Improved Health Financing for Sustainability: Insights from theory and practice.
Salt House
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Author: Modupe Laja , Social Good Lagos.
Introduction
Spendings on healthcare is rising throughout the world - a recent report by the World Health Organization (WHO) released on the global health expenditure database, provides country expenditures up to 2016. This evidence is to illustrate the state of health financing i.e., whether the world is on track to mobilise the financing needed to reach the health targets set out in the 3rd sustainable development goal (SDG 3). The world-class agency responsible for international public health, WHO, defines health financing as the operationalisation of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. This also includes achieving universal health coverage (health financing reforms) (WHO, 2023;Sch?ferhoff, 2019).
A story of Atinuke is a case of many who lack equitable access to sustainable health financing.
A 26-year-old trader, in her third trimester, is sitting on a wooden four-legged stool trying to cook for her husband. Atinuke’s husband is a local farmer who has been saving funds to afford the bills at the local maternal clinic about 500 miles away.
Moments later Atinuke feels some fluid trickle down her legs. Now she reacts quickly, puts off the gas, and screams, “Blessing” at the top of her voice. The 16-year-old girl rushes in to respond to her madam’s call and notices her panting and moving around the kitchen like a storm was approaching.
In 15 minutes, Atinuke and Blessing rushed out of the house with less than 1000 naira to a nearby maternal clinic. In the Taxi, Atinuke would occasionally utter a cry as the pain slowly became unbearable. But the taxi driver was more worried he had not negotiated the cab fare before embarking on their journey.
Atinuke screamed “Call my husband and tell him to come to the hospital”. Only then did Blessing realise that they had left the phone at home. On getting to the hospital, Atinuke was wheeled into a room to undergo some tests. As far as Atinuke was concerned, her mother pushed her out of her womb, and so did her grandmother. This was going to be no different. After all, it had already been discussed and finalised with the doctor.
1 hour later, and she could not believe her ears.
“You will need surgery, Ma. I know we had agreed you would do a vaginal delivery but the results of our test show that your placenta has moved from its previous position and now completely blocks your cervix, the pathway for your baby to come out. It is called Placenta Previa. We have no choice but to take you in for CS.”
“The medical bill for vaginal delivery, 40,000 Naira is much lower than the bill for caesarean section, 120,000. You need to pay an outstanding of 80,000 naira before we can wheel you into the theatre. Please bear with us as it is our policy to make all payments before service.”
According to Central Emergency Response Fund (2018), Africa’s health landscape and undersupply of sustainable healthcare human capital present challenges for driving SDG 3 “to ensure healthy lives and promote well-being for all at all ages”.
In African countries, healthcare financing remains low causing constraints in health coverage. Now more than ever, Africa is expected to increase health budget allocations to be able to move towards improved health status of its people and achieve international health goals (Sambo et al, 2013). To truly overcome the gaps and obstacles women like Atinuke face; it is paramount to empower women through policies adequately tailored to help make the right decisions for good health and well-being. This could have had a better ending if policies that consider peculiar cases of various health conditions and limitations due to costs and variation in social backgrounds exist.
The month of March hosts the International Women’s Day (IWD) and this year’s theme is “Embrace Equity”. The focal point of the 2023 IWD theme is on the women's rights movement, bringing attention to issues such as gender equality, reproductive rights, low representation, violence and abuse against women. Advocating for Universal Health Coverage is timely in that a lot of Nigerian women face medical emergencies, eventually paying exorbitant consultation fees, unrealistic diagnosis and treatment costs. This corroborates with statistics by a report for Health Policy Watch- Independent Global Health Reporting, which explains that almost 800 women died every day in 2020 due to preventable causes related to pregnancy and childbirth; 95% occurred in low and lower middle-income countries; and Nigeria is indeed a confirmed lower-middle income country.
Universal Health Coverage in simple terms, according to the World Health Organization (WHO) , means that people have access to the full range of quality health services they need, whenever and wherever, without financial hardship. Universal Health coverage links to protecting people, especially women, from the financial consequences of paying for health services out of their own pockets. It also reduces the risk that they may likely face unnecessary financial hardship leading to some economic crises and other unfavourable life issues such as gender equalities and health inequities. Examples of these conditions may be as a result of catastrophic health spending (and related indicators) (SDG 3.8.2) requiring them to use up their life savings, sell assets, or borrow at the expense of their futures and those of their children.
The UHC service coverage index (SDG indicator 3.8.1) under the SDG 3, for “all healthy lives and wellbeing" really matters. To meet basic requirements, there would be a strong need to examine the processes of how stakeholders accelerate their commitments as a window of opportunity. What this implies is that before impactful Universal Health Coverage can be achieved in Nigeria in two folds; we need to i) resolve a key component called healthcare financing which calls for a critical examination and protection of the finances of citizens accessing health care services in Nigeria ii) review the cost and quality of the service they pay for, keeping in mind that at 77%, Nigeria has one of the highest out-of-pocket expenditure on healthcare services in comparison to 37% for Africa, and a global value of 18%. According to WHO Global Health Observatory Data Repository for UHC, as the coverage of people increases, catastrophic out-of-pocket spending simultaneously increases. This is evidenced by the greatest increase in the South-east Asia Region and Western Pacific Region.
The Healthcare system began in Nigeria with the establishment of Sacred Heart Hospital, Lagos Island General Hospital, and National Orthopaedic Hospital in the 50’s. Since then, there have been more than 39,914 health facilities including public and private establishments catering to over 219 million Nigerians. Report by Datapythe indicates that on average, there are 17 health facilities for 100,000 persons. This data is alarming. The 2022 Multidimensional Poverty Index by the National Bureau of Statistics (NBS) revealed that 63% (133 million) of persons living in Nigeria are multidimensionally poor. Which means people like Atinuke in 5 years will be unable to pay for basic rights such as education, health bills, housing and clean water.
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What’s Next for Change?
This critical situation may see Africans resorting to self-medication and buying over-the-counter drugs risking kidney failure and liver damage which mostly contain incorrect self-diagnosis and inappropriate dosage. It might also lead to more of our people abandoning the healthcare system for the products and services of unlicensed individuals in their environment due to cheaper rates.
We need hope in action. We need education that translates to innovative healthcare solutions i.e., tailored healthcare solutions to the community. We need a new Nigeria where poor people’s lives are as important as the rich folks. We need to revise health laws and policies. We need healthcare benefits and incentives.
Recommendations
Every one of us is accountable. We, the citizens, must;
In addition, Health boards must;
Conclusion
It is disheartening when one considers the high levels of healthcare poverty that plagues the sector. These factors show the lapses in the implementation of the NHIA Act with regards to the 2023 budget. Still, there is hope for a new administration to bring about solutions that will surpass traditional approaches. African countries must be intentional to increase health budget allocations if they want to move towards improved health status of their people and achieve international health goals.
Some of the innovative health financing solutions must be in line with increased health expenditure, developed tax-based systems, improved tax compliance and revenue collection efficiency (Uzochukwu, 2015; Okongwu, 2019) African government must decide to prioritise the health of masses by increasing the avenues for generation of health funds, allocating it effectively, and utilising the funds maximally. This will make the healthcare system resilient and sustainable for every Nigerian.
Deliver more with less. This should be the mantra of health management organisations in serving the community. Health is for All, should not only be the goal of the World Health Organisation but the objective of every hospital unit. We must all work hand-in-hand to build a respectable and cherished healthcare system.
Contact Author
Name: Modupe Laja
Email: [email protected]
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