As high out-of-pocket payment dominates Nigeria’s healthcare spending and the attendant low priority accorded to health by state and local government health spending relative to the Federal Government’s, Nigeria’s quest to attain universal health coverage by 2015 is bleak.
And unless public health infrastructure to provide effective, safe and quality health services are strengthened, sufficient resources for health – from domestic and external sources are raised and financial barriers to health access before the need arises are removed, this gloomy prognosis may soon become the reality.
The present absence of financial protection has led most Nigerians to depend on out-of-pocket payment for healthcare financing with insurance penetration, which is a measure of the relationship between premiums earned and the nation’s Gross Domestic Product, put at less than 6 percent, according to industry experts.
Eyitayo Lambo, former health minister, in an interaction with BusinessDay said that universal health coverage is difficult to achieve if out-of-pocket payment is greater than 30 percent of total health expenditure.
Lambo explained that achieving universal health coverage would be hard to attain without expanding the fiscal space (through increasing domestic tax revenues, expanding tax base, developing social health insurance, getting debt relief).
The former health minister disclosed that inequalities in health outcomes exist between rural and urban areas, as well as across income groups with these poor outcomes resulting to weakness in the health sector, particularly in primary healthcare services.
“There is need to expand contributions from large profitable companies by up-scaling and pooling together resources, more than what they are doing currently. Tax from mobile phone operators to fund healthcare is one that can be considered. Gabon imposes 10 percent tax on mobile phone operators for use in healthcare of low-income groups.
“Other innovations include tobacco and alcohol exercise tax which is operational in Philippines, Thailand and Indonesia, excise tax on foods that contribute to an unhealthy diet, additional levy on top of existing VAT rate as is in the case with countries like Chile.
“Some issues to consider in evaluating each innovative method include administrative costs, magnitude of the potential revenue, political acceptability and whether such funds should go into Consolidated Government Revenues or be earmarked,” Lambo stated.
Chidi Ukandu, chief operating officer, IHMS HMO, noted that increased awareness on health insurance is important giving the 2015 target of achieving universal health coverage in the country.
“The non-mandatory nature of the present NHIS Act makes health insurance not compulsory. This is another barrier to deepening health insurance in the country. The National Health Bill has not been passed into law. These are some of the issues that should be addressed in order for universal health coverage to be attained,” Ukandu stated.
Abdulrahman Sambo, former executive secretary, NHIS, stated that the current Act establishing the National Health Insurance Scheme (NHIS) is voluntarily with no compulsion by state governments and employers to register their employees under the scheme.
By: Alexander Chiejina