economy are major factors responsible for the poor development of health services in Nigeria.

They note that households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay ‘out of pocket’ for healthcare services that are not affordable.
They also say social and financial risk protection for poor and vulnerable populations is a major development and policy issue across the globe, which the country has not addressed.

Nigeria has never met the 15 per cent allocation on health out of the budget of any country. This was a declaration made in Abuja some years ago. The data here suggest how the country has fared for the past eight years.

In spite of the health recurrent budget increasing from N237.31 billion in 2015 to N580.82 billion in 2023, while the health capital expenditure increased from N22.68 billion in 2015 to N404.08 billion in 2023.

However, despite the increase, only 5.75 per cent of the 2023 total budget is allocated to health, sustaining the country’s refusal to meet the commitment made by African leaders under the Abuja Declaration to allocate at least 15 percent of their annual spending to the sector.

This simply means that the budget may be heavy on paper, but light in expectations.
How will government tackle this?

Though a new dispensation is expected to emerge on May 29, there is no reason to wait for the new government to kickstart policy formulations and execution that will lift the sector and deepen healthcare process. Therefore, to alleviate these challenges, the Nigerian government has to implement policies and programmes that will improve healthcare access, including the establishment and functionality of the National Health Insurance Scheme (NHIS) to provide cost-effective healthcare services to all Nigerians, especially those in the informal sector.

In his ‘Healthcare in Nigeria: Challenges and recommendations’, Bolaji Aregbeshola noted that though the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence.

The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
The goals of the NHIS were to:
• ensure access to quality health care services,
• provide financial risk protection,
• reduce rising costs of health care services, and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.

He continued, “the NHIS was expected to provide social and financial risk protection by reducing the cost of healthcare and providing equitable access to basic health services. The most vulnerable populations in Nigeria include children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick. Although these vulnerable groups sometime benefit from free health care services and exemption mechanisms, they largely have to pay for health care services. Free healthcare services and exemption mechanisms are often politically motivated, are poorly implemented, do not become fully operationalised, and sometimes only last a few years.”

Free healthcare services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
A study conducted in 2016 concluded that the Basic Health Care Provision Fund (BHCPF) as established by the NHA to strengthen and improve PHC cannot assure UHC or universal financial protection of a basic minimum benefit package for all pregnant women and children under five. However, governments have to design and implement UHC schemes as a strategy to address the issues of high level of poverty, vulnerability and high level of inequality in health for which the poor and vulnerable populations are disadvantaged.

The government has also set up primary healthcare centres nationwide to offer fundamental health services at the grassroots level.
Despite these initiatives, many Nigerians, especially those residing in rural areas, still face significant challenges in accessing quality healthcare. As a result, some Nigerians rely on traditional healers or self-medication due to the high cost of medical treatment and the shortage of medical personnel.

While the recent proliferation of private healthcare providers has improved access to healthcare services, the cost of medical treatment has increased, rendering it unaffordable for many Nigerians.

While the Nigerian government has made strides in enhancing healthcare access, more work is required to tackle the obstacles confronting the healthcare system and ensure that all Nigerians can access affordable and quality healthcare services.

Our WHD 2023 Message

As we commemorate World Health Day, we implore our fellow Nigerians to give priority to their health and overall well-being. The ongoing COVID-19 pandemic is not over yet; it has rather underscored the critical importance of maintaining good health and taking care of our bodies.

By following simple yet effective measures such as regular hand washing, mask-wearing, physical distancing, and taking the available vaccines, we can significantly minimise the risk of infections to ourselves and our loved ones.
Additionally, we must pay attention to our mental health and seek help whenever necessary. This could involve confiding in trusted friends or family members, seeking professional support from qualified mental health experts, or engaging in mindfulness practices and self-care activities.

Let us all commit to prioritising our health not just today, but every day. Together, we can work towards creating a healthier and happier future for our communities and ourselves.