Moving Together to Achieve Universal Health Coverage for All

By Tariah Adams, Communications & Advocacy Officer, White Ribbon Alliance Nigeria

As part of a town hall meeting in Lapai Local Government Area of Niger State, Nigeria last year, Zainab told a crowd of community members that she does not use the local primary health care centre because it was just too expensive. Zainab is not alone. In a country where about 145 women die daily from pregnancy-related causes [1] and only 46% of deliveries are attended to by skilled attendants (NDHS 2018) [2], the local hospital costs 2600 naira, or $8 U.S. dollars, for an uncomplicated delivery in Zainab’s agrarian community. This is a significant obstacle to the poorest in Nigeria, where 86.9m [3] live on less than N693.5 or N$1.90 a day.

For the past decade, Nigeria’s health expenditure has been less than 10% [4] of its annual budget. Investments in the health sector were consistently low when compared to countries with similar economic status. Zainab and other Nigerians bear the brunt of this funding challenge by paying user fees out of pocket which accounts for about 72% [5]. Many people must forgo needed services because they can’t afford them. As a result, children of the poor are eight times more likely to die in infancy than children of the wealthy.

To lessen the cost of seeking healthcare and achieve universal health coverage, the National Health Act was passed into law in 2014. The Act provided the legal framework for the provision of universal health coverage for all Nigerians. To finance the promise of universal health coverage, the basic health care provision fund (BHCPF) was designed to bridge the gap and provide affordable health for all Nigerians. For Zainab, the implementation of this policy would mean access to a minimum package of health services including antenatal services, labour, delivery, emergency obstetrics and neonatal care. She would also be eligible for prevention and treatment for non-communicable diseases like hypertension; if she has an accident, she will be eligible for medical treatment at the scene, during transfer and at the facility with all expenses covered. The fund promises to provide essential medication at the primary health centre, human resources, equipment and maintenance of facilities and transportation.

The BHCPF pulls funds from the government, donor, international partners and the private sector to provide basic health care for all Nigerians at the primary health care level. The fund is available to all states of the federation that meet pre-set conditions for its release. However, implementation is slow as states are at varying levels of readiness and weak accountability framework constrains the ability of the fund to deliver the desired results.

While 21 out of 36 states have met minimum pre-set conditions, only nine of the 21 have fulfilled all the criteria required to receive funds. The federal government has commenced the disbursement of funds to States that have met the criteria and as at May 2019, a total of N12.7 billon ($41.5M) has been disbursed.

Another challenge is the low involvement of community members in the decision-making and oversight process. They should be the real drivers of the process as delays in implementation affects them the most. As a result, Zainab does not have a say with her policy makers and community leaders to help move the funds and address her healthcare needs. She is still missing out of a fundamental human right: a right to quality health care.

To ensure Nigerians can have access to basic health care, communities, the private sector, government, citizens and donors must work together. Local civil society groups must work with local communities who are the recipients of care to ensure their involvement in the process and demand timely implementation. Donors must support states to improve the capacity to meet the pre-set conditions for accessing the BHCPF in their states and ensure its timely implementation. The political will to implement the BHCPF must be demanded by all actors and sustained through active engagement of the citizenry with its political leaders. Government must also recognise that an efficient primary healthcare system is key for achieving the promise of universal health coverage and optimal performance in Nigeria must be prioritized.

The road to UHC in Nigeria requires more than good intentions of the Government. All hands must be on deck to ensure Zainab and everyone has access to the services provided in a timely manner, leaving no one behind.

*Name has been changed to protect identity

[1] Unicef 2015, Maternal and child health, https://www.unicef.org/children_1926.htm

[2] Nigerian demographic and health survey 2018

[3] https://www.theatlas.com/charts/Hynnu6C-7

[4] World bank, Basic Health CARE Provision Fund http://documents.worldbank.org/curated/en/935321526032427605/pdf/PIDISDS-BHCPF-Concept-stage-05042018.pdf

[5] World bank, Basic Health CARE Provision Fund http://documents.worldbank.org/curated/en/935321526032427605/pdf/PIDISDS-BHCPF-Concept-stage-05042018.pdf