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Who remembers the Presidential Summit on Universal Healthcare?

A little over  a year ago, on the 7th of March 2014, top level officials in the Nigerian health sector were called together to attend what was called a “Presidential Summit on Universal Healthcare”.  During the summit, we listened to several speeches and powerpoint presentations of wishes, hopes and aspirations on the concept of “universal health coverage” (UHC). At the end, the summit adopted “The 2014 Declaration”, a 23-point statement which recommends greater commitment of all tiers of government to improving UHC and the institution of mandatory health insurance. We were also told that Mr President had set the Dr. Femi Thomas led National Health Insurance Scheme (NHIS) the target of achieving 30% Health Insurance Coverage by 2015. The 2014 declaration also charged all levels of government in the country to increase budgetary allocation to health and define a standard benefits package of essential health services that addresses priority health care needs of Nigerians.

Since then, things have gone very quiet. The website of the NHIS leaves so much to be desired for such an important government agency. It is important to gain insights on the progress made towards enabling the coverage of 50 million Nigerians (30%) by the end of this year. We also need to hear from their flagship programme to enroll pregnant women and children under the age of five, which is not mentioned on their website with a single sentence.

I particularly remember Professor Obinna Onwujekwe’s talk on the day of the summit, where he proposed that UHC was only possible with enabling policies, legislation, strategic plans, getting improved efficiency, increased funding, innovative health financing as well as improved equity of access. Professor Onwujekwe encouraged State governments to develop their own insurance schemes, asserting that the process of sending state contributions up to the NHIS and then having the NHIS deduct 10% as administrative cost to disburse the funds was inefficient.

Since then, there has been continuing rhetoric about UHC. The President of the Nigerian Medical Association (NMA), Dr Kayode Obembe, asserted that “the focus in 2015 in the health sector should be universal health coverage.” He proposed community-based health insurance (CBHI) as a mechanism to deliver this. CBHI is definitely a model that will work for several states in Nigeria. One significant opportunity is the opportunity for third parties to contribute to the establishment of a CBHI, as we had previously described. There is a role for the Nigerian corporate sector to engage with the government in public private partnerships in supporting the emergence and growth of CBHIs.

Some states are progressing in the area of providing coverage for their citizens, one of them being Kwara State. Its successful community health insurance scheme, managed together with the Dutch Government’s Health Insurance Fund, Hygeia Community Health and PharmAccess Foundation, now covers about 80,000 thousand people. It is working in 10 local government areas and planning for state-wide expansion.

While the objective of UHC is universally supported, what we have failed to do in Nigeria is to define a mechanism to achieve it. So as we enter a new period of governance from May 29 2015, we must begin to define some targets for the health sector. If UHC is one of them, then we will need to define exactly how we plan to achieve this target.

The Nigerian Health Insurance Scheme is probably the largest potential force for good for the Nigerian health sector – for now that dream remains unfulfilled.

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