According to the 2010 World Health Statistics, out-of-pocket expenditure as percentage of private expenditure on health for Nigeria is 95.9 per cent. This shows that governments at all levels are not making enough investment in the health of the people which is supposed to be a national priority.
The over-reliance on user fees as a major source of financing health care in Nigeria is inequitable as majority of those who pay out-of-pocket for health services are taxed to provide health services for the rich who can afford health care. The 25.3 per cent general government expenditure as percentage of total expenditure on health is from the tax payers’ money most of whom are poor and cannot afford to pay for health services. Most Nigerians are made poor due to the cost of illness which is more than the cost of treatment. Meanwhile, poverty is also a cause of illness.
How would the poor people survive from poverty which is a cause and consequence of illness? Unfortunately, Nigeria is still battling with how to eradicate poverty in order to achieve economic progress. Many programs have been established at all levels to alleviate this disease called poverty but little has been achieved so far in lifting the over 70 per cent of Nigerians living below poverty line.
There is no doubt that out-of-pocket payment play an important role especially in many developing countries in the funding of the health sector. But the percentage of out-of-pocket expenditure as percentage of private expenditure on health is too high considering the fact that there are other methods of funding the health system which can help achieve the goal of equity. Most Nigerian’s household income have been drained in the process of meeting the cost of treatment for their brothers, sisters, mothers, fathers, wives, husbands, uncles, aunties, families, relations and so on. Many families are yet to recover from the expenses incurred in trying to save the lives of their members and nobody knows when majority of the poor people would be relieved of these catastrophic expenses. Though the National Health Insurance Scheme (NHIS) has been protecting some group of Nigerians from the financial hardship of huge medical bills.
Financing health systems is a major challenge in both developed and developing countries but Nigeria has yet to show the ability to face this challenge so that the health system can benefit all the citizens of the country. There is a need to incorporate other financing models for the health system if we must reduce the level of out-of-pocket expenditure for the poor. The out-of-pocket expenditure as percentage of private expenditure on health of 22.6 per cent in the USA shows that userfees are still needed in financing health care.
There is no reason why we should not intensify our efforts at properly utilizing donor funds; encouraging community financing; scaling up community-based health financing; increasing coverage of both the social and private health insurance schemes as well as increasing investment in health of the Nigerian people. Public-private partnership in the health sector have also proved to be a means of attracting more funds for the health system with reduced cost, improved quality, as well as speedy, efficient and cost effective delivery of health services as some of its advantages.
No matter the disadvantages and weakness of the above mentioned models of health financing, they are important in the sourcing of more funds for the health system. Health care leaders and policy makers have to pursue with vigor the National Health Policy objective of providing effective, efficient, quality, accessible and affordable health services so that Nigerians can have access to care based on need and not the ability to pay. Nigerians have suffered enough hardship and it would be unfair to watch them continue to wallow in abject poverty, this will cast doubts on governments resolve to improve the lives of Nigerians.
User fees cannot be completely removed in the funding of health systems but it should not be the main source of revenue for the health sector. The Nigerian case is such that the out-of-pocket expenditure as percentage of private expenditure on health has been 100 per cent for many years until recently when it dropped to 95.9 per cent. There is definitely a need to work on other models of health financing so that the health status of the citizens can be improved. This is the ultimate goal of the health system of every nation around the world. It is unfair and unjustifiable for most Nigerians to be taxed to provide health services they cannot afford or may be am not a good judge?
Bolaji Aregbesola contributes from Nigeria.