Lack of political will hinders implementation of Health Insurance Scheme –Dr. Awosika


 Dr. Ladi Awosika, the chairman of Total Health Trust Limited, has also served as a member of several committees of the Nigerian National Health Insurance Scheme. He has over the years been involved in health care financing, development and delivery of the private health care in Nigeria. Speaking in a recent interview with CHINYERE IKEANYI, the medical practitioner stressed the need for the affordability and accessibility of health care services in the society to improve the general well-being of an average Nigerian. He also delved into Covid-19 and appealed to government at all levels to create more awareness on the reality of the virus currently ravaging the entire world. Excerpts:

What is the relationship between health insurance and access to health care services?

Access to health care services is governed by two major factors, physical accessibility and financial access (affordability). Where health care facility is available, are the services there accessible and affordable?  In Nigeria there are 36 states plus the Federal Capital Territory. There are 774 Local Governments Areas.  In any of the local governments,  does anyone have to travel up to one hour before getting  to a health care facility even if it is a primary health care facility, that will determine  the level  of  physical access to health care in that environment . Secondly, when a person gets there, is he/she expected to or able to pay for services at that point? That is where affordability comes in.

We all know that we are operating in a society where 80 per cent of the people are classified as informally employed with variable income which can be seasonal; that is to say that they can only make money when they harvest their crops. This means that if they are sick they may not have the money to take care of themselves. That is why the world over the past 10 years has been talking about universal health care service and universal health care access to the people of all countries. We  are still lagging   behind in our  own environment in terms of  access to health care  whether financial our physical,  there are health  centers built all  over the  places, but  they may not have healthcare staff and are not operational and where they are operational, they do not have  the adequate materials to deliver the essential services and people still have to pay money out of their pockets for medicines and medical consumables.

In progressive environments, you have what is called universal health care which guarantees   access   to everybody to have a minimum package of healthcare services that is designed for that environment. Healthcare services cover a broad spectrum; it can start from primary health care for basic issues to tertiary and quaternary care such as for treatment of cancer. Each environment should determine what should be the basic package that should be available to every person in that environment that is what the National Health Bill that was passed some years ago is supposed to address. The bill addresses the provision of a basic minimum package of health care services to every Nigerian. It was put in place some years ago, but the implementation has not been holistic. It supposed to guarantee a basic irreducible package of basic health care to all Nigerians. The health care system is in dire state, all the laws and the bills are there, but the implementation has not followed what was put down on paper. So, we have a big problem, we are not delivering adequate health care to our people. Not only that,  there are still too much disparity and variation such that the level of success in certain parts of the country is different from other parts. For instance, Lagos State is far ahead when compared with other parts of the country and it should not be wholly so. In that case, l am saying that the system has failed the nation.

Many perceive the implementation of Health Insurance as an impossible project in Nigeria. What is you take on that?

 It is not impossible to fully implement health Insurance. The problem is the lack of political will. Why should the government cut budget on health, meanwhile, willing to spend about N27 billion to renovate the National Assembly Building? How long ago was it built that makes it require such major renovation? Is the building more important than the health of Nigerians? We have public buildings that were built before Independence and they are still in good shape. Nigeria is one of the poorest countries of the world but with highest paid legislators. So, we are not serious as a country when it comes to health care. We only pay lip service; we do not walk the talk. Health care is expensive and health is wealth. When a nation puts money in healthcare with proper allocative efficiency, such nation will achieve a high health status for her population either in terms of longevity, mental and physical attributes, that is what drives a productive economy. It is not how beautiful the House of Assembly is that makes the economy of the country. In the 2010 Abuja declaration, it was agreed that African nations should allocate 15 percent of national budget to health care. As at that time, Nigeria was spending just under 6 percent of the budget on health care but now, a decade later the Health Budget is about three per cent while at least 4 countries have moved up to 15 per cent, so it is a question of political will.

 What is the way forward?

The people should wise up and demand for quality health care services because it is their right. There is need for infrastructure, education, housing, electricity and other services; these are things that will drive a progressive economy. Governments in a democratic setting should implement policies that benefit majority of the people.

How would you describe the attitude of an average Nigerian towards his health status?

Everyone wants to be healthy because without it, one will not be able to earn a living. So, it is a matter of choice  that make people do whatever they do, Those who drink whatever concoction they see, do that because they think it will keep them healthy. It is a question of awareness and proper information. It’s also about what options the government makes available to the people to make health care affordable and accessible.  Some people patronize the woman that is hawking remedies because what she selling is cheap and accessible; some go to the patent medicine store or pharmacy because they believe going to the clinic/hospital will cost them more. But if health care services are generally affordable and accessible no one will want to harm themselves in the name of saving on cost.

Many say that health insurance scheme is fraudulent and skewed to shortchange Nigerians? What is your opinion?

    It is only 3 to 4 million Nigerians that are on Health Insurance Schemes and the population of Nigeria is about 180 million, so who is short changing who? Health Insurance is a means where you contribute a small affordable amount order to benefit from a package or packages of healthcare when you need it, so it is either you are the one contributing or someone is doing that on your behalf and that is how insurance differs in various countries of the world. It is not only one person that makes the contribution, those who are working or earning an income pay while someone else (sometimes the government) will pay for those that are underprivileged or the aged and children. It can be contributory or tax-funded.  That is what insurance is all about. Lagos state supposed to have started one, but people still need to be informed and educated on the benefits. Private insurance is working well.

 It has been severally reported that the life span of an average Nigerian is below 60 years of age. What do you think is responsible and in what ways can Nigerians improve their life span?

 It is because of our poor health status.  Health status is what determines longevity. Nigeria is a poor country with huge population. Only three per cent of Nigerians are above 65 years of age. Meanwhile, about 45 per cent to 50 per cent are under the age of 35 years. We have a relatively healthy young population, but as they get older, they develop all new diseases, non-communicable diseases such as hypertension, diabetes, kidney failure and by the time they get to 50 years of age, they are already in trouble. People die any time from 53- 54 years whereas in other countries of the world, they live above 80 years. There is need for the country to look after the population individually and nationally. Awareness is very important right from the primary school.  Children should be educated on lifestyle and civic responsibilities; on the need to avoid consumption of too much of sugar and salt. There is also need to have primary health care facility in every environment where people can go regularly to check their health status.

Considering the high rate of fatalities as a result of Covid-19 in other countries of the world, how would you assess government’s effort in tackling the spread of the virus?

The government assumes one thing; that everyone is getting adequate information. The question is how many people have access to radio, television and newspapers? I do not think that 30 per cent of Nigerians have access to radio and television because you need power to operate those electronic devices and there is no power in many areas. It is only very few that can afford to buy newspapers. So, there is need to get people informed about the virus. Some do not even know how to wear the mask because they are not educated on that. When you have no potable water to drink, how do you wash your hands? It is difficult to practice physical distancing in the cities and most people do not even use mask while those who have hang it on their neck not knowing that one can become infected through the nose, mouth and eyes. The local governments have failed in the area of creating more awareness.  If it was during political campaign, they will use their vans to draw the attention of the masses.  So, why can’t they apply the same method by using their vans and megaphones to draw people’s attention to the reality of the virus and what are expected of them? Lagos State is also ahead in terms of activity relative to other States but the resources allocated nationwide remain inadequate for mass testing, contact tracing, isolation and treatment.

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