The Lagos State Government has launched its mandatory health insurance scheme, known as the Lagos State Health Scheme, which is aimed at delivering basic health care to the majority of the resident of Lagos, with particular emphasis on the less privileged.
For the scheme to be successful, it is essential we direct our focus on to the Primary Healthcare system, which comprises of the Primary HealthCare Centers (PHC) and forms the foundational healthcare structure at the community level of any Universal Healthcare Coverage (UHC) strategy.
At the recently concluded Breakfast meeting organized by the Franco Nigerian Chamber of Commerce and Industry, we stated that across the whole of Nigeria, a good number of primary healthcare centers are dilapidated and not able to provide the services required. The situation is not very different in Lagos.
While there are over 300 PHCs in Lagos only 57 have doctors and the rest are manned by nurses under the remote supervision of a medical Officer of Health. Therefore, it is imperative that for the Lagos State Insurance scheme to work, we begin to engage all tiers of government to find the right funding and operational model. In addition, the right statutory governance oversight is required to ensure that we jointly take responsibility for these centers through efficient management systems.
According to the constitution of Nigeria, and the Lagos State Health Reform Act, the Local Government Area (LGA) health authority and Ward Committees have a major role and responsible for the functioning of the PHCs and so concerted advocacy efforts at this tier of government is required to initiate the revitalization process and long term sustainability.
However, the resources of the State Government are under strain and to attain UHC in record time, there is a growing recommendation for the two tiers of Government (State and LGA) to partner with the private sector for innovative solutions.
One of such innovations is the Access to Finance Scheme where the State in the previous dispensation, had commenced a pilot where 43 of underutilised PHCs would be allocated to the private sector for revitalization in a PPP arrangement. These private sector players would also have access to concessionary repayable loans bankrolled through blended financing which would ensure they have the capital for start up and to provide affordable services to the enrolees of the health insurance scheme.
But for this pilot project to be potentially effective, further stakeholder engagement at the community and LG level is necessary to get the buy in of the necessary structures to ensure the pilot is viable.
Nigeria is struggling to achieve the Abuja declaration of allocating 15 percent of its budget to health, which currently stands at about 4 percent. The situation is a bit better in Lagos as the average allocation to health is in the region of 8 percent.
The administration of Mr. Babajide Sanwo-Olu as part of the THEMES mandate has pledged to gradually increase the allocation to health to approach 15 percet over the tenure of this government. However, allocation is different from drawdown on the approved budgetary allocation. All efforts will hence forth be made to ensure that funding is available for capital and recurrent expenditure to ensure public facilities are well maintained and running efficiently. Moving forward, we will prioritise income generation projects, efficiencies and cost containment.
We have a unique situation in terms of population. The population of Lagos State has surpassed 20 million and rising daily, so now Lagos qualifies as a hyper city. This situation is brought about by constant migration of people into the city, either induced by the insurgencies and climatic forces north of Lagos or the attraction of the economic viability of the Centre of the Excellence.
This brings about a great strain on the existing facilities in the State by people who require healthcare services and also threatens its biosecurity. This is why there is an urgent need for all relevant stakeholders, including the Federal Government, to be involved in the propagation of primary care to congregate and brainstorm on the appropriate financing mechanism to rejuvenate this system. As a matter of priority, we are going to deeply engage with the LG structures and the house of Assembly on this critical issue.
Prof. Akin Abayomi, is the Honourable Commissioner for Health in Lagos
