MALLAM Aliyu Adamu, 58 years old, is a Jigawa-based trader. He caters for a family of six with his less than $2 a-day earning. He is poor and has nothing in savings.His only daughter fell critically ill recently but he could not take her for medical attention. He has no money to pay for her treatment. In fact, Adamu is still in debt to some neighbours for last year's rescue mission. Yet, his girl is dying.Adamu's story is not unusual across the country. In fact, estimate shows that over 50 per cent of Nigerians are indeed helpless, either watching their wards die or already bereaved by such losses, due to inability to pay for healthcare services.Records revealed that 54.4 per cent, that is about 80 million Nigerians, are poor, earning less than $2 a-day, while 70.8 per cent of these actually earn less than $1 a-day.Most disturbing, according to the 2005 National Health Accounts, is that Out Of Pocket Expenditure (OOPE) on health is 69 per cent high. High incidence of catastrophic health expenditure on health needs therefore increases the population living below $1 a-day, increasing the vulnerability of the poor to slip further into poverty, with more severe impact on the households.The telltale signs are already with us. Health indices revealed that the plight of health seeking Nigerians has worsened. No fewer than 10 per cent of global mortality occur in Nigeria; under-five mortality rate is 157/1,000 live births; maternal mortality rate is 545/100, 000 live births; infant mortality rate is 75/1,000 live births and new born mortality rate is 40/100 live births, etc.Stakeholders last week in Calabar, Cross Rivers State were unanimous that health financing is a major problem in accessing affordable healthcare in the country. At the three-day workshop on 'improving financial access to health services for the poor in Nigeria,' they harped on the urgent need for equitable health financing strategies that are sensitive to the needs of the poor, especially women and children.Their submissions were not different from the World Health Assembly's call on countries to move towards universal health coverage, featuring financial protection for all from the costs of healthcare and access to needed healthcare for all. In recent years, many countries in Africa, including Nigeria, have not seen significant progress.The Executive Secretary of National Health Insurance Scheme (NHIS), Dr. Mohammed Dogo said that despite government's intervention in the National Strategic Health Development Plan among other initiatives, the health system is still bedevilled by 'high OOPE in the face of extreme poverty, low literacy and awareness on health amongst the population.'The biggest share of the attendant burden is borne by the informal sector constituting more than 75 per cent of the Nigerian population.'Pregnant women and children under-five are the most vulnerable of this population sub-group, having 78 per cent of attendees in hospitals. All efforts at addressing our deplorable health indices will have to give serious consideration to the needs of these special groups,' he said.Sharing at the workshop, Dr. Chris Atim of the World Bank noted that countries like Ghana and Uganda have recorded significant improvement in caring for the vulnerable group through tax revenue and Community-Based Health Insurance (CBHI).The NHIS boss said that similar initiatives are currently deployed in Nigeria, but in need of political will and collective responsibility to achieve the needed result.Dogo at the event proposed that one-kobo-per-second charge on every phone call in the country, be remitted to healthcare fund. At the charge of one-kobo-per-second, it was estimated that the country could raise as much as N172 billion yearly to fund healthcare for the vulnerable group.His words: 'There are about 80 million telephone lines in the country. The national airtime utilization per day is 10 minutes, of which the calculation could raise as much as N172 billion in a year, to fund healthcare.'This is about five times more than the amount the current Health Bill. What we need is the political will to put in place this policy...'His proposal is similar to the experience in Gabon, where the state created a healthcare fund financed with 10 per cent of mobile phone companies' income and 1.5 per cent tax on foreign exchange transaction.Dogo added: 'NHIS is not demanding for increase in tariff, what we are saying is that whenever the tariff crashes form 17k to 12k per second for instance, instead of 12k make it 13k, so that you capture that 1k for health. And when it crashes further, you still maintain that 1k for health',' he said.THERE are efforts at addressing health-financing challenges to reduce OOPE to 50 per cent by 2015. Minister of Health, Prof. Onyebuchi Chukwu, said that one of such efforts is the NHIS and the National Health Bill. When passed into law, according to Chukwu, the health bill would increase funding for health in the country. He added that there is the need for sustainability of the funding mechanism, improved efficiency and equity for the funds.'If some other countries that are less endowed could ensure the development of universal insurance scheme for their people, then we can do it too. We have also learnt that we cannot continue to talk about more money, without the talk of increase efficiency as to how we use the money. It goes without saying that meeting universal coverage is a collective responsibility.'We are attempting to bridge the gap between few states that have queued into the NHIS and those that have not. That is why we are introducing the CBHIS. These are areas where the public, state governments should cooperate with us to be covered by the scheme,' he said.While awaiting President Goodluck Jonathan's assent of the bill, the health bill would give additional fund to the Primary Healthcare Centre (PHC) of the health sector, by setting up the National Primary Health Development Fund.Chukwu said: 'It will add about two per cent extra to what we already have in health. Meaning that in the 2011 budget, health may just enjoy about 7.5 per cent of the national budget. That is not like the 15 per cent that people have been talking about, but it will be an improvement on what we have currently.'Senate Committee chairman on Health, Giang Dantong, added that challenges of healthcare and its funding are huge and it is the collective responsibility in which the state and local councils must be proactive along with the Federal Government.Dantong said that it is worrisome that health is neither in the exclusive nor in the concurrent list. 'It means that health is nobody's business in this country. Meanwhile, it should be everybody's responsibility.'Considering the importance, we in the legislative arm need to revisit the constitution to make health occupy a prominent place. It should be on the concurrent list so that the three tiers of government will have something to do.'The Federal Government should provide 15 per cent. But the question is: Are the states and local councils providing 15 per cent also' If they can, it would go a long way to help healthcare services in the country. I know that is one of the issues to be addressed by the health bill,' Dantong said.A Malian delegate at the workshop, Seidu Traore commended Nigerians for brilliant initiatives always. He said that what is unfortunate is that 'Nigerians hardly put the ideas to use'But we in Mali, will try some of them,' he said.Another delegate form Liberia and Director, Policy and Health Financing, Ministry of Health, Liberia, Benedict Harris added that there was a need for Nigeria to get universal coverage of affordable quality health right.'Once Nigeria gets it right in providing affordable, quality health for the masses, West Africa will also get it right. Nigeria is a leading country in the region and whatever happens in Nigeria has far reaching implications on the rest of the region,' Harris said.
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