How lack of health insurance is causing needless loss of lives and the grand plan to change the situation.
Since the National Health Insurance Scheme came into effect, only seven million of Nigeria’s 200 million people have access to the programme. For those who don’t, like Mama Lateefa in Osogbo, poverty and the fear of hospital bills are recurring decimals in their lives.
Mama Lateefa as she is fondly called in her area in Osogbo, Osun State, barely escaped death from pregnancy related complications.
For the nine months she was pregnant, she did not visit any hospital for antenatal and when her childbirth developed complications, both her life and the baby’s were at risk.
Giving birth in her dingy room, in rather sobering circumstances, the intervention of some good Nigerians helped save both mother and child.
“We won’t be able to pay hospital bill, that’s why I decided to stay at home,” she said. “Even to eat is a problem. If I even have money, it will be used to get food instead of taken it to hospital.”
Another woman, simply identified as Mama Kunle, a middle-aged woman, had a more drastic case. She was rushed to a private hospital in Osogbo when her seven-month old pregnancy developed complications. She too had not had any antenatal care prior to that.
While on the bed, she told a nurse that she needed to use the toilet and as the nurse moved to her bed to assist her, the nurse discovered that the head of the premature baby had popped out already.
When the doctor told her husband to go to the pharmacy and buy certain things needed for the delivery, he broke down and started crying. He had no money.
With the pregnant woman in pains, the nurse made it clear to the husband that theirs was a private hospital, not a charity house.
The couple had to borrow a phone to call a relative for assistance.
While that drama was playing out, Mama Lateefat was still savouring her good fortune.
“I thank God for saving my life,” she said. “Of course, I know it was risky to not to go to hospital but what can I do? Even if I go to the hospital, would they attend to me? They will molest and insult me. If they take care of me, they will detain me and the baby at the hospital after the delivery. That’s why I stayed at home to deliver my baby. I need help.”
These women are not the only ones likely to face such situations of not having money to attend hospitals at critical periods in their lives and without health insurance, they are out of options.
According to the Minister of Health, Professor Isaac Adewole, 70% of total health expenditure in Nigeria is borne out of pocket, a rate far higher than the 30-40% acceptable worldwide. This has remained a major barrier to accessing health care.
Majority of cases result in death and women and children are most often the victims.
This ugly trend has attracted the attention of the United Nation Children’s Fund (UNICEF) and the Department for International Development (DFID) among other international agencies.
A UNICEF Health Specialist, Dr. Adebola Hassan said health insurance is very necessary to prevent avoidable deaths particularly among children.
Adebola said the benefits of health insurance are enormous particularly in attaining Universal Health Coverage (UHC) and ensuring good health for the people without experiencing out-of-pocket spending for healthcare.
Meanwhile, the Federal Government’s National Health Insurance Scheme (NHIS) could only capture a little over seven million Nigerians out of about 200 million people in the country.
This makes it imperative for states across the country to set up and run social health Insurance schemes for more citizens to partake and benefit in their respective states.
In 2014, Nigeria passed the National Health Act, which laid the foundation for the goal of achieving Universal Health Coverage (UHC). In 2016, the nation developed the National Health Policy and in 2018 approved the National Strategic Health Development Plan (NSHDPII). Both documents encapsulate the commitment to achieving UHC and the role of Primary Health Care as the bedrock of the health system. The approach is consistent with broader national goals as espoused in the Economic Recovery and Growth Plan (ERGP) and laid the foundation for implementation of BHCPF.
UNICEF Communication Specialist, Mrs Blessing Ejiofor said access to quality healthcare is a right of every child.
With sustained advocacy by the civil society actors and with the help of development partners, particularly the Partnership to Engage, Reform and Learn (PERL), a DFID programme, the push for domestication of health insurance at state level gained attention of the authorities to the extent that Basic Health Care Provision Fund (BHCPF), was accommodated in the 2018 budget but it was not implemented.
This means that for the foreseeable future, many Nigerians will continue to face hardship battling with health expenditure and dying when they were unable to pay for healthcare services.
However, there was hope on the horizon with the commencement of the implementation of BHCPF by the federal government.
The National Roll-out of the Implementation of Enrolment of beneficiaries of BHCPF was launched by the Minister of Health Professor Isaac Adewole in Osogbo.
Osun State Governor, Mr Gboyega Oyetola was also at the Primary Health Centre, Isale-Agbara where the event took place.
Speaking at the occasion, the Minister said the federal government has dedicated funding mechanism that creates additional fiscal space for primary health care services.
He assured of improved and stronger coordination between Federal and State governments, with roles and responsibilities clearly defined.
“I am positive that this will help reverse the poor health indices in the country. I am also hopeful that death during childbirth will be a thing of the past; and our children will no longer have to die as a result of vaccine preventable diseases or other common ailments. Also, access to health care will not be limited because of not having money to pay,” he said.
“To ensure equity in the disbursement of funds, we have allocated resources per state based on the incidence of poverty and also on a per capita basis. This guarantees that the BHCPF will help reduce inequality in use and access of services particularly by the most vulnerable.
Adewole disclosed that residents of Osun will benefit from services worth N916m over the next 9 months. “This amount is equivalent to payment for the management of 270,000 women with normal deliveries, 763,000 under five-childhood illnesses or 572,000 cases of malaria,” he said.
With plans for the programme to move to Niger and Katsina states and immediate roll outs in 17 other states, the programme would not have been possible without the funding of Global Facility Financing of the World Bank and the Bill and Melinda Gates Foundation (BMGF) that committed 20 Million USD and 2 Million USD respectively.
Other international partners, DFID, USAID, CIDA, WHO, the Norwegian Government have also contributed toshaping the UHC agenda.
Governor Oyetola expressed his joy over the development and reiterated the commitment of his administration to provide adequate, quality and qualitative healthcare delivery for the people of the state.
The governor said his administration had been working round the clock to reposition the health sector by making health facilities accessible, affordable and sustainable for all.
“Our administration is poised to bring quality healthcare delivery to the doorsteps of the citizenry with this noble initiative. The all-embracing programme involves making available drugs and modern equipment, training and re-training of personnel and powering of activities at the health facilities by modern technology,” the governor said.
With these in place, the likes of Mama Lateefa and Mama Kunle would not view childbirth with such dread and fear as they do now.