UHC – Need to Finance Primary Health Centres

Experts at the Nigerian Health Watch Primary Health Care Policy Dialogue recently harped on the importance of financing Primary Healthcare Centers and services in a bid to achieve Universal Health Coverage.

The World Health Organisation (WHO) describes a Universal Health Coverage (UHC) as the ability of all individuals and communities to receive health services they need without suffering financial hardship.

This also includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Achieving UHC was one of the targets the nations of the world set when adopting the Sustainable Development Goals (SDGs) in 2015.

The UHC also aims at eradicating generational poverty by protecting people from the financial consequences of paying exorbitantly for health services out of their own pockets, which they most times do by selling their assets and belongings or even borrowing.

Achieving universal health coverage requires a Health Insurance Scheme that minimises out-of-pocket expenditure, guarantees the provision of essential health services, and covers the majority of the population.

In Nigeria, the National Health Insurance Scheme (NHIS) established in May 1999, and became operational in 2005, is supposed to be the vehicle for achieving UHC in the country.

However, despite 16 years of its existence, NHIS enrollment has been very disappointing, just as funding of PHC.

Only about five per cent of the population in all the three NHIS programs, namely; formal sector, informal sector and vulnerable groups (pregnant women, inmates, children under five, retirees, aged), have been covered by the NHIS.

Recently, this lacuna informed experts deliberations at the policy dialogue titled, 'PHC in Nigeria: Progress, Challenges, and Collaborating for Transformation', recently held via zoom.

Providing more background to this, the Managing Director, Nigeria Health Watch, Vivianne Ihekweazu said health was a human right and everyone, irrespective of location or socioeconomic status has a right to healthcare at their point of need.

According to her, "for a heavily populated country like Nigeria where there are income inequalities, there is a need to examine the healthcare system through the lens of health equity, which is accessible, affordable, and offers healthcare for all that need it.

"This brings to the fore the importance of primary healthcare which is the bedrock of every health system and should be the first port of call for most Nigerians when seeking healthcare."

Speaking on the challenges in the Nigeria healthcare system, despite several policies targeted at PHC deliveries, the keynote speaker, Prof. Tanimola Akande, who is a Consultant at the University of Ilorin Teaching Hospital, said it was unfortunate that despite several government interventions, the challenges that limit the effective delivery of PHC services still exist.

According to him, these challenges include, "fragmented governance and coordination, poor and dilapidated health facilities, shortage of human resources and poor funding."

In addition to these challenges, the CEO of ACIOE Associates, Ekenem Isichei, during his presentation, highlighted insecurity and rising inflation as other factors mitigating the uptake of healthcare services in the country.

According to him, "Affordability and safety are essential requirements to accessing healthcare.

"Rising inflation costs are forcing a growing number of families to make the tough decision between using available resources to seek healthcare or purchase other basic needs like food.

"Also, several states are immersed in some form of insecurity further hindering access to healthcare for both the patient and the health worker."

He therefore concluded that when we have a stronger and more resilient health system, we save wealth, and make more money. He also harped on the need for the government to fully implement the National Health Act.

Speaking on the role of private partnership in improving PHC services, the Chief Medical Officer, EHA Clinics, Dr. Anthonia Hananiya, said Primary Healthcare in Nigeria has received little investment from the private sector over the years.

According to her, "Provision of quality, standard healthcare services require resources, epitomising the importance of private sector investment in the health sector,

"EHA Clinics, with two health facilities providing quality PHC services in Kano and Abuja, are a clear example of what happens when resources are made available and used shrewdly.

"Enormous resources were invested to ensure that the clinics provide patient centred, technology driven, healthcare services."

Speaking on how the state had leveraged the COVID-19 pandemic to improve on PHC service within Ekiti State, the Commissioner for Health and Human Services, Ekiti State, Dr. Oyebanji Filani, said the pandemic was the perfect opportunity for Ekiti State to augment the support of its PHC.

"Infection, Prevention and Control (IPC) mechanisms were improved across all the PHCs, in addition to improving vaccination capabilities of PHCs that resulted in Ekiti State being recognised as one of the best performing states for COVID-19 vaccine uptake in the country."

Dr. Filani said in 2020, the state carried out an assessment that examined the reasons for underperformance of the health sector in the state, adding that the results helped the state in designing and implementing targeted plans to effectively address the identified challenges.

"Some of the plans being implemented include the Ekiti State National Youth Service Scheme Medical Fellowship program, which involves deploying Corp members who are medical doctors to PHCs across the state, increasing the state health budget by 200 per cent and training of over 600 PHC workers.

"The results of these initiatives are beginning to show, with improvements in immunisation and skilled birth attendance across the state," he said.

Speaking on more ways to drive resources for PHC services, the President and Financial Director, Healthcare Innovation in Delivering Financial Analysis and Actionable Business Insights, Dr. Charles Ezuma-Ngwu, suggested the adoption of a cost-effective payment system in the form of capitation.

According to him, "Capitation is a method of payment for health services in which a physician or hospital is paid a fixed amount per enrollee, to cover a defined scope of services for a defined period, regardless of actual number or nature of services provided."

On the role of advocacy, the President of Medical Women Association of Nigeria (MWAN) Kano State, Dr. Rahila Mukhtar, said advocacy plays a very important role in both demand and supply of PHC services.

According to her, this is proven by the work of MWAN under the PacFah@Scale in Kano State, and its advocacy to both the Kano state Executive and Legislature, which has contributed to the passage of the PHC law in the state, adding that "it also led to the engagement of over 2000 PHC workers and improved funding for PHC services in the state".

She said the advocacy to religious and traditional leaders also improved uptake of PHC services such as antenatal, post-natal, skilled birth attendance and child immunisation in the state.

According to the WHO, about 80 to 90 per cent of an individual's healthcare needs throughout their lifetime could be met at the primary healthcare level. This further echoes the importance of standard, well equipped and well-staffed PHCs, particularly in rural communities.

Quote

For a heavily populated country like Nigeria where there are income inequalities, there is a need to examine the healthcare system through the lens of health equity, which is accessible, affordable, and offers healthcare for all that need it. This brings to the fore the importance of primary healthcare which is the bedrock of every health system and should be the first port of call