Positioning Nigerians Towards Achieving Universal Health Coverage With 'The Lancet Report'

Sunday Ehigiator writes that the newly commissioned 'Lancet Report' during the 'Global Launch of The Lancet Nigeria Commission', was a step in the right direction for Nigeria to achieve Universal Health Coverage by 2030

In public-health parlance, it is often said that a healthy nation is a wealthy nation'. Therefore, the Universal Health Coverage (UHC) is about ensuring that people have access to the health care they need without suffering financial hardship.

The Sustainable Development Goal 3 (SDG-3), regarding "Good Health and Well-being", is one of the 17 Sustainable Development Goals established by the United Nations (UN) in 2015. The official wording is: "To ensure healthy lives and promote well-being for all at all ages."

Target 8 of the SDG-3 particularly speaks about achieving universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.

Another aspect of the SDG-3 equally spoke about the need for a substantial increase in health financing and the recruitment, development, training, and retention of the health workforce in developing countries (such as Nigeria), especially in the least developed countries and small island developing states.

Therefore, Universal Health Coverage (UHC) aims to provide health care and financial protection to all people in a given country with three related objectives: equity in access, quality of health services, and financial risk protection.

The Nigeria Situation

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One of such challenge is system-wide inequities resulting from a lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care.

Although several efforts and initiatives have been put forth by the Nigerian Government to advance UHC in the country, these efforts have mostly been jeopardised by the faulty structure of the country's health system.

Hence, to get quality health care, you just have to visit private hospitals and facilities which are usually very expensive and unsubsidised. Out of pocket expenditures for health is the order of the day and it is seemingly peaking at an overall of about 70 per cent of the total contribution for healthcare services.

The consequence of this is evident in the country's high Maternal Mortality Rate (MMR) pegged at 814 deaths per 100,000 live births by the World Health Organisation (WHO), which also puts the lifetime risk of a Nigerian woman dying during pregnancy, childbirth, postpartum or post-abortion at one (1) in 22, in contrast to the lifetime risk in developed countries estimated at one (1) in 4,900.

The Lancet Report

Against the backdrop of finding lasting and workable solution applicable to every economic class of Nigerians, a multidisciplinary group of Nigerian academics based in Nigeria and around the world, working in close collaboration with UCL's Institute for Global Health, and policymakers, over two years reviewed existing disease burden in Nigeria and opportunities to improve health and came up with the recently launched Lancet Report.

The Lancet Nigeria Commission report, published on Wednesday, March 16, 2022, found that health outcomes remain poor in Nigeria, despite higher expenditure since 2001.

The team also maintained that while Nigeria is Africa's largest economy and most populous country - projected to become the world's third most populated country by 2050, its dismal health outcomes are holding back progress and threatening the future of an otherwise dynamic nation.

In an accompanying Lancet paper, the group also examined population health outcomes in Nigeria from 1998 to 2019 and compared it with 15 other West African Countries.

They analyzed gender patterns of mortality, years of life lost, years lived with disability, life expectancy, healthy life expectancy, and health system coverage. The authors concluded that Nigeria compares less favorably than similar nations in West Africa, despite recent improvements.

Recommendations

On recommendations, speaking on behalf of the team, the Team Lead, Professor Ibrahim Abubakar, said Nigeria urgently needs to improve access to health care by improving health financing and the efficiency of existing spending.

"Our report offers specific recommendations on innovation financing and specific interventions to improve healthcare staffing, information systems, and access to care for all.

"Given that the vast majority of factors that influence health lie outside the healthcare sector, health should be at the heart of all policies. This will require a re-think of governance for health with the establishment of inter-sectoral governance mechanisms that enable measurement of the health impact of different policies to hold all sectors accountable.

"This includes addressing poor access to water and sanitation; improving access to healthy foods; addressing the double burden of malnutrition due to underweight and overweight, and tackling the scourge of air pollution. Explicit consideration of equity in the implementation of programs and provision of social welfare, education, and employment opportunities should be paramount."

Yet the report presents a positive outlook that Nigeria can deliver equitable and optimal health outcomes.

It identifies bold recommendations for action in collaboration with policymakers, contributing to sustainable change on health policy and programming, national health outcomes, and global health goals.

The report's recommendations include calling for a new social contract centered on health to address Nigeria's need to define the relationship between the citizen and the state, prevention being at the heart of health policy, given Nigeria's young population, requiring a whole-of-government approach and community engagement.

It also proposed an ambitious program of healthcare reform to deliver a centrally determined, locally delivered health system, including providing health insurance coverage for 83 million poor Nigerians who cannot afford to pay premiums.

It proposed a health system that encourages innovation and engages communities, to ensure that existing nationally driven schemes have local buy-in and are sustainable, and reforming the policy and regulatory landscape to unleash the market potential of the private sector.

It demanded a whole system assessment of the investment needs in Nigeria's health security, in which the pandemic has exposed weaknesses.

Appraisals of the Report

Appraising the report before officially commissioning it, Vice President Osinbajo said the federal government had placed great emphasis on improving the health of all Nigerians, adding that "putting primary health care (PHC) at the center of a reform is proof of its sincerity".

He said that PHC ensures that high-quality basic health care services are provided to Nigerians, regardless of where they live or stay in the country.

He added that the federal government believes that the health of Nigerians does matter and would therefore focus interventions on Nigerians living in rural areas, women, and vulnerable populations.

"Of course, there was no way to say we've done it all because the challenges are the same everywhere and I think the report highlights those challenges, but we welcome innovation and fresh thinking.

"The report provides several excellent recommendations, some of which are already being implemented, but many of which we will need to consider carefully.

"This report is important. I think it is. Particularly just as the president launched the health reform committee, which he asked me to chair, and I think the committee will benefit Nigerians.

"I believe immensely in the input of these experts who wrote the entire report," he explained.

Osinbajo said the report further recommended that prevention had to be at the center of health policy, given Nigeria's young population, and that it required a lot of government focus and community engagement.

He said that to redesign and rethink the health security needs of the country, there is enough that the nation already knows.

"Governments must lead the development of standards for the digitisation of health records, better data collection systems, registration, and quality assurance."

Also speaking on the report, Secretary to the Government of the Federation and Chairman of the PSC on COVID-19, Boss Mustapha, said, analysis of the country's disease burden showed a combination of a high burden of maternal and child conditions, a reduced but still significant burden of infectious diseases, particularly malaria, and a growing burden of non-communicable diseases (NCDs), that pose a threat to the rapidly growing population of the country.

"Health is a unique political lever, which to date has been underutilised as a mechanism to bring populations together."

Mustapha said that as the country recovers from the COVID-19 pandemic, its growing population requires increased funding for its health care. However, he advised that the country must invest in its health and the future of its health care system, noting that to better respond to the needs of its citizens, the nation must invest in its health care system.

Quote

"Our report offers specific recommendations on innovation financing and specific interventions to improve healthcare staffing, information systems, and access to care for all. Given that the vast majority of factors that influence health lie outside the healthcare sector, health should be at the heart of all policies"