Access to quality healthcare has remained a challenge globally and efforts to improve these issues through universal health coverage (UHC) are essential. The World Health Organisation (WHO) defines UHC as ‘ensuring that all people have access to promotive, preventive, curative, and rehabilitative health services of quality, when and where they need them, without financial hardship.’
Globally, over 800 million people spend at least 10 percent of their household income on healthcare through direct out-of-pocket payments (OOPs), pushing millions of people further into poverty each year. The situation is dire in low-and-middle-income countries like those in Africa, where 27 out of 48 countries are significantly affected by direct OOPs for healthcare services.
Through this Act, efforts to tackle high poverty levels caused by OOPs for healthcare, through health insurance for all categories of Nigerians by 2030, are now more achievable than ever before
With public health epidemics and pandemics like the COVID-19 pandemic emphasizing the importance of UHC, there is an urgent need for appropriate health financing strategies in Africa that ensure financial risk protection and support sustainable health services towards the attainment of UHC.
Healthcare financing in Africa: Sustainable or not?
Access to quality healthcare services without individuals suffering financial hardship remains a challenge in Africa. For a larger percentage of the African population, individuals’ access to essential health services depends on OOPs. One of the consequences of this is that millions of people do not seek quality treatment for their health issues, exacerbating the problem and increasing the burden of preventable deaths in Africa.
We can approach health financing from two perspectives. The demand perspective, referring to individuals’ demand for quality and affordable healthcare services and the supply perspective, referring to the availability of quality healthcare infrastructure to meet the demand.
Some health financing approaches have been employed in various capacities across Africa to cater for the growing demand for affordable healthcare on the continent. A common approach is the National Health Insurance Scheme (NHIS).
Several countries are either in the process of fully implementing national health insurance as a sustainable health financing mechanism or already have such structures in place. A single, compulsory NHIS could provide the most equitable option, as voluntary health insurances can lead to further inequities and disparities among populations. However, implementing the NHIS in Africa, including Nigeria, has faced various challenges.
It is worth mentioning that in Nigeria, a new National Health Insurance Authority (NHIA) Act was signed into law in May 2022. The Act establishes and empowers the NHIA to ensure provision of health insurance for all Nigerians through a mandatory mechanism in collaboration with state health insurance agencies.
Through this Act, efforts to tackle high poverty levels caused by OOPs for healthcare, through health insurance for all categories of Nigerians by 2030, are now more achievable than ever before.
On the supply side of health financing, the establishment and strengthening of healthcare facilities such as hospitals, diagnostic centres, and laboratories that ensure the optimal supply of quality healthcare is critical. Addressing this issue of supply, African countries have begun to explore the role of public-private partnerships (PPPs) in strengthening healthcare.
A recent report by the African Development Bank (AfDB) emphasised the critical need to deploy a range of financing instruments, including private-sector operations and public-private partnerships, to help overcome the barriers to private investment in the health sector and address the overall financing gap.
Strategies to strengthen health financing in Africa
Achieving UHC in Africa requires systems that raise the bulk of funds through forms of prepayment (e.g. taxes and/or insurance), and then pool these funds to spread the financial risk of illness across the population. In view of these, Bloom Public Health recommends the following strategies to strengthen health financing in Africa:
• Increasing government health expenditure: Ensuring quality health services reach some of the most vulnerable communities where even basic health facilities are lacking requires investment. Increasing government’s commitment of domestic resources to health financing is essential to address the shortages of critical inputs, such as human resources for health and pharmaceuticals.
• Optimizing the health insurance schemes: Ensuring that there is a wider coverage for health insurance scheme in the country, by putting some mechanisms in place to include the vulnerable and the underserved population in the scheme.
• Enhancing public-private partnerships (PPPs): Sustaining increased health coverage requires the strengthening of health systems. Leveraging PPPs can help overcome the limitations of financial, technical, and human resources in different aspects of the healthcare system.
For example, Bloom Public Health’s strategic partnership with Katchey Laboratories, ND Western Limited, and the Independent Petroleum Producers Group (IPPG) to establish a world-class diagnostic laboratory in Delta State, Nigeria is an excellent model in health financing that should be emulated by other stakeholders in the public health sector. Another example is Bloom Public Health’s partnership with Ebonyi State Government to establish a Drug Revolving Fund that will ensure sustainable availability, affordability, and access to safe and quality medicines and medical products across Ebonyi State.
UHC is essential to guarantee equitable access to healthcare services for vulnerable population groups across Africa. Concerted efforts at various levels, between governments, donors and private sectors are necessary to address quality, efficiency, and financing issues in health service delivery in advancing towards UHC.
Anyakora is the CEO of Bloom Public Health and a public health expert
Odibeli is a pharmacist and the research and communications coordinator at Bloom Public Health