Behold the State of Health Care

Adequate Health Service: Not for the Vast Majority of Nigerians

By Chinedu Bosah

Health, like all other social services has been relegated to the background by all tiers of government, thereby leaving the vast majority of Nigerians to health hazard situation. Many Nigerians are dying because of inadequate medical care and incapacity to afford the little available. Statistics by WHO indicate that over 300, 000 Nigerian children die due to malaria yearly, while between about 15 percent of women, particularly during pregnancy, die of malaria annually. Rather than the three tiers of government to begin adequate funding of the health sector by employing well-qualified staff, more standardized hospitals, better health equipment etc., they are paying lip service to it. For example the three tiers of government account for only 17% of total health expenditure as against 65 per cent from patients as ‘out-of-pockets payments. Out of the 17%, the federal government commits 10%; states government commits 5% while the local government commits 2%.

The implication of this is that, the vast majority of Nigerians whom are basically very poor bear the burden of health care expenses and this in itself is a clear indication that the much talked and hypocritical health related aspect of the Millennium Development Goals (MDGs) is unattainable.

Matters have been made worse by the recent government backed privatised health insurance scheme. After several attempts, President Olusegun Obasanjo launched the National Health Insurance Scheme (NHIS) on June 6 2005. Nigeria first showed interest in the scheme in 1962. Then a bill was sent to the parliament. In the 1980s and 1990s, attempts at making the policy work failed. Though, the scheme should be a social security designed to provide access to improved healthcare service for the generality of Nigerians, in reality, the scheme has been used to drain further the pocket of already impoverished workers and poor masses.

In the scheme, government acts as regulator through a board. One of the functions of the board is to register Health Management Organizations (HMOs) whose mandate is to act as intermediaries, brokers between the provider and the user. The scheme would offer five types of programme: the formal sector social health insurance programme (FSSHIP), the urban self-employed social health insurance programme (USESHIP), the rural community social health insurance programme (RCSHIP), the under 5 healthcare programme, and the aged and prisoners’ programme.

The FSSHIP covers employers and employees in the public and organized private sector where both are expected to make compulsory contributions. The employers and employees are expected to contribute 10% and 5% respectively of the basic salary into a common fund pool, which shall be managed by HMOs whose responsibility is to make payments to health services providers for service rendered by them. In spite of the fact that the health insurance scheme talks of a level playing field, standard benefits and equal access is not guaranteed and if you want extra care, you have to pay for it. This includes denture, glasses, opportunity to be flown abroad etc.

X-raying the so-called health insurance scheme from the practical angle, the federal government claimed to have committed N4.8 billion for a population of 140 million a drop of water in ocean, while the poorly paid Nigerian workers have been made to pay all sorts of extortionate tax. There is the PAYE tax, 7.5%contribution to pension scheme, 5% to the National Housing Fund while they still contribute another 5% to the health sector. Over 20% will be deducted from the poverty stricken salary, which will benefit only the few rich.

Just to state also that in the least developed countries, which Nigeria is part of, health spending amounts to just about $11 per person, per year while $30 to $40 is recommended for only essential health care. In developed nations, health spending is put at $1,900 per person annually. Today, it takes at least an average of N10, 000 to treat malaria, the most common ailment in a substandard hospital and what it means is that the N4.8 billion ($35million) is nothing but a drop of water in the ocean.

The scheme is just a face saving measure since the so called providers have no capacity to render qualitative service at an affordable price. Most service providers (hospitals) do not have adequate equipment and facilities to render qualitative service while the very few ones that can render relative qualitative service are beyond the reach of the vast majority. Even up till now, most workers do not enjoy any benefit from the scheme while the larger population is not yet part of the package.

Worse still, the scheme is another way of funding the privately owned hospitals and deliberately killing/under funding the public health institution. The driving policy and philosophy, which has been fashioned out in line with neo-liberal policy of privatization, allows the corrupt government functionaries to set up their own private hospitals and schools which invariably will not meet the needs of the poor working masses who cannot afford the high cost for health care. This is in addition to the fact that the thieving ruling elite has penchant for using the looted money to seek quality medical attention in the West. The embrace of neo-liberal philosophy means that the anti-poor capitalist government does not commit public resources to provide infrastructure and adequately fund social services to satisfy the needs of all and sundry.

What is required at this moment is a radical and proper funding of the health sector, which will invariably guarantee more hospitals, properly and well paid staffs, better equipments etc., in order to meet the health needs of all Nigerians. The so-called privatised National Health Insurance Scheme will be nothing but a smokescreen which is only meant to further deepen the arrangement that denies workers and poor masses quality health care.

In conclusion, no amount of call, demand, pressure on the ruling class for adequate funding of the health actor and every other sector would be honoured. So, the masses, organised labour, peasants must come out with an independent political platform in order to defeat the present pro-rich government and their policies (privatisation, commercialisation, etc) and replace it with pro-masses government and policies meant to satisfy the needs of all other than the profit avarice of the few rich.