#WorldHealthDay: Universal Health Coverage; Everyone Everywhere

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According to the World Health Organization, at least half of the world’s population does not have full coverage of essential health services whilst over a 100 million people live on $ 1.90 or less a day because they have to pay for health care. Moreover, over 800 million people, approximately 12 percent of the world’s population, spend at least 10 percent of their household budgets on health care.

It is however phenomenal that achieving Universal Health Coverage by 2030 is one of the targets nations of the world set when adopting the Sustainable Development Goals (SDGs) in 2015. Universal Health Coverage connotes that all individuals get the health services they need without suffering financial hardship. Universal Health Coverage enables everyone to access the services that address the most important causes of disease and death and ensures that the quality of those services are good enough to improve the health of the people who receive them.

For every 1000 children in Nigeria, one hundred and ninety one (191) die before the age of Five years old. According to World Health Organization, a huge percentage of women living in the rural part of Nigeria are exposed to just one Antenatal Hospital visit during the course of their pregnancy. A large percentage of rural women do not have the privilege of being attended to by medical professionals making births by unskilled personnel prevalent. Alarmingly, Nigeria has the second highest maternal death rate in the world with an estimated number of 58000 maternal deaths every year since 2016.

Despite the fact that Life Expectancy had risen in the past decade, Nigeria still ranks 194 out of 201 countries according to the United Nations 2015 survey. Some of these health concerns include:

  • Nigeriasuffers the world’s greatest malaria burden, with approximately 51 million cases and 207,000 deaths reported annually with 97 % of the total population at risk of infection;
  • A total 559 people have been hospitalised since February as a result of an outbreak of cholera in Bauchi State. Unfortunately, Government medical facilities lack sufficient financing required to provide adequate health services for the country’s growing population
  • Recently, 243 patients were admitted to a 70-bed cholera treatment center at Abubakar Tafawa Balewa Teaching Hospital as rural areas lack access to electricity for their medical centers.

In the 2018 Budget proposal, 3.9 percent of Government Expenditure was allocated to the Health sector, which is less than the 4.16 percent and 4.23 percent allocated to the health sector in the 2017 and 2016 budgets. It has become evident that the Government cannot singularly provide for basic health care to the growing population.

In 1999, the National Health Insurance Scheme Act was introduced to ensure all Nigerians gain access to basic health care at an affordable cost through various prepayment schemes. Nevertheless, only an estimated 6 million out of 186 million people are covered by health insurance. Clearly, both private and public organisations/employers of labour including SMEs have roles to play in ensuring that every Nigerian has access to basic health care.

Role of Business Owners/Employers

Last year, the National Assembly announced its plans to reform the 2004 National Health Insurance Scheme Act and replace it with the National Health Insurance Commission Act. One of such reforms includes making it compulsory for employers of labor with at least five workers to subscribe to the scheme, which is unlike the 2004 NHIS Act where employers were not mandated to subscribe.

Multinational Corporations, Banks, Government Agencies and Business Owners are expected to provide Health Insurance packages for their staff, which most corporations do through the Health Maintenance Organizations (HMOs). However, a large number of Small Business Owners do not have Health Insurance packages for their staff leaving a huge portion of the lower class and middle class earners to pay for health services out of pocket.

Nevertheless, Health Benefit Schemes have been in existence for decades in more developed countries and are heavily enforced irrespective of the number of staff. For instance, health insurance is a benefit obtained by approximately two-thirds of Americans, as part of their employment compensation package.

Private organisations can bridge the health coverage gap not only by granting their staff direct access to health services through the HMO but, also by aligning some of their social strategies towards providing health access to their communities of operation. This is turn yields direct benefit to the community, the business and the society at large as a healthy community patronises a socially-conscious organisation.

MTN for instance, through its Yellow Heart Initiative is providing free healthcare services to less privileged women and children in order to increase access to health care to; reducing the scourge of maternal deaths arising from poor health facilities. Chevron Nigeria is also another example, with major interests in the treatment and Prevention of HIV/AIDS, Prevention and Treatment of Malaria, Mass De-worming. Chevron also created a River Boat Clinic in collaboration with the Nigerian National Petroleum Corporation and the government of Delta State. The aim of the river boat clinic is to provide health care to people with little or no access to proper health care, especially in the Niger Delta areas. Coca-Cola Bottling Company, via Coca-Cola Africa Foundation, also established an employee healthcare program for HIV/AIDS and related conditions in Africa.

Apart from contributing to the development of the community, social investments improve a business’ public image, attracts and retains international investors whilst boosting Employee Engagement. According to the Double the Donation Research, 55% of consumers are willing to pay more for products from socially responsible companies and 65% of Fortune 500 companies’ base their CSR strategies on Health, Education and Women Empowerment.

Going Forward

Moving towards Universal Health Care and achieving SDG 3 requires a total restructuring of the health systems in Nigeria, with a combined effort of every sector of the economy:

  • In more developed countries, the Government sets up structures to ensure its citizens enjoy primary health benefits. For example, the United States of America makes use of the Medicaid which is a joint federal and state program that helps alleviate the burden of medical costs on its citizens with limited income and resources. About 13% of Americans receive healthcare through the Medicare programme, which includes the elderly population and younger people with disabilities. Certain categories of the poor receive healthcare through the Medicaid programme, paid for from general government revenues. For Nigeria to attain a similar stage, however, robust financing structures are crucial which can be derived by setting up efficient tax structures.
  • Ensuring Universal Health Coverage is the responsibility of both the Government and the Employer. Enterprises, particularly SMEs which make up a large percentage of businesses, need to set up policies in their establishments that ensure every single staff despite their levels, have access to health services. This can be done via the HMO’s or the NHIS.
  • Improved health service coverage and health outcomes depends on the availability, accessibility and capacity of health workers to deliver quality integrated health care. Currently, there is a huge migration of medical talent from the country. It is therefore important that there are incentives in place to retain these professionals. Equally important is the investment in the education of upcoming and already practicing doctors.
  • Provision of incentives to the private sector will also serve as an encouragement to invest in the Health sector as a CSR focus.

Achieving Universal Health Coverage will improve progress towards the other health-related targets attainable while also providing the basis for long-term economic development. Access and use of health services enables people to be more productive and active contributors to their families and communities. Improving health outcomes would in turn tackle poverty by reducing the impoverishment associated with payment for health services.

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