Medical personnel at the clinic were blamed for being heartless. The other side of the story from the clinic operators never made it to the public domain. The truth, however, is that both the medical personnel at the clinic and Ijeoma are symptoms of a bigger challenge in the Nigerian society. Ijeoma’s story attracted media attention because her husband’s brother brought it to the attention of the media. There are many more deaths that never get reported. The 2012 World Health Statistics report published by the World Health Organisation (WHO) put the number of women that die during childbirth at 630 per 100,000 births, making Nigeria one of the world’s riskiest places for a mother to give life to a child.
The bigger challenge is Nigeria’s low healthcare spend per head and the inadequacy of the existing health insurance scheme as captured in BusinessDay Research report, “Innovative Healthcare Financing: Challenges and Opportunities”.
Nigeria healthcare spend per head is put at $67 (2012 World Health Statistics Report). South Africa spends seven times more on healthcare per head while Angola spends more than three times more. But Nigeria’s healthcare spend per head actually pales into insignificance when measured against some developed countries like the USA, which spends an average of $7,000 per head; Switzerland, which spends about $6,000 per head; or an average spend of $3,600 per head among developing countries in Europe.
Low healthcare spend, when combined with the inefficiency that is inbuilt in the spending generally, leads to low quality healthcare in a society. The WHO estimates that 20 percent to 40 percent of healthcare spending is usually wasted.
The impact of a low healthcare spend by the government is that citizens will have to meet their healthcare expenses from their own pockets or income. When citizens are forced to meet their healthcare spend from their own income, it can lead to tragic ends like the story of Ijeoma or, in many cases, financial ruin. This is why it is common in Nigeria to hear appeals over the media for financial aid for poor Nigerians suffering from serious health issues. Government officials, at public expense, and the rich usually take the option of checking out of the country to meet their health needs.
To avoid the type of situations that led to the death of Ijeoma, the WHO recommends that nations pursue universal health coverage for all its citizens. WHO defines universal health coverage as “ensuring that all people have needed access to health services – prevention, promotion, treatment and rehabilitation – without facing financial ruin because of the need to pay for them”.
To meet the goal of universal health coverage, WHO recommends that countries spend a minimum of $44 per head (or N6,820) on healthcare needs of their citizens. To meet the WHO target, Nigeria’s annual health expenditure in 2013 should be N1.13 trillion, instead the budgeted N279 billion. This is about 23 percent of Nigeria’s 2013 budget proposal. This creates a healthcare financing gap of N852 billion in the 2013 budget at the federal level.
This financing gap does not take into consideration what different state governments spend on healthcare. BusinessDay Research analysis, however, shows that even if this is taken into consideration, Nigeria’s healthcare financing gap will still remain significant. For example, Lagos State government, which is the richest state in the federation, budgets N39.754 billion for healthcare in 2013, which is just 8.2 percent of its total budget for the year. Evidence shows that no state in the federation can match Lagos’ spend on healthcare. Edo State budget on healthcare in 2013, for example, is only N2.69 billion, as information on the state’s website shows. This is just about 1.81 percent of its total budget.
So the healthcare financing gap nationally in 2013 could still be significantly high even if state expenditure is taken into consideration. And this gap is based on the WHO recommended minimum healthcare spend of $44 per person.
If the Abuja declaration by the African Union to spend a minimum of 15 percent of national budgets on healthcare is taken into consideration, the health financing gap could actually be wider. For example, figures from the Central Bank of Nigeria (CBN) 2011 annual report show that total state revenues for 2011, including allocations from the Federal Government and internally-generated revenues, stood at N3.41 trillion. Assuming states were to allocate 15 percent of this to healthcare, then annual expenditure on healthcare at the state’s level in 2011 should have been N511 billion per annum. The evidence is that states may not even be doing half of this per annum.
The federal and state governments may, however, be really constrained on the revenue side to meet the healthcare expenditure needs of the country. BusinessDay Research in its report suggests several strategies that the Nigerian state can adopt to expand healthcare spend. These include increasing Value Added Tax (VAT) and retaining a proportion to finance healthcare, introducing a special tax on harmful products like cigarettes and alcohol, or adopting an innovative phone tax system. These suggestions have been tried in many other countries. Ghana, for example, imposes VAT of 2.5 percent to finance healthcare. Gabon has a special levy on phone use to finance healthcare.
Health is the most valuable asset any citizen can have. No country will progress where the healthcare of its citizens is not a priority. Citizens cannot be left on their own to fend for themselves when it comes to healthcare provision. So it is time the Nigerian government took the healthcare needs of Nigerians very seriously. The truth is that it is possible to achieve universal healthcare, it just takes the right innovations and policies to achieve it.