However the issue has always not been about the spending in healthcare but equity in access to healthcare which Universal Health Coverage entails. This simply means affordable and equitable access to the most basic of healthcare services as an inalienable right.
It is therefore refreshing to note that this new mantra has found solace with the World Bank Group and the World Health Organisation through the United Nations. Such is the attention given to achieving Universal Health Coverage amongst nations of the world that a whole day session was devoted to this at the recently concluded Spring meetings of the World Bank Group/IMF Civil Society Policy Forum meetings in Washington DC.
The highlight of the occasion were the speeches given by the UN Secretary General, Ban Ki-moon and the president of the World Bank, Jim Yong Kim which heralded the fourth of the series of panel discussion for the day; Investing in Health: Towards Universal Health Coverage and Ending Poverty by 2030. This panel discussion was moderated by the Director General of World Health Organisation, Margaret Chan and featured Lawrence Summers, President Emeritus at Harvard University and one of the Lancet Health Commission’s reports that advocated for ”progressive universalism” to target the poor in achieving health and financial protection through Universal Health Coverage. The other panel discussants were Michael Bloomberg; philanthropist and three-term Mayor of New York City as well as Ngozi Okonjo-Iweala, Nigeria’s Minister of Finance.
Summers reiterated his position on the pay-off in health investment as published in the Lancet Health Commission report which shows that the ROI in health is higher than previously estimated and may account for as much as 24% of growth in developing countries. He therefore advocated for increased investment and strategic innovation in providing secondary heath care as well as scaling in investments in primary health care.
Bloomberg harped on the importance of health education and prevention and pointed out this effect on the life expectancy of the New Yorker which is 2% higher than the average of the United States of America. He therefore pointed out that government at all levels needed to provide incentives for these changes with efficiency of health care services being buoyed up by preventive efforts.
Okonjo-Iweala made a clarion call for high net worth individual’s participation in health investment which necessitated the setting up of the Private Sector Health Alliance in Nigeria at the forefront of this drive. She also talked about Nigeria’s efforts at achieving Universal Health Coverage which is one of the cardinal objectives of the recently passed National Health Bill which aims to make at least 30% of Nigerians have health insurance by 2015 as 95% of health payments are out of pocket with 67% of health care providers being in the private sector.
The issue that however kept nagging at me was how the Universal Health Coverage target by 2030 by the World Bank and UN with the twin aim of ending poverty and therefore targeting the achievement of the MDG’s can be rapidly scaled up in developing countries and especially Nigeria. Beyond the rhetoric and grandstanding, there has to be increased budgetary allowance to healthcare and not the 6% of the 2014 national budget amounting to N262 billion ($1.7 billion) out of which 82% will go to recurrent expenditure. Of course it was expediently argued by Okonjo-Iweala that other sectors like education, water resources and transportation which are ancillary to the provision of good health care needs to be catered for with the scarce resources that the economy is faced with which may be fair enough in her exalted understanding.
The way out therefore is concerted efforts by all and sundry in maximising the gains of affordable healthcare and ensuring that the country and indeed ordinary Nigerians without the wherewithal to visit their GP’s (General Practitioners) in the UK or afford medical check-ups in America and India benefit from the world’s galvanised efforts at achieving equity and efficiency in access to healthcare. This can be achieved by the organised private sector and Civil Society Organisations (CSO’s) that are all stakeholders in healthcare delivery as it is clear that government efforts alone will be somewhat slow in diffusing to have maximal impact.
This is therefore the crux of the strategic partnership between Mitera Health and Rights Monitoring Group – a coalition of 45 CSO’s in Nigeria – towards making sure that Nigerians set aside regular contributions for their health needs through health insurance as enshrined in the act setting up the National Health Insurance Scheme. This partnership is also being extended to subsidise health care costs for the vulnerable poor in addition to health education and prevention in rural communities.
Japan achieved Universal Health Coverage about 50 years ago while the United Kingdom’s NHS stands head high in achieving equitable health services to majority of her citizens. It is therefore timely that Nigeria, West Africa and indeed the developing world takes advantage of the World’s Bank and United Nations’ institutional collaboration in achieving Universal Health Coverage by 2030.