•  Health care workers vaccinating their babies at the Comprehensive Health Centre Arakale in Akure, Nigeria on June 26, 2018. Photo: Dominic Chavez/The Global Financing Facility

4 ways governments can make health for all a reality in the COVID-19 era

Friday, 11 Dec 2020
As the COVID-19 pandemic threatens to reverse the gains some countries have made towards achieving universal health care (UHC), this blog looks at what countries like Nigeria can do to get closer to providing health care for all.

A popular saying goes “Attaining universal health coverage (UHC) is a journey”.

As we celebrate the UHC day this year in the midst of a global pandemic, I think countries should reflect on two pertinent questions: Where are we on our UHC journey, particularly as COVID-19 may threaten to reverse the gains some countries have made?  And what can we do to accelerate progress towards achieving UHC by 2030?

Nigeria, the ‘giant of Africa’, is, for example, still in the nascent stages of its UHC journey as financial barriers represent a major bottleneck to progress. With about 50% of the population living on less than $1.9 a day, the country is the poverty capital of the world,. Yet, the majority must pay out-of-pocket every time as less than 10% of Nigeria’s population has some form of financial protection against medical costs. In some cases, households must sell their assets to afford essential health services. As healthcare costs may plunge households into financial hardship or abject poverty, many people avoid accessing essential health services.

Ghana, on the other hand, is approaching the middle of its UHC journey as more than 40% of the population are covered for essential health services by the National Health Insurance Scheme.

But there is one country which is undoubtedly at an advanced stage of the journey: Rwanda. The World Health Organization has declared the East African country ‘a beacon of UHC’ because up to 91% of the population have access to essential health services without any financial hardship.

So, what can countries like Nigeria do to get closer to achieving universal health coverage?

1. Prioritise quality health care in rural communities

First, they need to deliberately prioritise the provision of quality primary health care in rural communities, which was underscored by a lack of COVID-19 testing facilities in many rural communities in Nigeria and subsequent misdiagnosis and underreporting. But health facilities in Nigeria’s rural communities also lack essential drugs, qualified health workers and lifesaving equipment because government resources are almost exclusively directed to facilities in the country’s urban centers. In Rwanda, however, health authorities decided to move services closer to the population by focusing most of its resources on providing essential health services to remote rural areas that sit at the ”bottom of the income pyramid“.

2. Also prioritise universal access to family planning services to increase economic productivity

Second, to achieve universal health coverage, countries must also prioritise universal access to voluntary family planning services, also throughout the pandemic, to optimise their population structure and increase economic productivity. The COVID-19 pandemic has adversely impacted the Nigeria’s economy, leading to its second economic recession in just five years. With a population growth rate of 2.6%  and a population projection of 400 million by 2050, the government may run a race that would be impossible to win because the resources required to attain UHC may always outstrip those that are available.

3. Set up national databases to ensure that no one is left behind

Countries like Nigeria also urgently need to ‘know their citizens’ by obtaining population data and setting up national databases. This is the only way to objectively track who has access to quality health services, where they live (in urban or rural areas), who is left behind and how they can be reached.

But the most crucial and overarching element to progress towards achieving UHC is leadership and political commitment to improve public investments in the health sector. But even though African Heads of Government committed to allocate at least 15% of their national budgets to their health sectors in 2001. But nearly 20 years later, total healthcare expenditure in countries across Africa, such as Nigeria, Chad, Togo, Cameroon, Congo, Côte d’Ivoire, Equatorial Guinea, Gabon, Angola, Ghana, Mauritania and Mozambique, still only amounts to an average of five to six percent of their gross domestic product, and continent is estimated to have a US $66 billion financing gap for the health sector annually.

4. The private sector, civil society organisations, religious and traditional institutions must also play a role in promoting health for all

But is the journey towards UHC only the government’s responsibility?

The answer is no. Citizens groups, religious and traditional institutions as well as the private sector all have an important role to play.  

Civil society organisations (CSOs) should reflect on how well they have been tracking government commitments to invest in health care and influencing its UHC policy decisions. 

Traditional and religious institutions are usually powerful in shaping government decisions but have they done enough to support its UHC journey? They could do more to support CSO advocacy efforts for policy reforms that would accelerate UHC.

In Nigeria, a coalition of private sector companies recently provided financial and technical support to the government to enable it to fund and implement its COVID-19 response plan. This is very commendable. But are they doing the same for UHC? The answer is no. But the health sector could really benefit from the private sectors’ ability to influence quick decision-making, funding as well as efficient implementation through public-private partnerships.

If low-middle-income countries like Nigeria want to achieve UHC by 2030, they must make concerted efforts to close their health financing gap by mobilising more private sector funding and domestic public resources. These resources should then be used to close the health infrastructure gap between rural and urban centers to improve access to primary healthcare for the poor, vulnerable and rural populations. E-health and telemedicine could be a cost-effective way of increasing access to healthcare for underserved populations, especially in the COVID-19 era. 

This piece was written by Dr Michael Olawuyi, Nigeria's National Sustainability Lead for Options' Women's Integrated Sexual Health (WISH) programme.
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