By: Omodolapo Shobowale & Esther Ilesanmi
Health financing is not merely about generating funds for healthcare, it concerns the “mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO, 2000).
Most countries are ambitious towards the accomplishment of the 2030 SDG goals (specifically SDG 3 – good health and wellbeing). As much as this is good, health financing is one of the building blocks of health system, its level of functionality has direct effect on the overall functioning of the health system. Hence, promoting good health and wellbeing of the populace. So, the questions are: Why is health care financing important for the realization of SDG – 3? ; How is Nigeria fairing in healthcare financing? Nigeria’s healthcare between now and 2030?
Why Is Health Care Financing Vital For The Realization Of SDG – 3?
Finance is vital to building a sustainable healthcare system. Overtime, countries like Germany, Canada and Thailand haveshown that universal health coverage (UHC) is attainable. When healthcare is sustainable, it means that there is efficient funding sufficient to protect the population from financial risks in accessing essential health services. Therefore, building such health system entail considerations for, inter alia, budgeting frameworks, the design of benefit packages for health, social protection and health insurance frameworks, including community-based health insurance and free health care policies, resource tracking and revenue raising, fiscal space for health, public health taxes. Improvement in the sustainability and impact of health financing necessitate the combination of approaches on policy development and programmatic interventions.
How Is Nigeria Fairing In Healthcare Financing?
Health financing mechanisms in Nigeria at present do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Financial resources are not allocated equitably or in a way that minimizes wastage and improves efficiency of the system. None of the mechanisms effectively protects individuals/households from ruinous health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations(HMOs) as purchasers.
No doubt, to allocate an insignificant 4.2 per cent of the budget to the health sector at a time when the country is facing numerous challenges such as the scourge of COVID-19 pandemic, cholera, malaria, tuberculosis and other infections is a sad commentary not just on the state of the health sector, but also on how the Federal Government view the needs of the sector. Going by the approved budget for 2022, with the country’s population of over 206.1 million as estimated by the World Bank, an average Nigerian is only entitled to N3,510worth of medical care throughout the year. Most payments are out-of- pockets by individuals.
In all of these, Primary Healthcare Facilities bear the brunt. They are the worst affected with most of them poorly staffed and without necessary medical equipment which further impact the attainment of Universal Health Coverage. Being the closest to the community, the PHCs were designed to cater for the basic health needs of the people.
Nigeria’s healthcare between now and 2030: How Do We Make Progress?
2030 is a significant year in the accomplishment of the SDG goals globally. With barely 8 years to go, our country, Nigeria should not be left out either. There should be a significant scale up in healthcare financing. So, the question is how can Nigeriascale up to have sustainable health system leveraging health financing?
Fortunately, the country has the potential to reverse the trend by learning from other countries all over the globe which have achieved UHC by adopting either a tax-based insurance scheme or a SHI scheme. According to Lancet, universality requires that the funding base, particularly but not only in low-income and middle–income countries (LMICs), would rely predominantly on general government budget revenues, regardless of whether they flow directly to providers or via a service purchasing agency such as a health insurance fund. For any payment system paid from government budget revenues to be effective, budget formulation, and execution—the fundamentals of public financial management—will need to function sufficiently well to enable providers to receive a steady, predictable flow of funds with the ability to manage these flexibly.
This can be facilitated with the design of a programme-based budget that is defined in a way (For instance, as access to PHC services) that aligns with the capitation strategy and shifts control and monitoring from inputs to predefined performance indicators that are progressively refined over time.
However, it is recommended that the scheme (NHIS) is overhauled and repositioned to promote equity and access to healthcare across all population groups. This can be done using an excise tax or “sin tax”. The revenue generated could be used to finance the health of the entire country in combination with the existing NHIS. Also, it is recommended that the law that established the NHIS be amended to make insurance mandatory to increase participation. Also, adequate awareness should be created for the same reason. The currently fragmented NHIS should be amalgamated for efficiency, risk sharing and fund pooling. The benefits package should also be reviewed to be more comprehensive to attract and encourage enrollees. Enrolment could also be boosted by providing free healthcare to the poor, marginalized and underserved population, thereby removing inequality and inaccessibility.
Finally, in line with the 15% Abuja declaration for budget allocated to healthcare, there is a need for the government to demonstrate political commitment toward UHC by increasing budgetary allocation to health. For until then can our healthcare system scale up to becoming sustainable.
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