Universal health coverage: Nigeria, a country where vehicle insurance is mandatory, health insurance is not

Off all forms of global inequalities, injustice in access to healthcare is the most inhuman. In Nigeria, millions of people die from all sorts of preventable diseases, which are as a result healthcare injustices and so much is said about this in Nigeria’s high-level conversations, but it is never matched with actions. We are so focused on other issues, with less or no focus to the health of Nigerians. Nigeria’s healthcare sector is never any government’s priority. Our legislative and executive arms of government give no priority to healthcare and our healthcare coverage is the poorest in Africa and has always remained deplorable. Citizens are not aware that the right to the highest attainable standard of health is a human right, including access to timely, socially and culturally acceptable and affordable healthcare of appropriate quality.

 

In Nigeria, vehicle insurance is mandatory, while health insurance (human insurance) is not mandatory. Simply put, if you are a regular user of the Wuse, Garki and Maitama routes in Abuja it is almost impossible for you not to have experienced the harassment of different enforcement agencies asking for one insurance document and another.  Is it a shame that we have about two agencies in Nigeria whose mandate is to ensure that all vehicles on Nigerian roads have an insurance – mandatorily; but, for the people driving the vehicles, very little is done to mandate them to insure themselves. The National Health Insurance Scheme (NHIS) which is supposed to insure all Nigerians shamefully covers only less than 5%. The NHIS seems to be unsure or has no accurate data of the number of Nigerians covered by the scheme. Few weeks ago, Attahiru Ibrahim, the acting executive secretary of NHIS said that the scheme covers only less than 5%; few months ago, the former executive secretary said that for the period of 12years only 1.5% Nigeria. Whichever data is correct, it clearly shows that our health coverage is among the poorest in Africa; as countries like Ghana and Kenya have covered up to 69% of their populations. There is a need to make health insurance mandatory for all Nigerians including people working in the informal sectors, state government staff and employees of private organizations and self-employed. The current state of covering only federal staff cannot protect the health of a good number of Nigerians.

 

Today, Nigeria is yet to find solutions to most of the health challenges in the country like incessant outbreaks of Lassa fever, high maternal and child deaths, poor primary health facilities, lack of functioning cancer machines, malnutrition, poor health emergency responses and many others. This is happening because the Nigerian government but at federal and state level does not place priority to healthcare. The government does not allocate sufficient funds to healthcare. The government does not see health of her people as their human right; it is seem as one of the sectors that individuals can cater for themselves.

 

In specifics, in 2017 national budget of N7.298 trillion, only 4.17% was allocated to health; in my estimation this is one of the most critical sectors that drive other sectors of the country. Specifically, about N304 billion on the health of over 180 million Nigerians, amounting to N1,688 per citizen for the whole year. When prisoners in some countries gets over $7million in the same year. Clearly, someone needs to be healthy people to plan and work on other sectors. It is only a healthy soldier that can stand to secure Nigeria from territorial incursion. It is only a healthy economist that can strategize and plan for a better economy. It is only a healthy politician that can think well to provide policies needed for growth and development of the society.

Poor health budgeting and financing is one of the rationales for Nigerian having the worst health records in the world. The country’s average mortality is put at 52years. For instance, while the number of deaths of infants under one year per 1000 live births in Nigeria is about 72.7, according to a 2015 report from World Fact Book, that of Rwanda is 58 deaths per 1000 children under five. That of Malawi is 42 deaths per 1000. Gabon is 46, Togo is 45, Kenya is 39, while Libya is just 11. Painfully, in 2001, Nigeria hosted the Abuja Declaration by African Union where African nations signed a pact to raise health to 15% of their total budget. Sixteen years after the Abuja Declaration, Nigeria is yet to raise its budget to 15%, whereas Rwanda reportedly devoted 18% to healthcare. Botswana 17%, Malawi 17.1%, Zambia 16.%, Burkina Faso 15.8% and many others.

 

If we desire to achieve universal health coverage we need to make national health insurance mandatory for all Nigerians, increase health budget and engage all stakeholders to make healthcare a priority in federal, state and local government levels. Achieving universal health coverage in Nigeria means healthcare for all and this amount to ensuring accessibility, affordability and availability of healthcare services. So many high income Nigerians and our top politicians always travel to the United States of America and United Kingdom for healthcare needs. In fact, it has become a thing of pride for pregnant women from wealthy backgrounds to travel abroad for delivery. While, some Nigerians are travelling abroad for delivering and maternal care, so many communities such as Tarkwa Bay have a hospital which is 20 minutes boat ride and an hour long car ride away. Most people did not own boats. Hence, a woman in labour could bleed to death before she could reach the hospital. Nigerians dying of preventable deaths is a healthcare injustice and an inhuman act. I have asked this question several times, Is Healthcare a Human Right? Until we are able to answer this question, we may continue to have a misplaced priority.

 

Runcie C.W. Chidebe

Chidebe is a Cancer Control Advocate, Project Pink Blue, Health & Psychology Trust Centre (HPTC)