ALTHOUGH Nigeria has made primary health care the official basis of its national health policy since 1986, it took almost 30 years to legally back a standard package of services with legislative approval and the presidential signing of the National Act. of Health in 2014. The law establishes that “all citizens shall have the right to a minimum basic package of health services…” defined as “the set of health services that the Minister may periodically prescribe after consulting the National Health Council” . The minimum package must reflect Nigeria’s minimum core obligations in terms of health care, constitutional rights to life and human dignity. The definition is important to cost and finance the minimum package. The legislature is invited to use the power of supervision to push the Minister of Health to facilitate the definition of this package.
This is even more imperative as Section 1 of the National Health Insurance Authority Act establishes the National Health Insurance Authority, while Section 3 states that its functions include, among others, promoting, integrating and regulating all health insurance plans operating in Nigeria; ensure that health insurance is compulsory for all legal residents and Nigerians; and enforce the basic minimum package of health services for all Nigerians in all health insurance schemes operating within the country, including federal, state and FCT, as well as private health insurance schemes. Clearly providing equal access to healthcare for all Nigerians is central to the country’s National Health Act. But Nigeria’s Health System ranks poorly in terms of access and quality, just as the country also ranks poorly in Transparency International’s Corruption Perceptions Index.
The problem of lack of access to quality health care is related to the waste of primary care services in reference centers. In rural communities where the burden of morbidity and mortality from disease is high, spending and the efficient use of health services are affected by the absence of adequately functioning primary health centers (PHCs), deficient cost-sharing schemes or inadequate and due to corrupt practices in the health services. sector.
In order to curb these problems, it is useful to consider policy options such as renewing the PHC and prioritizing the delivery of a minimum basic health care package. In addition, the implementation of robust actions to combat corruption in the health sector will improve access to care and health outcomes and does not imply additional financial investment. This can be achieved by improving public financial management and limiting corruption by making the right decisions in the allocation of resources towards pro-poor interventions. Similarly, a well-designed service package and prioritization of primary care making the best use of human resources will be beneficial. This is relevant to the Nigerian health system, taking advantage of the country’s decentralized administration and strengthening the role of community health committees to ensure accountability and transparency in PHCs. In addition, taking into account the role that community health committees play in driving demand in rural communities, the National Primary Health Care Development Agency (NPHCDA) can coordinate the development of a joint action plan for the provision of healthcare between this committee(s) and each respective PHC facility. .
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This will promote the efficient use of resources and facilitate access to quality health care at each facility. Strategic actions such as modernizing PHCs and prioritizing the delivery of basic minimum packages through national and state insurance schemes are important to fill policy gaps to optimize healthcare delivery. But without strong anti-corruption action in Nigeria, the UHC remains aspirational and unrealistic. While PHC renewal is in line with global recommendations as an efficient route to UHC, the country’s economic realities make it less feasible. Similarly, prioritization of the basic minimum package through the state rollout of cost-sharing schemes would support broader coverage, but its implementation lags behind in the states. It is a call to action relevant to the health sector and feasible through an initial assessment of the vulnerability of the health sector.
While more local evidence needs to be generated to guide concrete steps, political support will also be essential to drive this policy forward by ensuring appropriate sanctions against corrupt practices where necessary to produce measurable impact.
- Okeke writes from the Center for Social Justice (CSJ) Nigeria.