Across the globe, healthcare is a necessity and a basic human need. This is in view of the invaluable nature it confers. It is in recognition of this that the Alma Ata Declaration of 1979 in Kazakhstan called on all governments, all health and development workers, and the world community to protect and promote the health of all viz-a-viz ensuring the basic needs, including health and food are met.
Sadly however, for most developing nations, the prospects of achieving even a minimal level of adequacy in health services remain a mirage. While healthcare needs are increasing, government expenditure on health in developing countries is declining. This has resulted in a situation whereby as populations get older, as more people suffer chronic diseases, and as new and more expensive treatments appear, health costs seem to soar.
In Nigeria, healthcare sector hasn’t fared much better on the World Health Organisation’s measures for individual contribution to healthcare. This is because effective financing which is critical to revamping the health sector is lacking. ‘Out-of-pocket’ expenditure as percentage of private expenditure on health is put at 90 percent in Nigeria compared with 79 percent in Ghana and 24 percent in the United States of America.
This data show the nascent state of the health insurance scheme in Nigeria as patients bear the full and direct brunt of their medical expenses without any significant assistance from the company or institution they work for (if not enrolled in the National Health Insurance Scheme-NHIS)
Going further, WHO ’s report of 2005 revealed that per capital government expenditure on health in Nigeria was $14 compared to $32 (Ghana) and $2,861 (USA). In the same period, total expenditure on health as a percentage of Gross Domestic Product was put at 3.9 percent compared to 6.5 percent in Ghana and 15 percent in USA.
Furthermore, the total government expenditure on health as a percentage of total government expenditure in 2005 was 3.5 per cent compared to 6.9 percent (Ghana), and 18.7 per cent (USA).
Giving this reality, health experts have called for increased budgetary allocation for the health sector in Nigeria if the sector wants to operate at optimal capacity and deliver healthcare to millions of Nigerians
Speaking to BusinessDay, Saheed Babajide, Secretary General, Association of Resident Doctors, Lagos State University Teaching Hospital (LASUTH) disclosed that the health sector collects less than four per cent of the national’s budget which is inadequate in delivering the minimum health delivery.
Babajide stated that it the sector can get 25 per cent of budget allocations, it will go a long way in improving healthcare delivery in all tiers of government-Local, State and Federal in the sense that one won’t to travel outside the country for medical attention.
According to him “In this case, all levels of healthcare –from the primary, secondary and tertiary levels will be improved. Don’t forget that adequate equipment and the enabling environment for better health care delivery will be provided with these funds which will in turn reduce mortality rates in the country. Don’t forget that this will also improve health research which is currently been underfunded by the government and has left some of these research centres at the mercies of foreign agencies and grants.”
For Edamisan Temiye, Chairman, Nigerian Medical Association (NMA), Lagos state Branch, Nigeria has not able to meet the African heads of state commitment in Abuja in 2000 to spend 15 percent of their national budgets on health, since only N34 billion representing about seven percent has been proposed in the 2011 budget.
Temiye stated that it is believed that 70 percent of the nation’s health budget spent in urban areas where about 30 percent of the population resides. He noted that to actualize the goals of the Millennium Development Goals and solve most of health care problems, Nigeria is expected to spend 15 percent of its total budget on health.
In his words “Nigeria’s allocation to the health sector in the 2009 budget was N39.6 billion (out of N796 billion earmarked for capital expenditure the same year). If you cast your mind back, N114billion has been spent by Bill Gates in eradicating Polio in Nigeria. Gates have spent N1.2 Trillion on polio eradication globally. This amount is one-third of Nigeria’s 2010 budget of N4.079 Trillion.
No doubt, there is the need for increase in budgetary allocation which currently hovers between six and seven percent. Though there have been health reforms in the past as well as the exploration of e-health and m-health [electronic and mobile health] tools in the country, expectations of our people have not completely in providing care and ensuring that our people benefit from good health care. There is room for improvements in budgetary provisions to the health sector. The current health minister Onyebuchi Chukwu must be commended in with regards to reforms in the sector but there’s room for improvement.”
With the year set to meet the MDGs inch close and the nation’s worrisome indices, healthcare financing must not be left in the hands of government alone. At the moment, countries like Japan that manage to ensure health services are available to the entire population have done so by reducing dependence on direct, out of pocket payments and increasing prepayment - generally through insurance or taxes or a mix of the two.
The funds raised are then pooled, so that it is not just those who are unlucky enough to get sick that bear the financial burden. This is the model used in many European countries, with Chile, Colombia, Mexico, Rwanda, Thailand and Turkey all making significant progress in the last decade - along with Brazil, China, Costa Rica, Ghana and Kyrgyzstan.
For Femi Ajayi, Chairman, Olabisi Teaching University Teaching Hospital, Sagamu, given that most governments (even in more efficiently run countries) have shown that they cannot do better than the markets in terms of healthcare administration, it becomes imperative that Nigeria must redefine its policy to healthcare administration. The private sector must be allowed (indeed, encouraged) to lead development in this area.
“Government's role should not be in the provision of healthcare; instead, it should be to work with the private sector to ensure that policies are designed to meet the needs of consumers. Also, public private partnerships should be encouraged”, Ajayi concluded.
Alexander Chiejina
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