How primary healthcare can check high cost of treatment

Due to a lack of adequate government financing in infrastructure, modern equipment, skilled health personnel and insurance penetration, cash-strapped Nigerians often bypass primary healthcare centres to seek care at higher health facilities.

Such neglect costs more to the average Nigerian who already foots almost 77 percent of total medical expenses out-of-pocket.

But with a strong and active primary healthcare system, people with minor ailments can access services at a reduced cost as more than 90 percent of essential services can be delivered through primary health centres (PHCs), Tedros Ghebreyesus, director-general of the World Health Organisation (WHO) said, reacting to questions at the conference on Investing in Health for All by the European Investment Bank.

These services, including early detection of disease outbreaks, would avoid the need for more costly services at general and university teaching hospitals, the director explained.

He noted that the referral system operated among hospitals must be tactfully organised for any country looking to reduce private out-of-pocket payments.

“Many invest mainly in what we call sexy programmes. It could be malaria, HIV or tuberculosis. While investment in strengthening health systems or in PHCs is not taken seriously for many years. The strategic solution is first identifying health as a fundamental human right,” Ghebreyesus said.

“But that alone cannot solve out-of-pocket expenditure. We have to look into a strong referral system that helps hospitals to address health challenges based on their capacity at each level.”

He also identified the management of medicine procurements as a means to reduce the cost of drugs, easing personal drug expenses.

Read also: September’s inflation rate to hit 20.9% – FDC

Nigeria unfortunately is not well positioned to reap the benefit of this solution with more than 70 percent of about 30,000 health facilities in decrepit conditions.

PHCs should naturally respond to reproductive care, including maternal, neonatal, child and adolescent health needs at community levels, with the goal of curbing preventable maternal and child deaths in Nigeria.

Only three of 36 states: Lagos Ogun, and Anambra met these expectations according to a 2019 ranking of performance by the National Healthcare Development Agency.

Niger, Kebbi, Zamfara, Katsina, Kano, Jigawa, Bauchi, and Gombe States were ranked extremely poor in performance.

Bayelsa, Akwa-Ibom, Sokoto, Nasarawa, Kaduna, Taraba, Yobe and Borno were categorised as poor; while Oyo, Ekiti, Kogi, Benue, Delta, Ebonyi, Plateau and Adamawa were rated average.

A study by Bolaji Aregbeshola, a public health researcher at the Department of Community Health and Primary Care, University of Lagos shows that most of the primary facilities across the country cannot provide essential services. The majority of those that provide are of poor quality of service.

At a time when inflation is catching up with input costs in healthcare and the skilled medical workers are declining in numbers, the overall health expenditure is poised to spike further with care providers likely to pass the cost on to patients, according to projections by Mckinsey and Company.

The United States is for instance estimated to see a $370 billion increase in annual national health expenditure by 2027 due to the impact of inflation compared to the pre-pandemic levels.

The implication for Nigerians is that there will be no soft-landing in out-of-pocket health spending except the government overhauls the primary health structure and stick to the promise of mandatory insurance coverage for all.

The Institute for Health Metrics and Evaluation projects that not much will improve Nigeria’s health financing by 2050 as 19.4 percent of total health expenditure will come from the government, 76.4 from out-of-pocket spending and 2.1 percent from development assistance for health.

Akin Osibogun, professor of public health at the College of Medicine, University of Lagos said the critical challenge in Nigeria is that most local governments are not alive to their responsibilities as stipulated by the national health policy.

He hopes that with the diligent implementation of the new National Health Insurance Act passed by President Muhammadu Buhari in May, more funds will be available to rehabilitate PHCs through the consolidated revenue of the federation.

“Before you start seeing the effect, it may take some five years or more. But if we implement it faithfully, more Nigerians will have access to healthcare and it means there will also be more funds to rehabilitate health centres that are not currently in a good state,” Osibogun.

Under the National Health Act of 2014, one percent of the consolidated revenue of the federation is allotted to the Basic Healthcare Provision Fund. 50 percent of that one percent is supposed to go through the gateway of national health insurance which is then deployed to support the indigent Nigerians to pay for health insurance.

“So the challenge before us is that of implementation. The concepts are already there and the laws are there now. Let us be faithful to the implementation and ensure that government puts that one percent of the consolidated revenue fund for the basic healthcare provision fund.”