Making healthcare affordable to the poor
Ordinarily, news that COVID-19 pandemic has adversely affected the economy and consequently the living conditions of many parts of the world should not come as a surprise. In all countries, including Nigeria, the signs are tell-tale. What the World Health Organisation (WHO) has done lately is simply to bring the issue to the fore, and to emphasise its dire nature. Ultimately, it is a challenge for Nigeria and other countries affected to rise to the occasion and demonstrate real governance in the interest of its huge populace.
Undoubtedly, the inability of most Nigerians to pay for simple healthcare treatment in hospitals has been compounded by the ravaging COVID-19 pandemic, which has impacted negatively on the precarious human development situation in the country. This is a serious drawback on the progress recorded before the outbreak of COVID-19.
Fresh statistics from the World Health Organisation (WHO) and the World Bank have indicated that the COVID-19 pandemic could likely halt two decades of global progress towards Universal Health Coverage. The organisations also revealed that more than half a billion people are being pushed into extreme poverty due to health expenses. “There is no time to spare,” said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, adding:
“All governments must immediately resume and accelerate efforts to ensure every of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary healthcare systems that can provide essential care close to home,” he added.
A healthy population is an asset; a sickly populace is a burden. Most rural dwellers and the urban poor are among the group that cannot afford to pay for hospital treatment. It is incumbent on government at all levels to resume and accelerate efforts towards ensuring that every citizen can access health services without fear of the financial burden. Promoting a free and affordable massive primary healthcare in the country would help to ensure a healthy and productive population. There can be no national aspirations without a vibrant population.
The virus has also triggered the worst economic crisis since the 1930s, making it increasingly difficult for people to pay for medical care. Even before the pandemic, half a billion people were reportedly being pushed (or still pushed further) into extreme poverty because of payments they could not afford for healthcare. The organisations expect that that the number is now considerably higher.
For instance, in 2019, prior to the pandemic, 68 per cent of the world’s population was reportedly covered by essential health services, such as pre-and post-natal care and reproductive health services, immunisation services, treatment for diseases like HIV, TB and malaria and services to diagnose and treat non-communicable ailments like cancer, heart conditions and diabetes.
But they had not made such advances in ensuring affordability. As a result, the poorest groups and those living in rural areas are the least able to obtain health services, and the least likely to be able to cope with the consequences of paying for them. Sadly, Nigerians, in both rural and urban settings, constitute a good number of the victims highlighted, because of their high level of poverty.
Up to 90 per cent of all households incurring impoverishing out-of-pocket health spending are already at or below the poverty line – underscoring the need to exempt poor people from out-of-pocket health spending, backing such measures with health financing policies that enable good intentions to be realised in practice.
This is not happening in many of the affected countries, including Nigeria.
Recently, the Executive Secretary of the National Health Insurance Scheme (NHIS), Professor Yusuf Usman disclosed that a whopping N381 billion was disbursed under the NHIS within the past 12 years, out of which administration fee alone got a whooping N60 billion. This is worrisome, considering that a mere 450, 000 are enrolled in the scheme out of over 200 million Nigerians.
The question remains how was the money spent? Who got what and for what purpose? Truth is that opaqueness thrives in the scheme and must be curbed before it can be effective. The NHIS has so far under-achieved, as it is yet to cover the medical treatment of most Nigerians. There is need to expand its coverage to include both formal and informal sectors. The seeming focus on the formal sector comprising mainly people in paid employment is flawed. Greater consideration is required for the rural poor who suffer the worst impact.
Apart from the periodic child immunisation shots carried out across the country under the Expanded Programme on Immunisation (EPI) campaign of the federal and state governments, government has not shown sufficient concern about the deplorable state of primary healthcare delivery in the country. Even the tempo of the immunisation campaign as well as participation of members of the public seems to be fading by reason of reduced focus and low budget for healthcare.
Gone were the days when free health care, including dispensaries, existed in rural communities. Quality drugs were available. Sanitary inspectors did their job. Churches and faith organisations owned health facilities. Local governments played prominent role in promoting rural healthcare. Today, hospitals charge exorbitant fees when a lot of people have no job or income. The Nigerian authorities must work in concert to restore and improve on the state of public health.